Varicocelectomy in men with nonobstructive azoospermia

The management of nonobstructive azoospermia (NOA) is challenging. Even the most successful intervention for this condition, microsurgical testicular sperm extraction (microTESE) with in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI), is not successful at least 40% of the time. Varicocele is present in 15% of young men, and varicocelectomy improves fertility outcomes in men with palpable varicoceles and abnormal semen analyses. Unfortunately, there are limited investigations into the effect of varicocelectomy in men with NOA. Uncontrolled cohort studies report the return of sperm to the ejaculate after treatment of the varicoceles in men with NOA. That finding should be viewed in the context that sperm are found in the subsequent semen analyses of men with NOA without any intervention. Limited controlled studies do report higher rates of sperm retrieval during microTESE in men with treated varicoceles compared with controls. The histopathology of testicular biopsies obtained during varicocelectomy correlates with the return of sperm to the semen and sperm retrieval rates during subsequent microTESE The evidence supporting varicocele treatment in men with NOA is very limited, and clinicians should make this fact clear when counseling patients with these conditions.