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Varicocele

  • Sherman Silber
Chapter

Abstract

There is probably no subject that has been more controversial in the area of male infertility than varicocele. Most non-urologist infertility specialists in the world are skeptical of the role of varicocele or varicocelectomy in the treatment of male infertility, especially since the advent of ICSI [1]. However many urologists strongly recommend varicocelectomy, and now in 2017, there is another push to reestablish this surgery for infertile couples with male factor infertility. The September 2017 issue of Fertility and Sterility was dedicated to varicocelectomy with all positive, and no negative, reviews [2]. It has been suggested that in addition to infertility, varicocele has a negative impact on Leydig cell function, testosterone level, and overall “male health,” and that varicocelectomy will raise testosterone levels and improve “overall male health” [3–5]. It has also been suggested that varicocelectomy improves the results of ART (assisted reproductive technology) even though most early papers on ICSI showed no relation of sperm parameters to success or failure [6–9]. However, another equally large and very similar cohort study showed no difference in success with ICSI in men with varicocele who underwent varicocelectomy than in men who did not [10]. Interestingly, the study which showed improvement was only when there were younger female partners, and not older female partners. To confuse things more, a meta-analysis of these studies concluded no improvement in pregnancy rate with varicocelectomy performed before ART but there was improvement in birth rate [6]. With azoospermia TESE cases there was only a “strong trend” toward improvement after varicocelectomy [6]. Because of this enthusiastic resurgence of interest in varicocelectomy, I would like to once again review previous literature to objectively evaluate whether it is appropriate to perform varicocelectomy for male infertility in the era of ICSI.

References

  1. 1.
    Devroey P, Vandervorst M, Nagy P, Van Steirteghem A (1998) Do we treat the male or his gamete? Hum Reprod 13(Suppl 1):178–185CrossRefPubMedGoogle Scholar
  2. 2.
    Brannigan RE (2017) Introduction: varicoceles: a contemporary perspective. Fertil Steril 108:361–363CrossRefPubMedGoogle Scholar
  3. 3.
    Sathya Srini V, Belur Veerachari S (2011, 2011) Does varicocelectomy improve gonadal function in men with hypogonadism and infertility? Analysis of a prospective study. Int J Endocrinol:916380Google Scholar
  4. 4.
    Hsiao W, Rosoff JS, Pale JR, Powell JL, Goldstein M (2013) Varicocelectomy is a ssociated with increases in serum testosterone independent of clinical grade. Urology 81:1213–1217CrossRefPubMedGoogle Scholar
  5. 5.
    Clavijo RI, Carrasquillo R, Ramasamy R (2017) Varicoceles: prevalence and pathogenesis in adult men. Fertil Steril 108:364–369CrossRefPubMedGoogle Scholar
  6. 6.
    Kirby EW, Wiener LE, Rajanahally S, Crowell K, Coward RM (2016) Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis. Fertil Steril 106:1338–1343CrossRefPubMedGoogle Scholar
  7. 7.
    Coward RM (2017) Evolving role of varicocele repair in the era of assisted reproduction. Fertil Steril 108:596–597CrossRefPubMedGoogle Scholar
  8. 8.
    Kohn TP, Kohn JR, Pastuszak AW (2017) Varicocelectomy before assisted reproductive technology: are outcomes improved? Fertil Steril 108:385–391CrossRefPubMedGoogle Scholar
  9. 9.
    Nagy ZP, Liu J, Joris H et al (1995) The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters. Hum Reprod 10:1123–1129CrossRefPubMedGoogle Scholar
  10. 10.
    Pasqualotto FF, Braga DP, Figueira RC, Setti AS, Iaconelli A Jr, Borges E Jr (2012) Varicocelectomy does not impact pregnancy outcomes following intracytoplasmic sperm injection procedures. J Androl 33:239–243CrossRefPubMedGoogle Scholar
  11. 11.
    Silber SJ (2001) The varicocele dilemma. Hum Reprod Update 7:70–77CrossRefPubMedGoogle Scholar
  12. 12.
    Baker HW, Burger HG, de Kretser DM, Hudson B, Rennie GC, Straffon WG (1985) Testicular vein ligation and fertility in men with varicoceles. Br Med J (Clin Res Ed) 291:1678–1680CrossRefGoogle Scholar
  13. 13.
    Nieschlag E, Hertle L, Fischedick A, Behre HM (1995) Treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Hum Reprod 10:347–353CrossRefPubMedGoogle Scholar
  14. 14.
    Hargreave TB (1993) Varicocele—a clinical enigma. Br J Urol 72:401–408CrossRefPubMedGoogle Scholar
  15. 15.
    Baker HW, Burger HG, de Kretser DM, Lording DW, McGowan P, Rennie GC (1981) Factors affecting the variability of semen analysis results in infertile men. Int J Androl 4:609–622CrossRefPubMedGoogle Scholar
  16. 16.
    Baker HW, Straffon WG, McGowan MP, Burger HG, de Kretser DM, Hudson B (1984) A controlled trial of the use of erythromycin for men with asthenospermia. Int J Androl 7:383–388CrossRefPubMedGoogle Scholar
  17. 17.
    Baker HW (1993) Management of immunological infertility. In: Berger HG, Oshima H (eds) An approach to clinical andrology. Serona Symposia Reviews, 29. p 105–110.Google Scholar
  18. 18.
    Baker HW, Kovacs GT (1985) Spontaneous improvement in semen quality: regression towards the mean. Int J Androl 8(6):421CrossRefPubMedGoogle Scholar
  19. 19.
    Baker HW, Burger HG (1986) Male infertility in reproductive medicine. In: Steinberger E, Frajese G, Steinberger A (eds) Reproductive medicine. Raven Press, New York, pp 187–197Google Scholar
  20. 20.
    Baker HW (1986) Requirements for controlled therapeutic trials in male infertility. Clin Reprod Fertil 4:13–25PubMedGoogle Scholar
  21. 21.
    Silber SJ (1989) Pregnancy after vasovasostomy for vasectomy reversal: a study of factors affecting long-term return of fertility in 282 patients followed for 10 years. Hum Reprod 4:318–322CrossRefPubMedGoogle Scholar
  22. 22.
    Johnson D, Sandlow J (2017) Treatment of varicoceles: techniques and outcomes. Fertil Steril 108:378–384CrossRefPubMedGoogle Scholar
  23. 23.
    Uehling DT (1968) Fertility in men with varicocele. Int J Fertil 13:58–60PubMedGoogle Scholar
  24. 24.
    Thomason AM, Fariss BL (1979) The prevalence of varicoceles in a group of healthy young men. Mil Med 144:181–182CrossRefPubMedGoogle Scholar
  25. 25.
    Tulloch WS (1955) Varicocele in subfertility; results of treatment. Br Med J 2:356–358CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C (1992) Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol 148:1808–1811CrossRefPubMedGoogle Scholar
  27. 27.
    Marmar JL, Kim Y (1994) Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol 152:1127–1132CrossRefPubMedGoogle Scholar
  28. 28.
    Silber SJ (1979) Microsurgical aspects of varicocele. Fertil Steril 31:230–232CrossRefPubMedGoogle Scholar
  29. 29.
    Silber SJ (1989) The relationship of abnormal semen parameters to male fertility. Hum Reprod 4:947–953CrossRefPubMedGoogle Scholar
  30. 30.
    Devroey P. The relevance of semen analysis. Presented at Thirty-Second Annual Postgraduate Program of the American Society for Reproductive Medicine in Toronto, Canada, September 1999; p 15–32.Google Scholar
  31. 31.
    Hargreave TB, Elton RA (1983) Is conventional sperm analysis of any use? Br J Urol 55:774–779CrossRefPubMedGoogle Scholar
  32. 32.
    Smith KD, Rodriguez-Rigau LJ, Steinberger E (1977) Relation between indices of semen analysis and pregnancy rate in infertile couples. Fertil Steril 28:1314–1319CrossRefPubMedGoogle Scholar
  33. 33.
    Zukerman Z, Rodriguez-Rigau LJ, Smith KD, Steinberger E (1977) Frequency distribution of sperm counts in fertile and infertile males. Fertil Steril 28:1310–1313CrossRefPubMedGoogle Scholar
  34. 34.
    Steinberger E, Rodriguez-Rigau LJ (1983) The infertile couple. J Androl 4:111–118CrossRefPubMedGoogle Scholar
  35. 35.
    Schoysman R, Gerris J (1983) Twelve-year follow-up study of pregnancy rates in 1291 couples with idiopathically impathically impaired male fertility. Acta Eur Fertil 14:51–56PubMedPubMedCentralGoogle Scholar
  36. 36.
    Samplaski MK, Lo KC, Grober ED, Zini A, Jarvi KA (2017) Varicocelectomy to "upgrade" semen quality to allow couples to use less invasive forms of assisted reproductive technology. Fertil Steril 108:609–612CrossRefPubMedGoogle Scholar
  37. 37.
    Mordel N, Mor-Yosef S, Margalioth EJ et al (1990) Spermatic vein ligation as treatment for male infertility. Justification by postoperative semen improvement and pregnancy rates. J Reprod Med 35:123–127PubMedGoogle Scholar
  38. 38.
    Macleod J, Gold RZ (1953) The male factor in fertility and infertility. VI. Semen quality and certain other factors in relation to ease of conception. Fertil Steril 4:10–33CrossRefPubMedGoogle Scholar
  39. 39.
    Macleod J, Gold RZ (1951) The male factor in fertility and infertility. II. Spermatozoon counts in 1000 men of known fertility and in 1000 cases of infertile marriage. J Urol 66:436–449CrossRefPubMedGoogle Scholar
  40. 40.
    Silber SJ, Nagy Z, Devroey P, Camus M, Van Steirteghem AC (1997) The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection. Hum Reprod 12:2693–2700CrossRefPubMedGoogle Scholar
  41. 41.
    Rodriguez-Rigau LJ, Smith KD, Steinberger E (1978) Relationship of varicocele to sperm output and fertility of male partners in infertile couples. J Urol 120:691–694CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sherman Silber
    • 1
    • 2
  1. 1.Infertility Center of St. LouisSt. Luke’s HospitalSt. LouisUSA
  2. 2.University of MichiganAnn ArborUSA

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