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Varicocele repair: does it still have a role in infertility treatment?

Nevoux, Pierrea; Mitchell, Valérieb; Chevallier, Danielc; Rigot, Jean-Marca; Marcelli, Françoisa

Current Opinion in Obstetrics and Gynecology: June 2011 - Volume 23 - Issue 3 - p 151–157
doi: 10.1097/GCO.0b013e32834552d7
Fertility: Edited by Aydin Arici
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Purpose of review To review the role of varicocele repair in the treatment of male infertility.

Recent findings Since the advent of technologies bypassing boundaries of natural selection, this question may seem outdated. Over the past 20 years, fertility has decreased, and testicular damage (cryptorchidism, tumors) has increased. Thus the exploration of the infertile male is still unavoidable. However, what should be done and assigned to the discovery of a varicocele?

The issue raised is whether varicocele found during the review of the infertile couple should be treated or ‘ignored’.

This study will update significant findings with regards to the pathophysiology of varicocele-induced infertility, such as oxidative stress and role of varicocele in bilaterality of testicular damage. Benefits of varicocele repair in semen analysis and simplifications of assisted reproductive techniques are reported. But reviews of randomized clinical trials have raised doubts about the benefit of varicocele treatment in infertile men.

Summary We conclude that varicocele repair may be effective in men with subnormal semen analysis, a clinical varicocele and otherwise unexplained infertility. Deleterious cofactors, like obesity or smoking, could also be reduced for the benefit of general health and fertility.

aDepartment of Andrology, Calmette Hospital, France

bInstitut de Biologie de la Reproduction, Calmette Hospital, Groupe de recherche EA 4308 Spermatogenesis and Male Gamete Quality, CHRU, Lille, France

cDepartment of Urology, Hôpital Universitaire Pasteur, Nice, France

Correspondence to François Marcelli, MD, Department of Andrology, Calmette Hospital, CHRU 59037 Lille, France Tel: +33 3 20 44 49 39; e-mail: francois.marcelli@chru-lille.fr

© 2011 Lippincott Williams & Wilkins, Inc.