When is surgical correction of a varicocele indicated?

Updated: Jan 02, 2019
  • Author: Wesley M White, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Reasons for surgical correction of a diagnosed variocele include relieving significant testicular discomfort or pain not responsive to routine symptomatic treatment, reducing testicular atrophy (volume < 20 mL, length < 4 cm), and addressing the possible contribution to unexplained male infertility. A varicocele may cause progressive damage to the testes, resulting in further atrophy and impairment of seminal parameters.

A 2014 committee opinion of the American Society for Reproductive Medicine and the Society for Male Reproduction and Urology recommended considering treatment of varicocele in the male partner of a couple attempting to conceive when most or all of the following conditions are met [10] :

  • The varicocele is palpable on physical examination of the scrotum
  • The couple has known infertility
  • The female partner has normal fertility or ­a potentially treatable cause of infertility, and time to conception is not a concern
  • The male partner has abnormal semen parameters

A man with a palpable varicocele who is not currently attempting to achieve conception is a candidate for varicocele repair if he has one or more of the following [10] :

  • Abnormal semen analysis results
  • A desire for future fertility
  • Pain related to the varicocele

Similarly, 2014 European Association of Urology guidelines in male infertility recommend considering varicocele repair in patients with the following [11] :

  • Clinical varicocele
  • Oligospermia
  • Infertility duration of ≥2 years
  • Otherwise unexplained infertility in the couple.
  • Varicocele treatment is recommended for adolescents with progressive failure of testicular development documented by serial clinical examination.

The guidelines recommend against varicocele treatment in infertile men who have normal semen analysis or in men with subclinical varicocele. [11]

A scrotal varicocele is the most correctable factor in a male with poor semen quality; therefore, varicocele repair should be considered a viable choice for appropriately selected individuals and couples with otherwise unexplained infertility because varicocele repair has been shown to improve semen parameters in most men and possibly improve fertility; in addition, the risks of varicocele repair are small.

A systematic review and meta-analysis found that in oligospermic and azoospermic patients with clinical varicocele, repair of the varicocele leads to improved live birth rates and pregnancy rates with in vitro fertilization (IVF) or IVF/intracytoplasmic sperm injection (ICSI). In men with persistent azoospermia after varicocele repair who require testicular sperm extraction for IVF/ICSI, varicocele repair improves sperm retrieval rates.

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