Medical Therapy in Varicocele-Related Infertility

  • Gian Maria BusettoEmail author
  • Francesco Del Giudice
  • Ettore De Berardinis


Even if varicocele is considered as one of the first known causes of male infertility, to date, it is still under debate if varicocele repair is able to improve fertility.

The pathophysiology of varicocele, infertility, and testicular growth arrest has been extensively studied. Scrotal and testicular hyperthermia and increase in blood flow could be causes of altered spermatogenesis. A wide range of hormonal abnormalities and the stasis of the blood in the pampiniform plexus, with related hypoxia, could negatively act on sperm production.

All these mechanisms are considered to be the initiators of an oxidative stress process causing spermatogenesis defects. Oxidative stress usually occurs when there is an imbalance between ROS production and removal, and between oxidants and antioxidants. Varicocele is known to exacerbate the oxidative stress process, and the grade of varicocele can be related to oxidative stress levels.

When considering surgery as an effective option for varicocele treatment, recurrence and complications are prone to occur. Furthermore, results and fertility increase after surgery are still not well-established.

Medical treatment is another option featured by less invasiveness, cost, and side effects. Unfortunately, even these treatments are highly debated.

To date, there are following treatments:
  1. 1.

    Antioxidant agents that are able to decrease oxidative stress and lower ROS levels. Many elements have been studied and can be used as antioxidant agents. Currently, carnitines, selenium, coenzyme Q10, vitamin C and E, vitamin B12, bioflavonoids, lycopene, kallicrein, cinnoxicam, pentoxyfilline, zinc, folic acid, GSH, and NAC are used.

  2. 2.

    Hormonal agents like gonadotropins, tamoxifene, clomiphene, and menotropin that can restore hormone levels.

  3. 3.

    Chinese medicine with a multitude of antioxidants and anti-inflammatory agents. The most common products are qianjing, guizhi fuling wan, escin, jingling, and green tea.


In spite of adopting all available medical treatments for varicocele, these treatments are not recommendable and surgery remains the gold standard option for varicocele. On the other hand, these products could be considered as a good option for a combination therapy after surgery, to earlier and better restore spermatogenesis.


Varicocele oxidative stress antioxidants reactive oxygen species male infertility hormonal agents Chinese medicine 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gian Maria Busetto
    • 1
    Email author
  • Francesco Del Giudice
    • 1
  • Ettore De Berardinis
    • 1
  1. 1.Department of Urology, Sapienza Rome UniversityPoliclinico Umberto IRomeItaly

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