From the Guidelines
Varicocele can negatively impact fertility in men [ 1 ].
Impact of Varicocele on Fertility
The presence of a varicocele, particularly a clinically palpable one, is associated with impaired semen parameters and reduced fertility [ 1 ].
- Semen Parameters: Varicocele can affect semen volume, total sperm number, sperm concentration, vitality, progressive motility, total motility, and morphologically normal forms [ 1 ].
- Treatment Options: Treatment of a clinically palpable varicocele may be offered to the male partner of an infertile couple when there is evidence of abnormal semen parameters and minimal/no identified female factor [ 1 ].
Treatment Approaches
- Varicocelectomy: This surgical procedure can improve sperm count, motility, and morphology, thereby enhancing fertility [ 1 ].
- Assisted Reproductive Technologies: In vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may also be considered, especially when a female factor is present [ 1 ].
- Medications: Medications like clomiphene citrate may be prescribed to improve sperm quality, but varicocelectomy remains the primary treatment for varicocele-related infertility [ 1 ].
Diagnostic Evaluation
- Scrotal Ultrasound: Can be used to confirm the presence of varicocele and determine procedural success after correction [ 1 ].
- Imaging: Transrectal ultrasonography (TRUS) or pelvic MRI may be recommended in cases suggestive of ejaculatory duct obstruction, but not as part of the initial evaluation [ 1 ].
From the Research
Varicocele and Fertility
- Varicocele is a common cause of male subfertility, and its correction can improve semen parameters and pregnancy rates 2, 3, 4, 5, 6
- The pathophysiology of varicocele-associated male infertility is not fully understood, but it is thought to be related to changes in the testicular microenvironment, including increased oxidative stress, scrotal hyperthermia, testicular hypoxia, and blood-testis barrier disruption 2, 4, 6
- Varicoceles can impair semen parameters, including sperm concentration, motility, and normal morphology, and can also damage sperm DNA 4, 5, 6
- Repair of varicoceles can improve semen parameters, reduce oxidative stress and sperm DNA damage, and increase pregnancy and live birth rates 3, 4, 5, 6
- The current consensus is that varicocele repair can improve fertility outcomes, including spontaneous pregnancy rates and live birth rates, and that it should be considered as a treatment option for men with varicoceles and impaired semen parameters 4, 5
- Varicocele repair must be proposed in young adult men with impairment of seminal parameters and not yet interested in pregnancy, and men of infertile couples should be adequately counselled concerning the high possibility of attaining a significant improvement in seminal parameters after varicocele repair 5