Pros: Should Sperm DNA Fragmentation Testing Be Used in Men with Varicocele?

  • Nannan ThirumavalavanEmail author
  • Joseph Scott Gabrielsen
  • Alexander W. Pastuszak


Varicocele repair (VR) has been a mainstay of treatment for male factor infertility for decades. Many males have varicoceles but identifying those who would benefit most from varicocele repair is challenging. This challenge has become more significant with the advent of assisted reproductive technologies (ART), when patients readily proceed to intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI), even with suboptimal semen parameters. In this chapter, we argue that infertile couples with a male partner having a varicocele will benefit from varicocele repair, prior to proceeding to any form of ART. VR may eliminate the need for ART in some couples, and for those couples who still require ART after VR, repair improves success rates by improving sperm counts and quality and is cost-effective.


Varicocele repair Varicocelectomy Assisted reproductive technology In vitro fertilization Intrauterine insemination Intracytoplasmic sperm injection 



The authors would like to thank Christopher R.V. Hoover, MD (Gallup, NM), for creating and kindly providing the figures included in this chapter.

This work is supported in part by NIH grants K12 DK0083014, the Multidisciplinary K12 Urologic Research (KURe) Career Development Program awarded to DJL (NT is a K12 Scholar) and R01DK078121 from the National Institute of Kidney and Digestive Diseases to Dolores J Lamb. Alexander W. Pastuszak is supported by a K08 Mentored Career Development Award from the National Institute of Kidney and Digestive Diseases (DK115835-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nannan Thirumavalavan
    • 1
    Email author
  • Joseph Scott Gabrielsen
    • 2
  • Alexander W. Pastuszak
    • 3
  1. 1.Urology InstituteUniversity Hospital / Case Western Reserve UniversityClevelandUSA
  2. 2.Division of Male Reproductive Medicine and Surgery, Scott Department of UrologyBaylor College of MedicineHoustonUSA
  3. 3.Department of Surgery, Division of UrologyUniversity of Utah School of MedicineSalt Lake CityUSA

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