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The Use of Varicocelectomy Surgery in the Treatment of the Infertile Male

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Biennial Review of Infertility

Abstract

Varicoceles are diagnosed in about 15% of men in the general population, but these lesions are seen in 40% of male infertility patients. For decades, urologists have considered these lesions as a possible cause of male infertility, and they have performed varicocelectomies on infertile men with palpable varicoceles and at least one persistently abnormal semen parameter. With the advancements in IVF/ICSI, reproductive endocrinologists (REs) have taken a different approach and they usually recommend some form of ART instead of the surgical alternative. In recent years, the debate has intensified because of conflicting publications and subsequent commentaries on the subject of varicoceles and pregnancy. There have been limited prospective randomized trials (PRTs), and many uncontrolled studies. Nevertheless, urologists generally contend that there is sufficient experimental and clinical evidence to support the surgical correction of these lesions, whereas the REs usually minimize the role of varicoceles as a cause of infertility. The conflicting opinions reached new heights recently, when two meta-analyses on varicoceles and fertility appeared in prominent peer review journals with completely opposite results. One meta-analysis was written by two REs, whereas the other was written by a team of urologists, basic scientists and statisticians. In this chapter, the differences between these meta-analyses will be explored, current concepts related to the pathophysiology of varicoceles will be presented, different methods for the correction of varicoceles will be considered and new protocols will be analyzed that combine surgery and ART. The intent of the chapter will be to enlighten both urologists and REs with current information related to varicoceles, varicocelectomies and ART.

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References

  1. Jarow JP, Sharlip ID, Belker AM, et al. Best practice policies for male infertility. The Journal of Urology 2002;167(5):2138–44.

    PubMed  Google Scholar 

  2. Sharlip ID, Jarow JP, Belker AM, et al. Best practice policies for male infertility. Fertility and Sterility 2002;77(5):873–82.

    PubMed  Google Scholar 

  3. Madgar I, Weissenberg R, Lunenfeld B, Karasik A, Goldwasser B. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertility and Sterility 1995;63(1):120–4.

    PubMed  CAS  Google Scholar 

  4. Okuyama A, Fujisue H, Matsui T, et al. Surgical repair of varicocele: effective treatment for subfertile men in a controlled study. European Urology 1988;14(4):298–300.

    PubMed  CAS  Google Scholar 

  5. Schlesinger MH, Wilets IF, Nagler HM. Treatment outcome after varicocelectomy. A critical analysis. The Urologic Clinics of North America 1994;21(3):517–29.

    PubMed  CAS  Google Scholar 

  6. Marmar JL, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. The Journal of Urology 1994;152(4):1127–32.

    PubMed  CAS  Google Scholar 

  7. Onozawa M, Endo F, Suetomi T, Takeshima H, Akaza H. Clinical study of varicocele: statistical analysis and the results of long-term follow-up. International Journal of Urology 2002;9(8):455–61.

    PubMed  Google Scholar 

  8. Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology 2000;55(5):750–4.

    PubMed  CAS  Google Scholar 

  9. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. The Journal of Urology 1992;148(6):1808–11.

    PubMed  CAS  Google Scholar 

  10. Sayfan J, Soffer Y, Orda R. Varicocele treatment: prospective randomized trial of 3 methods. The Journal of Urology 1992;148(5):1447–9.

    PubMed  CAS  Google Scholar 

  11. Segenreich E, Israilov SR, Shmueli J, Niv E, Servadio C. Correlation between semen parameters and retrograde flow into the pampiniform plexus before and after varicocelectomy. European Urology 1997;32(3):310–4.

    PubMed  CAS  Google Scholar 

  12. Clinical guidelines: Fertility: assessment and treatment for people with fertility problems. National Collaborating Centre for Women’s and Children’s Health 2004:54–5.

    Google Scholar 

  13. Kamischke A, Nieschlag E. Varicocele treatment in the light of evidence-based andrology. Human Reproduction Update 2001;7(1):65–9.

    PubMed  CAS  Google Scholar 

  14. Nilsson S, Edvinsson A, Nilsson B. Improvement of semen and pregnancy rate after ligation and division of the internal spermatic vein: fact or fiction? British Journal of Urology 1979;51(6):591–6.

    PubMed  CAS  Google Scholar 

  15. Grasso M, Lania C, Castelli M, Galli L, Franzoso F, Rigatti P. Low-grade left varicocele in patients over 30 years old:the effect of spermatic vein ligation on fertility. BJU International 2000;85(3):305–7.

    PubMed  CAS  Google Scholar 

  16. Breznik R, Vlaisavljevic V, Borko E. Treatment of varicocele and male fertility. Archives of andrology 1993;30(3):157–60.

    PubMed  CAS  Google Scholar 

  17. Rageth JC, Unger C, DaRugna D, et al. Long-term results of varicocelectomy. Urologia Internationalis 1992;48(3):327–31.

    PubMed  CAS  Google Scholar 

  18. Krause W, Muller HH, Schafer H, Weidner W. Does treatment of varicocele improve male fertility? results of the ‘Deutsche Varikozelenstudie’, a multicentre study of 14 collaborating centres. Andrologia 2002;34(3):164–71.

    PubMed  CAS  Google Scholar 

  19. Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet 2003;361(9372):1849–52.

    PubMed  Google Scholar 

  20. Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertility and Sterility 2007;88(3):639–48.

    PubMed  Google Scholar 

  21. Templeton A. Varicocele and infertility. Lancet 2003;361(9372):1838–9.

    PubMed  Google Scholar 

  22. Marmar JL, Benoff S. Varicoceles. The Journal of Urology 2006;175(3 Pt 1):818–9.

    PubMed  Google Scholar 

  23. Ficarra V, Cerruto MA, Liguori G, et al. Treatment of varicocele in subfertile men: The Cochrane Review–a contrary opinion. European Urology 2006;49(2):258–63.

    PubMed  Google Scholar 

  24. Agarwal A, Deepinder F, Cocuzza M, et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology 2007;70(3):532–8.

    PubMed  Google Scholar 

  25. Nieschlag E, Hertle L, Fischedick A, Abshagen K, Behre HM. Update on treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Human Reproduction (Oxford, England) 1998;13(8):2147–50.

    CAS  Google Scholar 

  26. Williams JK. Understanding evidence-based medicine: a primer. American Journal of Obstetrics and Gynecology 2001;185(2):275–8.

    PubMed  CAS  Google Scholar 

  27. Peipert JF, Phipps MG. Observational studies. Clinical Obstetrics and Gynecology 1998;41(2):235–44.

    PubMed  CAS  Google Scholar 

  28. Norris SL, Atkins D. Challenges in using nonrandomized studies in systematic reviews of treatment interventions. Annals of Internal Medicine 2005;142(12 Pt 2):1112–9.

    PubMed  Google Scholar 

  29. Comhaire F. Clinical andrology: from evidence-base to ethics. The ‘E’ quintet in clinical andrology. Human Reproduction (Oxford, England) 2000;15(10):2067–71.

    CAS  Google Scholar 

  30. Cook DJ, Sackett DL, Spitzer WO. Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam Consultation on Meta-Analysis. Journal of Clinical Epidemiology 1995;48(1):167–71.

    PubMed  CAS  Google Scholar 

  31. Stroup DF, Berlin JA, Morton SC, et al Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 2000;283(15):2008–12.

    PubMed  CAS  Google Scholar 

  32. Yavetz H, Levy R, Papo J, et al. Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality. International Journal of Andrology 1992;15(4):338–44.

    PubMed  CAS  Google Scholar 

  33. Shlansky-Goldberg RD, VanArsdalen KN, Rutter CM, et al. Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes. Journal of Vascular and Interventional Radiology 1997;8(5):759–67.

    PubMed  CAS  Google Scholar 

  34. Horwitz RI, Viscoli CM, Clemens JD, Sadock RT. Developing improved observational methods for evaluating therapeutic effectiveness. The American Journal of Medicine 1990;89(5):630–8.

    PubMed  CAS  Google Scholar 

  35. Marmar JL. The pathophysiology of varicoceles in the light of current molecular and genetic information. Human Reproduction Update 2001;7(5):461–72.

    PubMed  CAS  Google Scholar 

  36. Uehling DT. Fertility in men with varicocele. International journal of fertility 1968;13(1):58–60.

    PubMed  CAS  Google Scholar 

  37. Kursh ED. What is the incidence of varicocele in a fertile population? Fertility and Sterility 1987;48(3):510–1.

    PubMed  CAS  Google Scholar 

  38. Libman J, Jarvi K, Lo K, Zini A. Beneficial effect of microsurgical varicocelectomy is superior for men with bilateral versus unilateral repair. The Journal of Urology 2006;176(6 Pt 1):2602–5; discussion 5.

    PubMed  Google Scholar 

  39. Steckel J, Dicker AP, Goldstein M. Relationship between varicocele size and response to varicocelectomy. The Journal of Urology 1993;149(4):769–71.

    PubMed  CAS  Google Scholar 

  40. Tinga DJ, Jager S, Bruijnen CL, Kremer J, Mensink HJ. Factors related to semen improvement and fertility after varicocele operation. Fertility and Sterility 1984;41(3):404–10.

    PubMed  CAS  Google Scholar 

  41. Dhabuwala CB, Hamid S, Moghissi KS. Clinical versus subclinical varicocele: improvement in fertility after varicocelectomy. Fertility and Sterility 1992;57(4):854–7.

    PubMed  CAS  Google Scholar 

  42. McClure RD, Khoo D, Jarvi K, Hricak H. Subclinical varicocele: the effectiveness of varicocelectomy. The Journal of Urology 1991;145(4):789–91.

    PubMed  CAS  Google Scholar 

  43. Yarborough MA, Burns JR, Keller FS. Incidence and clinical significance of subclinical scrotal varicoceles. The Journal of Urology 1989;141(6):1372–4.

    PubMed  CAS  Google Scholar 

  44. Kohler FP. On the etiology of varicocele. The Journal of Urology 1967;97(4):741–2.

    PubMed  CAS  Google Scholar 

  45. Ahlberg NE, Bartley O, Chidekel N, Fritjofsson A. Phlebography in varicocele scroti. Acta Radiologica: Diagnosis 1966;4(5):517–28.

    CAS  Google Scholar 

  46. Coolsaet BL. The varicocele syndrome: venography determining the optimal level for surgical management. The Journal of Urology 1980;124(6):833–9.

    PubMed  CAS  Google Scholar 

  47. Comhaire F, Kunnen M. Selective retrograde venography of the internal spermatic vein: a conclusive approach to the diagnosis of varicocele. Andrologia 1976;8(1):11–24.

    PubMed  CAS  Google Scholar 

  48. Turner TT, Jones CE, Roddy MS. Experimental varicocele does not affect the blood-testis barrier, epididymal electrolyte concentrations, or testicular blood gas concentrations. Biology of Reproduction 1987;36(4):926–32.

    PubMed  CAS  Google Scholar 

  49. Saypol DC, Howards SS, Turner TT, Miller ED Jr. Influence of surgically induced varicocele on testicular blood flow, temperature, and histology in adult rats and dogs. The Journal of Clinical Investigation 1981;68(1):39–45.

    PubMed  CAS  Google Scholar 

  50. Snydle FE, Cameron DF. Surgical induction of varicocele in the rabbit. The Journal of Urology 1983;130(5):1005–9.

    PubMed  CAS  Google Scholar 

  51. Sofikitis N, Miyagawa I. Bilateral effect of unilateral varicocele on testicular metabolism in the rabbit. International Journal of Fertility and Menopausal Studies 1994;39(4):239–47.

    PubMed  CAS  Google Scholar 

  52. Fussell E, Lewis R, Roberts JA, Harrison RM. Early ultrastructural findings in experimentally produced varicocele in the monkey testis. Journal of Andrology 1981;2:111–9.

    Google Scholar 

  53. Harrison RM, Lewis RW, Roberts JA. Pathophysiology of varicocele in nonhuman primates: long-term seminal and testi-cular changes. Fertility and Sterility 1986;46(3):500–10.

    PubMed  CAS  Google Scholar 

  54. Kay R, Alexander NJ, Baugham WL. Induced varicoceles in rhesus monkeys. Fertility and Sterility 1979;31(2):195–9.

    PubMed  CAS  Google Scholar 

  55. Green KF, Turner TT, Howards SS. Varicocele: reversal of the testicular blood flow and temperature effects by varicocele repair. The Journal of Urology 1984;131(6):1208–11.

    PubMed  CAS  Google Scholar 

  56. Caruso A, Walsh R, Ross L, Trummer H, Meacham R. Experimental varicocele induces testicular germ cell apoptosis in the rat. The Journal of Urology 1999;161:280.

    Google Scholar 

  57. Sharma RK, Agarwal A. Role of reactive oxygen species in male infertility. Urology 1996;48(6):835–50.

    PubMed  CAS  Google Scholar 

  58. Baccetti B, Collodel G, Piomboni P. Apoptosis in human ejaculated sperm cells (notulae seminologicae 9). Journal of Submicroscopic Cytology and Pathology 1996;28(4):587–96.

    PubMed  CAS  Google Scholar 

  59. Benoff SH, Millan C, Hurley IR, Napolitano B, Marmar JL. Bilateral increased apoptosis and bilateral accumulation of cadmium in infertile men with left varicocele. Human Reproduction (Oxford, England) 2004;19(3):616–27.

    CAS  Google Scholar 

  60. Mitropoulos D, Deliconstantinos G, Zervas A, Villiotou V, Dimopoulos C, Stavrides J. Nitric oxide synthase and xanthine oxidase activities in the spermatic vein of patients with varicocele: a potential role for nitric oxide and peroxynitrite in sperm dysfunction. The Journal of Urology 1996;156(6):1952–8.

    PubMed  CAS  Google Scholar 

  61. Middendorff R, Mueller D, Wichers S, Holstein A, Davidoff M. Evidence for production and functional activity of Nitric oxide in seminiferous tubules and blood vessels of the human testes. The Journal of Clinical Endocrinology and Metabolism 1997;82:4154–61.

    PubMed  CAS  Google Scholar 

  62. Romeo C, Ientile R, Santoro G, et al. Nitric oxide production is increased in the spermatic veins of adolescents with left idiophatic varicocele. Journal of Pediatric Surgery 2001;36(2):389–93.

    PubMed  CAS  Google Scholar 

  63. Santoro G, Romeo C, Impellizzeri P, et al. Nitric oxide synthase patterns in normal and varicocele testis in adolescents. BJU International 2001;88(9):967–73.

    PubMed  CAS  Google Scholar 

  64. Benoff S, Hurley IR, Yuan L, Marmar JL. Endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) are separately induced and have separable effects in varicocele infertility. Journal of Andrology 2006;27:57.

    Google Scholar 

  65. Weese DL, Peaster ML, Himsl KK, Leach GE, Lad PM, Zimmern PE. Stimulated reactive oxygen species generation in the spermatozoa of infertile men. The Journal of Urology 1993;149(1):64–7.

    PubMed  CAS  Google Scholar 

  66. Hendin B, Kolettis P, Sharma RK, Thomas AJ, Agarwal A. Stimulated reactive oxygen species generation in spermatozoa of infertile men. The Journal of Urology 1999;161:1831–4.

    PubMed  CAS  Google Scholar 

  67. de Lamirande E, Gagnon C. Reactive oxygen species and human spermatozoa. I. Effects on the motility of intact spermatozoa and on sperm axonemes. Journal of Andrology 1992;13(5):368–78.

    PubMed  CAS  Google Scholar 

  68. Smith R, Kaune H, Parodi D, et al. Increased sperm DNA damage in patients with varicocele: relationship with seminal oxidative stress. Human Reproduction (Oxford, England) 2006;21(4):986–93.

    CAS  Google Scholar 

  69. Koksal IT, Usta M, Orhan I, Abbasoglu S, Kadioglu A. Potential role of reactive oxygen species on testicular pathology associated with infertility. Asian Journal of Andrology 2003;5(2):95–9.

    PubMed  CAS  Google Scholar 

  70. Chen LP, Wang SQ, Zhao YZ, Liu L, Wang SX, Lu YZ. [The changes of IL-1 and NO levels in the testes of rats with experimental varicocele]. Zhonghua nan ke xue = National Journal of Andrology 2002;8(2):125–6.

    PubMed  Google Scholar 

  71. Zini A, Buckspan M, Jamal M, Jarvi K. Effect of varicocelectomy on the abnormal retention of residual cytoplasm by human spermatozoa. Human Reproduction (Oxford, England) 1999;14(7):1791–3.

    CAS  Google Scholar 

  72. Nallella KP, Allamaneni SS, Pasqualotto FF, Sharma RK, Thomas AJ Jr, Agarwal A. Relationship of interleukin-6 with semen characteristics and oxidative stress in patients with varicocele. Urology 2004;64(5):1010–3.

    PubMed  Google Scholar 

  73. Aitken RJ, Clarkson JS. Cellular basis of defective sperm function and its association with the genesis of reactive oxygen species by human spermatozoa. Journal of Reproduction and Fertility 1987;81(2):459–69.

    PubMed  CAS  Google Scholar 

  74. Iwasaki A, Gagnon C. Formation of reactive oxygen species in spermatozoa of infertile patients. Fertility and Sterility 1992;57(2):409–16.

    PubMed  CAS  Google Scholar 

  75. Mostafa T, Anis TH, El-Nashar A, Imam H, Othman IA. Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. International Journal of Andrology 2001;24(5):261–5.

    PubMed  CAS  Google Scholar 

  76. Mancini A, Milardi D, Conte G, Festa R, De Marinis L, Littarru GP. Seminal antioxidants in humans: preoperative and postoperative evaluation of coenzyme Q10 in varicocele patients. Hormone and Metabolic Research Hormon- und Stoffwechselforschung 2005;37(7):428–32.

    CAS  Google Scholar 

  77. Deepinder F, Cocuzza M, Agarwal A. Should seminal oxidative stress measurement be offered routinely to men presenting for infertility evaluation? Endocrine Practice 2008;14(4):484–91.

    PubMed  Google Scholar 

  78. Wu GJ, Chang FW, Lee SS, Cheng YY, Chen CH, Chen IC. Apoptosis-related phenotype of ejaculated spermatozoa in patients with varicocele. Fertility and Sterility 2008.

    Google Scholar 

  79. Goldstein M, Eid JF. Elevation of intratesticular and scrotal skin surface temperature in men with varicocele. The Journal of Urology 1989;142(3):743–5.

    PubMed  CAS  Google Scholar 

  80. Lue YH, Lasley BL, Laughlin LS, et al. Mild testicular hyperthermia induces profound transitional spermatogenic suppression through increased germ cell apoptosis in adult cynomolgus monkeys (Macaca fascicularis). Journal of Andrology 2002;23(6):799–805.

    PubMed  Google Scholar 

  81. Sinha Hikim AP, Lue Y, Diaz-Romero M, Yen PH, Wang C, Swerdloff RS. Deciphering the pathways of germ cell apoptosis in the testis. The Journal of Steroid Biochemistry and Molecular Biology 2003;85(2–5):175–82.

    PubMed  CAS  Google Scholar 

  82. Miller D, Brough S, al-Harbi O. Characterization and cellular distribution of human spermatozoal heat shock proteins. Human Reproduction (Oxford, England) 1992;7(5):637–45.

    CAS  Google Scholar 

  83. Dix DJ, Allen JW, Collins BW, et al. Targeted gene disruption of Hsp70-2 results in failed meiosis, germ cell apoptosis, and male infertility. Proceedings of the National Academy of Sciences of the United States of America 1996;93(8):3264–8.

    PubMed  CAS  Google Scholar 

  84. Brackin P, Marmar JL, Millan C, Benoff S. Identification of heat shock protein 70-1 (HSP 70-1) in testis tissue of men with varicocele. The Journal of Urology 2003;169:415.

    Google Scholar 

  85. Tapanainen JS, Tilly JL, Vihko KK, Hsueh AJ. Hormonal control of apoptotic cell death in the testis: gonadotropins and androgens as testicular cell survival factors. Molecular Endocrinology (Baltimore, MD) 1993;7(5):643–50.

    CAS  Google Scholar 

  86. Hikim AP, Swerdloff RS. Temporal and stage-specific effects of recombinant human follicle-stimulating hormone on the maintenance of spermatogenesis in gonadotropin-releasing hormone antagonist-treated rat. Endocrinology 1995;136(1):253–61.

    PubMed  CAS  Google Scholar 

  87. Erkkila K, Henriksen K, Hirvonen V, et al. Testosterone regulates apoptosis in adult human seminiferous tubules in vitro. The Journal of Clinical Endocrinology and Metabolism 1997;82(7):2314–21.

    PubMed  CAS  Google Scholar 

  88. Rajfer J, Turner TFR. Inhibition of testicular testosterone biosynthesis following experimental varicocele in rats. Biology of Reproduction 1997;36:933–7.

    Google Scholar 

  89. Weiss DB, Rodriguez-Rigau L, Smith KD, Chowdhury A, Steinberger E. Quantitation of Leydig cells in testicular biopsies of oligospermic men with varicocele. Fertility and Sterility 1978;30(3):305–12.

    PubMed  CAS  Google Scholar 

  90. Amelar RD, Dubin L. Human chorionic gonadotrophin therapy in male infertility. JAMA 1977;237(22):2423.

    PubMed  CAS  Google Scholar 

  91. Check JH. Improved semen quality in subfertile males with varicocele-associated oligospermia following treatment with clomiphene citrate. Fertility and Sterility 1980;33(4):423–6.

    PubMed  CAS  Google Scholar 

  92. Rodriguez-Rigau LJ, Weiss DB, Zukerman Z, Grotjan HE, Smith KD, Steinberger E. A possible mechanism for the detrimental effect of varicocele on testicular function in man. Fertility and Sterility 1978;30(5):577–85.

    PubMed  CAS  Google Scholar 

  93. Hadziselimovic F, Leibundgut B, Da Runga D. The value of testicular biopsy in patients with varicoceles. The Journal of Urology 1986;135:707–710.

    Google Scholar 

  94. Benoff S, Hurley IR, Xu H, Marmar JL. Alteration in Leydig cell nuymber and morphology among infertile men with varicoceles. Fertility and Sterility 2006;86(Supl 2):S48–9.

    Google Scholar 

  95. Marmar JL, Benoff S. The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome. Human Reproduction (Oxford, England) 2005;20(8):2279–88.

    Google Scholar 

  96. Li L, Wine RN, Chapin RE. 2-Methoxyacetic acid (MAA) – induced spermatocyte apoptosis in human and rat testis: an in vitro comparison. Journal of Andrology 1996;17:538–49.

    PubMed  CAS  Google Scholar 

  97. Ku WW, Wine RN, Chae BY, Ghanayem BI, Chapin RE. Spermatocyte toxicity of 2-methoxyethanol (ME) in rats and guinea pigs: evidence for the induction of apoptosis. Toxicology and Applied Pharmacology 1995;134(1):100–10.

    PubMed  CAS  Google Scholar 

  98. Brinkworth MH, Weinbauer GF, Bergmann M, Nieschlag E. Apoptosis as a mechanism of germ cell loss in elderly men. International Journal of Andrology 1997;20(4):222–8.

    PubMed  CAS  Google Scholar 

  99. Cohen MS, Plaine L, Brown JS. The role of internal spermatic vein plasma catecholamine determinations in subfertile men with varicoceles. Fertility and Sterility 1975;26(12):1243–9.

    PubMed  CAS  Google Scholar 

  100. Comhaire F, Vermeulen A. Varicocele sterility: cortisol and catecholamines. Fertility and Sterility 1974;25(1):88–95.

    PubMed  CAS  Google Scholar 

  101. Cockett AT, Takihara H, Cosentino MJ. The varicocele. Fertility and Sterility 1984;41(1):5–11.

    PubMed  CAS  Google Scholar 

  102. Ito H, Fuse H, Minagawa H, Kawamura K, Murakami M, Shimazaki J. Internal spermatic vein prostaglandins in varicocele patients. Fertility and Sterility 1982;37(2):218–22.

    PubMed  CAS  Google Scholar 

  103. Vine MF, Tse CK, Hu P, Truong KY. Cigarette smoking and semen quality. Fertility and Sterility 1996;65(4):835–42.

    PubMed  CAS  Google Scholar 

  104. Klaiber EL, Broverman DM, Pokoly TB, Albert AJ, Howard PJ Jr, Sherer JF Jr. Interrelationships of cigarette smoking, testicular varicoceles, and seminal fluid indexes. Fertility and Sterility 1987;47(3):481–6.

    PubMed  CAS  Google Scholar 

  105. Chia SE, Ong CN, Tsakok FM. Effects of cigarette smoking on human semen quality. Archives of Andrology 1994;33(3):163–8.

    PubMed  CAS  Google Scholar 

  106. Jones MM, Xu C, Ladd PA. Selenite suppression of cadmium-induced testicular apoptosis. Toxicology 1997;116(1–3):169–75.

    PubMed  Google Scholar 

  107. Benoff S, Auborn K, Marmar JL, Hurley IR. Link between low-dose environmentally relevant cadmium exposures and asthenozoospermia in a rat model. Fertility and Sterility 2008;89(2 Suppl):e73–9.

    PubMed  Google Scholar 

  108. Peng BC, Tomashefsky P, Nagler HM. The cofactor effect: varicocele and infertility. Fertility and Sterility 1990;54(1):143–8.

    PubMed  CAS  Google Scholar 

  109. Benoff S, Gilbert BR. Varicocele and male infertility: Part I. Preface. Human Reproduction Update 2001;7(1):47–54.

    PubMed  CAS  Google Scholar 

  110. Tulloch WS. Varicocele in subfertility; results of treatment. British Medical Journal 1955;2(4935):356–8.

    PubMed  CAS  Google Scholar 

  111. Czaplicki M, Bablock L, Janczewski Z. Varicocelectomy in patients with azoospermia. Archives of Andrology 1979;3:51–5.

    PubMed  CAS  Google Scholar 

  112. Matthews GJ, Matthews ED, Goldstein M. Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertility and Sterility 1998;70(1):71–5.

    PubMed  CAS  Google Scholar 

  113. Kim ED, Leibman BB, Grinblat DM, Lipshultz LI. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. The Journal of Urology 1999;162(3 Pt 1):737–40.

    PubMed  CAS  Google Scholar 

  114. Lee JS, Park HJ, Seo JT. What is the indication of varicocelectomy in men with nonobstructive azoospermia? Urology 2007;69(2):352–5.

    PubMed  Google Scholar 

  115. Pasqualotto FF, Sobreiro BP, Hallak J, Pasqualotto EB, Lucon AM. Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update. Fertility and Sterility 2006;85(3):635–9.

    PubMed  Google Scholar 

  116. Schlegel PN, Kaufmann J. Role of varicocelectomy in men with nonobstructive azoospermia. Fertility and Sterility 2004;81(6):1585–8.

    PubMed  Google Scholar 

  117. Pryor JL, Kent-First M, Muallem A, et al. Microdeletions in the Y chromosome of infertile men. The New England Journal of Medicine 1997;336(8):534–9.

    PubMed  CAS  Google Scholar 

  118. Turek PJ, Cayan S, Black L. The response to varicocelectomy in oligospermic men with and without genetic infertility. Fertility and Sterility 2000;74:528.

    Google Scholar 

  119. Evers JL, Collins JA, Clark J. Surgery or embolisation for varicocele in subfertile men. The Cochrane Library 2008; (3):CD000479.

    Google Scholar 

  120. Ivanissevich O, Gregorini H. A new operation for the care of varicocele. Semana Medica 1978;25:575.

    Google Scholar 

  121. Ivanissevich O. Left varicocele due to reflux; experience with 4,470 operative cases in forty-two years. The Journal of the International College of Surgeons 1960;34:742–55.

    PubMed  CAS  Google Scholar 

  122. Palomo A. Radical cure of varicocele by a new technique: Preliminary report. The Journal of Urology 1948;61:604–7.

    Google Scholar 

  123. Dubin L, Amelar RD. Etiologic factors in 1294 consecutive cases of male infertility. Fertility and Sterility 1971;22(8):469–74.

    PubMed  CAS  Google Scholar 

  124. Silber SJ. Microsurgical aspects of varicocele. Fertility and Sterility 1979;31(2):230–2.

    PubMed  CAS  Google Scholar 

  125. Wosnitzer M, Roth JA. Optical magnification and Doppler ultrasound probe for varicocelectomy. Urology 1983;22(1):24–6.

    PubMed  CAS  Google Scholar 

  126. Marmar JL, DeBenedictis TJ, Praiss D. The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertility and Sterility 1985;43(4):583–8.

    PubMed  CAS  Google Scholar 

  127. Zampieri N, Zuin V, Corroppolo M, Chironi C, Cervellione RM, Camoglio FS. Varicocele and adolescents: semen quality after 2 different laparoscopic procedures. Journal of Andrology 2007;28(5):727–33.

    PubMed  Google Scholar 

  128. Iaccarino V. A nonsurgical treatment of varicocele: trans-catheter sclerotherapy of gonadal veins. Annales de Radiologie 1980;23(4):369–70.

    PubMed  CAS  Google Scholar 

  129. Lima SS, Castro MP, Costa OF. A new method for the treatment of varicocele. Andrologia 1978;10(2):103–6.

    PubMed  CAS  Google Scholar 

  130. Walsh PC, White RI Jr. Balloon occlusion of the internal spermatic vein for the treatment of varicoceles. JAMA 1981;246(15):1701–2.

    PubMed  CAS  Google Scholar 

  131. Tauber R, Johnsen N. Antegrade scrotal sclerotherapy for the treatment of varicocele: technique and late results. The Journal of Urology 1994;151(2):386–90.

    PubMed  CAS  Google Scholar 

  132. Comhaire F, Kunnen M, Nahoum C. Radiological anatomy of the internal spermatic vein(s) in 200 retrograde venograms. International Journal of Andrology 1981;4(3):379–87.

    PubMed  CAS  Google Scholar 

  133. Sayfan J, Adam YG, Soffer Y. A new entity in varicocele subfertility: the “cremasteric reflux”. Fertility and Sterility 1980;33(1):88–90.

    PubMed  CAS  Google Scholar 

  134. Feneley MR, Pal MK, Nockler IB, Hendry WF. Retrograde embolization and causes of failure in the primary treatment of varicocele. British Journal of Urology 1997;80(4):642–6.

    PubMed  CAS  Google Scholar 

  135. Kaufman SL, Kadir S, Barth KH, Smyth JW, Walsh PC, White RI Jr. Mechanisms of recurrent varicocele after balloon occlusion or surgical ligation of the internal spermatic vein. Radiology 1983;147(2):435–40.

    PubMed  CAS  Google Scholar 

  136. Zuckerman AM, Mitchell SE, Venbrux AC, et al. Percutaneous varicocele occlusion: long-term follow-up. Journal of Vascular and Interventional Radiology 1994;5(2):315–9.

    PubMed  CAS  Google Scholar 

  137. Zucchi A, Mearini L, Mearini E, Costantini E, Bini V, Porena M. Treatment of varicocele: randomized prospective study on open surgery versus Tauber antegrade sclerotherapy. Journal of Andrology 2005;26(3):328–32.

    PubMed  Google Scholar 

  138. Al-Said S, Al-Naimi A, Al-Ansari A, et al. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. The Journal of Urology 2008;180(1):266–70.

    PubMed  Google Scholar 

  139. Galarneau G, Nagler HM. Cost effective infertility therapies in the 90s: to treat or to cure? Contemporary Urology 1999;11:32–45.

    Google Scholar 

  140. Cocuzza M, Cocuzza MA, Bragais FM, Agarwal A. The role of varicocele repair in the new era of assisted reproductive technology. Clinics (Sao Paulo, Brazil) 2008;63(3):395–404.

    Google Scholar 

  141. www.cdc.gov/reproductivehealth/index/htm.

    Google Scholar 

  142. Richardson I, Grotas AB, Nagler HM. Outcomes of varicocelectomy treatment: an updated critical analysis. The Urologic Clinics of North America 2008;35(2):191–209; viii.

    PubMed  Google Scholar 

  143. Guzick DS, Overstreet JW, Factor-Litvak P, et al. Sperm morphology, motility, and concentration in fertile and infertile men. The New England Journal of Medicine 2001;345(19):1388–93.

    PubMed  CAS  Google Scholar 

  144. Benoff S, Goodwin LO, Millan C, Hurley IR, Pergolizzi RG, Marmar JL. Deletions in L-type calcium channel alpha1 subunit testicular transcripts correlate with testicular cadmium and apoptosis in infertile men with varicoceles. Fertility and Sterility 2005;83(3):622–34.

    PubMed  CAS  Google Scholar 

  145. O’Brien J, Bowles B, Kamal KM, Jarvi K, Zini A. Does the gonadotropin-releasing hormone stimulation test predict clinical outcomes after microsurgical varicocelectomy? Urology 2004;63(6):1143–7.

    PubMed  Google Scholar 

  146. Matkov TG, Zenni M, Sandlow J, Levine LA. Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy. Fertility and Sterility 2001;75(1):63–8.

    PubMed  CAS  Google Scholar 

  147. Cayan S, Erdemir F, Ozbey I, Turek PJ, Kadioglu A, Tellaloglu S. Can varicocelectomy significantly change the way couples use assisted reproductive technologies? The Journal of Urology 2002;167(4):1749–52.

    PubMed  Google Scholar 

  148. Zini A, Boman J, Baazeem A, Jarvi K, Libman J. Natural history of varicocele management in the era of intracytoplasmic sperm injection. Fertility and Sterility 2008.

    Google Scholar 

  149. Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost-effectiveness analysis. Urology 1997;49(1):83–90.

    PubMed  CAS  Google Scholar 

  150. Meng MV, Greene KL, Turek PJ. Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. The Journal of Urology 2005;174(5):1926–31; discussion 31.

    PubMed  Google Scholar 

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    Joel L. Marmar

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    Marmar, J.L. (2009). The Use of Varicocelectomy Surgery in the Treatment of the Infertile Male. In: Voorhis, B., Schlegel, P., Racowsky, C., Carrell, D. (eds) Biennial Review of Infertility. Humana Press. https://doi.org/10.1007/978-1-60327-392-3_18

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