Varicocele and male infertility

Key Points Varicoceles have detrimental effects on semen quality, sperm function, and pregnancy outcomes in some men Oxidative stress seems to have a central role in the pathogenesis of varicocele-induced infertility Current evidence supports beneficial effects of varicocelectomy on semen parameters, sperm function, and pregnancy outcomes in men from couples with documented infertility with clinical varicoceles and affected semen parameters The optimal technique for performing varicocelectomy is a microsurgical approach, owing to reduced complication rates and increased pregnancy rates compared with other techniques Current evidence supports varicocele repair in adolescents with clinical varicoceles when progressive testicular growth retardation and/or impaired semen quality is observed Varicocelectomy might have beneficial effects on pregnancy outcomes following assisted reproduction> Varicocele is the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention, and so the link between varicoceles and male infertility remains a matter of debate. Oxidative stress seems to be a central mechanism of testicular damage; however, no single theory to explain the differential effect of varicoceles on infertility has been suggested. In this Review, a panel of expert authors discuss the epidemiology and pathophysiology of varicocele-related infertility, and consider the optimal treatment for men with varicocele. The link between varicoceles and male infertility has been a matter of debate for more than half a century. Varicocele is considered the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention. In addition, improvements in semen quality after varicocelectomy do not always result in spontaneous pregnancy. Studies regarding possible pathophysiological mechanisms behind varicocele-induced infertility have tried to address these controversies. Oxidative stress seems to be a central mechanism; however, no single theory is able to explain the differential effect of varicoceles on infertility. As a consequence, careful patient selection for treatment based on couple fertility status, varicocele grade, and semen quality is critical for achieving a chance of a subsequent pregnancy. A substantial amount of data on the effects of varicocelectomy has been gathered, but inadequate study design and considerable hetero