Pro: Should Varicocele Be Repaired in Azoospermic Infertile Men?
The coexistence of palpable varicocele and nonobstructive azoospermia has led urologists to offer varicocele repair as a means to improve reproductive outcomes for men with spermatogenic failure seeking fertility. In this chapter, we critically discuss the existing evidence concerning the potential beneficial effect of varicocele repair on selected men with NOA and spermatogenic failure. We also examine the prognostic factors affecting postoperative outcomes to help clinicians best identify those candidates for varicocele repair. Providing care for infertile men with nonobstructive azoospermia, including those with varicocele, involves a coordinated multi-professional effort. Clinicians should judiciously examine the existing evidence and discuss with their patients with NOA and concomitant varicocele the possibility of improvement in reproductive outcomes by varicocele repair. Offering varicocele repair to selected men with NOA is valid and sound provided that the advantages and limitations of the intervention have been made clear to the patient.
KeywordsVaricocele Nonobstructive azoospermia Varicocele repair Male infertility Varicocelectomy Sperm retrieval Intracytoplasmic sperm injection Assisted reproductive technology Pregnancy Reproductive outcomes
Conflict of Interest
The author has nothing to disclose.
- 7.de Sousa Filho EP, Christofolini DM, Barbosa CP, Glina S, Bianco B. Y chromosome microdeletions and varicocele as aetiological factors of male infertility: a cross-sectional study. Andrologia. 2018;50(3)Google Scholar
- 14.Esteves SC, Gosálvez J, López-Fernández C, Núñez-Calonge R, Caballero P, Agarwal A, Fernández JL. Diagnostic accuracy of sperm DNA degradation index (DDSi) as a potential noninvasive biomarker to identify men with varicocele-associated infertility. Int Urol Nephrol. 2015;47(9):1471–7.CrossRefGoogle Scholar
- 24.Kirby EW, Wiener LE, Rajanahally S, Crowell K, Coward RM. 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. 2016;106(6):1338–43.CrossRefGoogle Scholar
- 36.Tulloch WS. A consideration of sterility factors in the light of subsequent pregnancies. II. Sub fertility in the male. Tr. Edinburgh Obst. Soc. session 104. Edinb Med J. 1951–1952;59:29–34.Google Scholar