Varicocele is the most common cause of male infertility. The association between varicocele and infertility should be evaluated from different aspects. Varicocele is known as dilatation of the pampiniform plexus belonging to the testicles. Varicocele can either be inspected or diagnosed by a doppler ultrasonographic examination. Other common symptoms of varicocele besides infertility are pain and feeling of pressure in the groins.
20% of men who got their wife pregnant beforehand are diagnosed with varicocele. Varicocele is present in 35 to 40% of infertile couples in which the female partner is normal. The way varicocele leads to infertility is not clear. The difference in sperm count, motility and morphology between men with and without varicocele could not be shown in all of the studies.
Current treatment of varicocele is by microsurgery. Abnormally dilated veins are ligated via a surgical procedure called spermatic vein ligation. This procedure is performed either endoscopically or via radiological techniques. Most urologists agree that subclinical varicocele does not require any treatment. Clinical varicocele with the complaints of pain and pressure or varicoceles diagnosed during adolescents merit treatment. Another subject of debate is usefulness of varicocele operation for infertile men with poor sperm parameters. Randomized trials failed to prove any usefulness of varicocele repair in terms of clinical pregnancy rates. Varicocele repair is especially useless for men with severe oligospermia or azospermia.
Repair of a relapsing varicocele is not advised in the absence of clinical symptoms. In brief, varicocele is a disorder which is overdiagnosed and overtreated, especially among infertile couples. We thus accept varicocele as a coincidental finding for infertile couples and advise treatment for selected cases.
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