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A Critical Appraisal on the Role of Varicocele in Male Infertility

DOI: 10.1155/2012/597495

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Abstract:

Varicocele is a major cause of male infertility, as it may impair spermatogenesis through several distinct physiopathological mechanisms. With the recent advances in biomolecular techniques and the development of novel sperm functional tests, it has been possible to better understand the mechanisms involved in testicular damage provoked by varicocele and, therefore, propose optimized ways to prevent and/or reverse them. Up to now, there is still controversy involving the true benefit of varicocele repair in subfertile men as well as in certain specific situations such as concomitant contralateral subclinical varicocele or associated nonobstructive azoospermia. Also, with the continued development of assisted reproductive technology new issues and questions are emerging regarding the role of varicocelectomy in this context. This paper reviews the most recent data available on the pathogenesis, diagnosis, and management of varicocele with regard to male infertility. 1. Introduction Approximately 8% of men in reproductive age seek medical assistance for fertility-related problems. Among them, 1%–10% carry a condition that compromise their fertility potential and varicocele alone accounts for 35% of these cases [1, 2]. Our personal database of a referral tertiary center for male reproduction presents an incidence of 21.9% of varicocele in 2,875 analyzed subjects [3]. While varicocele has an incidence of 4.4%–22.6% in the general population, 21%–41% of men with primary infertility and 75%–81% of those with secondary infertility have this condition [4, 5]. The impact of varicocele on male fertility was not suspected until the end of the 19th century, when occlusion of dilated veins from the pampiniform plexus was shown to improve semen quality [4, 6]. MacLeod in 1965 demonstrated decreased sperm count, decreased motility and higher prevalence of abnormal forms in semen specimens collected from infertile men with varicocele [7]. Although the physiopathology of varicocele and its relationship with male infertility has been discussed for the last 50 years, the exact mechanisms that would ultimately lead to an infertile/subfertile state are still controversial. Even more debatable is the true benefit from its surgical repair [8, 9]. Treating male factor infertility should have as its ultimate goal to achieve a live birth. However, efforts must be made to maximize the couple’s fertility potential. In this sense, it is argued that varicocele treatment may be critical to restore or optimize testicular function. We present a review on the current concepts and

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