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Volume 18, Issue 2 (March 2016) 18, 239–245; doi: 10.4103/1008-682X.172639

Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men

Bruno C Tiseo1, Sandro C Esteves2, Marcello S Cocuzza1

1Department of Urology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 7 andar ‑ Sala 710F, Sao Paulo, 05403‑000, Brazil; 2ANDROFERT, Center for Male
Reproduction, Av. Dr. Heitor Penteado 1464, Campinas, Sao Paulo, 13075‑460, Brazil.

Correspondence: Dr. MS Cocuzza (mcocuzza@uol.com.br)


The objective of this review was to summarize the evidence concerning the benefit of varicocele treatment to improve natural
fertility in subfertile males. We also analyzed the effect of varicocele treatment on conventional semen parameters and sperm
functional tests. An electronic search to collect the data was performed using the PubMed/MEDLINE databases until July 2015.
Data pooled from a variety of study designs indicate that varicocelectomy improves semen parameters in the majority of the
treated men with clinical varicocele and abnormal semen parameters regardless of the chosen surgical method. Surgical varicocele
repair was beneficial not only for alleviating oxidative stress‑associated infertility but also to improve sperm nuclear DNA integrity.
However, given the low magnitude of the effect size in sperm DNA integrity, further research is needed to elucidate its clinical
significance. Conflicting results on the effect of varicocele treatment on natural fertility seem to be due to heterogeneous study
designs and, more importantly, patient selection criteria. When these issues are controlled, current evidence indicates that
treatment of subclinical varicocele is not warranted, as it does not seem to improve fertility. On the contrary, fair evidence indicates
that varicocele treatment should be offered to infertile patients with palpable varicocele and abnormal semen parameters. This
evidence supports the current guidelines issued by the American Urological Association and European Association of Urology,
which state that varicocele treatment should be offered to male partners of infertile couples presenting for evaluation with clinical
varicocele and semen parameters alterations.

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