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Varicocelectomy in men with nonobstructive azoospermia.

Bobby B Najari1

  • 1Department of Urology, NYU Langone Medical Center, New York University Grossman School of Medicine, New York, New York.

Fertility and Sterility
|April 1, 2026
PubMed
Summary
This summary is machine-generated.

Varicocele treatment in men with non-obstructive azoospermia (NOA) shows limited evidence. While some studies suggest benefits, sperm retrieval rates in microTESE may be higher after varicocelectomy.

Keywords:
Varicocelemicrosurgical testicular sperm extractionnonobstructive azoospermiavaricocelectomy

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Area of Science:

  • Reproductive Medicine
  • Urology
  • Andrology

Background:

  • Non-obstructive azoospermia (NOA) management is challenging, with microTESE and IVF-ICSI success rates below 60%.
  • Varicocele affects 15% of young men, and varicocelectomy improves fertility in those with palpable varicoceles and abnormal semen.
  • Limited research exists on varicocelectomy's impact on NOA patients.

Purpose of the Study:

  • To evaluate the effect of varicocelectomy on fertility outcomes in men diagnosed with non-obstructive azoospermia.
  • To assess the correlation between varicocele treatment, sperm presence in ejaculate, and microTESE success rates in NOA patients.

Main Methods:

  • Review of uncontrolled cohort studies and limited controlled studies on varicocelectomy in NOA.
  • Analysis of sperm retrieval rates during microTESE in men with and without prior varicocele treatment.
  • Correlation of testis biopsy histopathology with semen sperm presence and microTESE outcomes.

Main Results:

  • Uncontrolled studies report sperm return to ejaculate post-varicocelectomy in NOA, though sperm can be found without intervention.
  • Limited controlled studies indicate potentially higher sperm retrieval rates during microTESE after varicocelectomy.
  • Testis biopsy findings during varicocelectomy correlate with subsequent sperm presence and retrieval success.

Conclusions:

  • The evidence supporting varicocele treatment for men with NOA is currently very limited.
  • Clinicians must clearly communicate the limited evidence base to patients when discussing varicocele treatment options for NOA.