Curr Opin Urol. 2012 Nov;22(6):489-94. doi: 10.1097/MOU.0b013e328358e115.
Varicocele repair for infertility: what is the evidence?
Ficarra V, Crestani A, Novara G, Mirone V.
aDepartment of Surgical, Oncologic and Gastroenterologic Sciences, Urologic Unit, University of Padova, Padova, Veneto bDepartment of Urology, University "Federico II" Napoli, Naples, Italy.
PURPOSE OF REVIEW:
Considering the persistent controversy concerning the impact of varicocele repair on fertility, we decided to perform an update of the review of the literature with the aim to evaluate whether the most recent research in this field gives us more evidence about the indications to treat or not to treat varicocele in dyspermic or infertile men.
Randomized controlled trials (RCTs) and prospective studies evaluating semen parameters before and after varicocelectomy clearly demonstrate that varicocele repair is associated with a significant improvement of sperm concentration, motility and normal morphology. Moreover, some recent studies highlighted the potential role of varicocelectomy in reduction of seminal oxidative stress and sperm DNA damage. One recent RCT showed a statistically significant advantage in favor of varicocelectomy in comparison with observations in terms of spontaneous pregnancy rate. Meta-analysis including this study confirmed the heterogeneity of pooled studies and showed a significant trend in favor of varicocele repair. This trend has become statistically significant when an 'as-treated' analysis is performed (odds ratio 2.69, 95% confidence interval 1.16-6.24). The advantages in favor of varicocele treatment were also observed in a recent RCT analyzing couples with first-term recurrent miscarriage.
Varicocele repair must be proposed in young adult men with impairment of seminal parameters and not yet interested in pregnancy. Men of infertile couples should be adequately counselled concerning the high possibility of attaining a significant improvement in seminal parameters after varicocele repair. This condition can be associated with a spontaneous pregnancy rate of 30%. The main alternative remains the use of artificial reproductive techniques.