Varicocele

Abstract

This chapter discusses the current concepts and controversies regarding the epidemiology, pathophysiology, diagnosis, treatment, and significance of clinical and subclinical varicoceles in male infertility. It also reviews the management of varicoceles in azoospermic patients and the novel indications of varicocelectomy in the era of assisted reproductive technology (ART). A critical commentary, based on the author's 15-year experience treating infertile men with varicoceles, and a review of important publications from the last 5 years are included. Varicocele is still one of the most controversial issues in the field of male infertility, especially regarding why, when, and to whom treatment should be applied. Varicocele repair is considered the treatment of choice for varicocele-associated infertility, but its effectiveness has been discussed for several years. Although the ultimate end point for the treatment of male factor infertility is a live birth, efforts to maximize the couple's fertility potential by improving testicular function should be the main purpose of varicocele treatment. Approximately 8% of men in reproductive age seek for medical assistance for fertility-related problems. Of these, 1–10% carry conditions that compromise the reproductive potential, and varicocele accounts for 35% of the cases. In a group of 2,875 infertile couples attending our tertiary center for male reproduction, a varicocele was identified in 21.9% of the male partners.