The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success
of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was
previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection
has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available
to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when.
Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of
the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy
of varicocele repair as well as cost‑effectiveness of repair compared to immediate microTESE in azoospermic men and assisted
reproductive technology in men with suboptimal semen parameters will be reviewed.

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