Varicocele repair: does it still have a role in infertility treatment?

To review the role of varicocele repair in the treatment of male infertility.

Varicocele is a common finding among men with infertility and its repair has been a mainstay of surgical therapy in these men. Although each year multiple discoveries are made concerning the mechanism of varicocele-induced infertility, the exact pathophysiologic mechanism remains unknown. This study will update significant findings in regard to the pathophysiology of varicocele-induced infertility, such as increased expression of the aquaporin receptor and new findings related to testicular blood flow and vas deferens motility. Recent information concerning the effects of apoptosis and oxidative stress are also reviewed. With regard to the efficacy of varicocele repair, previous meta-analysis of the available data has been misleading due to improper selection criteria. Available clinical data are critically evaluated, with a focus on new meta-analyses that contradict the findings of the Cochrane database review, a study that has been accepted by many as evidence against varicocele repair.

We conclude that varicocele repair not only is an effective treatment for appropriately selected patients but can also be the most cost effective option.