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Grade of Evidence on Varicocele Treatment

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Varicocele and Male Infertility

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Abstract

The deleterious effects of varicocele on male infertility were first described in 1955, when Tulloch first reported improvement of sperm parameters and successful paternity after varicocele ligation. After more than six decades of medical research, however, varicocele treatment remains one of the most controversial subjects in the field of urology.

The degree to which varicocelectomy improves pregnancy rates and assisted reproductive technology outcomes remains not completely elucidated due to the lack of controlled studies, precise diagnostic parameters, as well as clear treatment guidelines. Although the ultimate end point for the treatment of male factor infertility is an increased pregnancy rate, efforts to maximize the couple’s fertility potential by improving sperm quality or avoiding a decline in testicular function are an important objective of treatment. Moreover, even when pregnancy is not achieved, improved seminal quality after surgical procedure can circumvent or downstage the need for assisted reproductive technologies.

Nevertheless, numerous quality researches investigated the effects of varicocele treatment on human reproduction through the scope of evidence-based medicine. This review discusses the existing literature on the efficacy of varicocele repair for the treatment of infertility and summarizes the leading concepts in how varicocelectomy interferes in assisted reproductive technologies outcomes. It also discusses the current indications of varicocelectomy in azoospermic patients, adolescents, as well as hypogonadic males. Finally, the authors critically review the cost-effectiveness of the surgical treatment of a varicocele as compared with assisted reproductive technologies.

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Authors and Affiliations

  1. Department of Urology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Guilherme J. A. Wood & Marcello Antonio Signorelli Cocuzza

Authors
  1. Guilherme J. A. Wood
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  2. Marcello Antonio Signorelli Cocuzza
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Correspondence to Marcello Antonio Signorelli Cocuzza .

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Editors and Affiliations

  1. ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, São Paulo, Brazil

    Sandro C Esteves

  2. S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Chak-Lam Cho

  3. Department of Urology, Hamad Medical Corporation, Weill Cornell Medicine Qatar, Doha, Qatar

    Ahmad Majzoub

  4. Department of Urology, Cleveland Clinic, Cleveland, OH, USA

    Ashok Agarwal

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Wood, G.J.A., Cocuzza, M.A.S. (2019). Grade of Evidence on Varicocele Treatment. In: Esteves, S., Cho, CL., Majzoub, A., Agarwal, A. (eds) Varicocele and Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-79102-9_58

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  • DOI: https://doi.org/10.1007/978-3-319-79102-9_58

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