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Varicocele: To Fix or Not to Fix

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Male Infertility

Part of the book series: Current Clinical Urology ((CCU))

Abstract

Tulloch (1955) reported that ligation of the spermatic vessels cured a 27-year-old azoospermic male with bilateral varicoceles. Within 3 months of the surgery, spermatozoa had returned to the seminal fluid, and within 9 months the patient’s wife became pregnant. Tulloch’s account sparked a renewed interest in the surgical correction of varicoceles, but this interest would not be long-lasting. Uncertain of the value of treating varicoceles for infertility, Baker et al. (1985) reviewed a series of 651 subfertile couples in which the man had a varicocele. They detected no improvement in pregnancy rates in couples where the man had undergone varicocele ligation and concluded that testicular vein ligation is not effective in improving fertility. They declared that the “onus is now on proponents of the treatment of varicoceles in infertile men by operation or other techniques to prove their case.” The debate has since raged, and countless studies and reviews have been published on this topic, few of which have succeeded in bringing clarity to the controversy. In the past decade, several controlled studies involving modern techniques of diagnosis and treatment have been published on this subject. In this review, we discuss the evidence and the role of varicocele repair for the treatment of male infertility.

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References

  • Agarwal A, Prabakaran S, Allamaneni SS. Relationship between oxidative stress, varicocele and infertility: a meta-analysis. Reprod Biomed Online 2006; 12: 630–633

    Article  PubMed  CAS  Google Scholar 

  • Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Shart RA, Sabanegh E, Marmar JL. Efficacy of varicocelectomy in improving semen parameters: new meta-analytic approach. Urology 2007; 70: 532–538

    Article  PubMed  Google Scholar 

  • Agger P, Johnsen SG. Quantitative evaluation of testicular biopsies in varicocele. Fertil Steril 1978; 29: 52–57

    PubMed  CAS  Google Scholar 

  • Akbay E, Cayan S, Doruk E, Duce MN, Bozlu M. The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescentes. BJU Int 2000; 86: 490–493

    Article  PubMed  CAS  Google Scholar 

  • Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YN, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology 2007; 69: 417–420

    Article  PubMed  Google Scholar 

  • Alukal JP, Lipshultz LI. Why treat the male in the era of assisted reproduction? Semin Reprod Med 2009; 27(2): 109–114

    Article  PubMed  Google Scholar 

  • Alukal JP, Zurakowski D, Atala A, et al. Testicular hypotrophy does not correlate with grade of adolescent varicocele. J Urol 2005; 174(6): 2367–2370

    Article  PubMed  Google Scholar 

  • Ayodeji O, Baker HW. Is there a specific abnormality of sperm morphology in men with varicoceles? Fertil Steril 1986; 45: 839–842

    PubMed  CAS  Google Scholar 

  • Baker HW, Burger HG, de Kretser DM, Hudson B, Rennie GC, Straffon WG. Testicular vein ligation and fertility in men with varicoceles. Br Med J (Clin Res Ed) 1985; 291: 1678–1680

    Article  CAS  Google Scholar 

  • Barqawi A, Furness P III, Koyle M. Laparoscopic Palomo varicocelectomy in the adolescent is safe after previous ipsilateral inguinal surgery. BJU Int 2002; 89(3): 269–272

    Article  PubMed  CAS  Google Scholar 

  • Barqawi A, Caruso A, Meacham RB. Experimental varicocele induces testicular germ cell apoptosis in the rat. J Urol 2004; 171: 501–503

    Article  PubMed  Google Scholar 

  • Bedford JM, Yanagimachi R. Epididymal storage at abdominal temperature reduces the time required for capacitation of hamster spermatozoa. J Reprod Fertil 1991; 91: 403–410

    Article  PubMed  CAS  Google Scholar 

  • Benoff S, Gilbert BR. Varicocele and male infertility: Part I. Preface. Hum Reprod Update 2001; 7: 47–54

    Article  PubMed  CAS  Google Scholar 

  • Braedel HU, Steffens J, Ziegler M, Polsky MS, Platt ML. A possible ontogenic etiology for idiopathic left varicocele. J Urol 1994; 151: 62–66

    PubMed  CAS  Google Scholar 

  • Buschi AJ, Harrison RB, Norman A, et al. Distended left renal vein: CT/sonographic normal variant. Am J Roentgenol 1980; 135: 339–342

    CAS  Google Scholar 

  • Callam MJ. Epidemiology of varicose veins. BJU Int 1994; 81: 167–173

    CAS  Google Scholar 

  • Cam K, Simsek F, Yuksel M, et al. The role of reactive oxygen species and apoptosis in the pathogenesis of varicocele in a rat model and efficiency of vitamin E treatment. Int J Androl 2004; 27: 228–233

    Article  PubMed  CAS  Google Scholar 

  • Canales BK, Zapzalka DM, Ercole CJ, Carey P, Haus E, Aeppli D, Pryor JL. Prevalence and effect of varicoceles in an elderly population. Urology 2005; 66: 627–631

    Article  PubMed  Google Scholar 

  • Castro-Magana M, Angulo M, Uy J. Elevated serum estradiol associated with increased androstenedione–testosterone ratio in adolescent males with varicocele and gynecomastia. Fertil Steril 1991; 56: 515–518

    PubMed  CAS  Google Scholar 

  • Cavallini G, Biagiotti G, Ferraretti AP, Gianaroli L, Vitali G. Medical therapy of oligoasthenospermia associated with left varicocele. BJU Int 2003; 91(6): 513–518

    Article  PubMed  CAS  Google Scholar 

  • Cavallini G, Ferraretti AP, Gianaroli L, Biagiotti G, Vitali G. Cinnoxicam and l-carnitine/acetyl-l-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermia. J Androl 2004; 25(5): 761–770

    PubMed  CAS  Google Scholar 

  • 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): 750–754

    Article  PubMed  CAS  Google Scholar 

  • Cayan S, Erdemir F, Ozbey I, Turek P, Kadioglu A, Tellaloglu S. Can varicocelectomy significantly change the way couples use assisted reproductive technologies? J Urol 2002; 167: 1749–1752

    Article  PubMed  Google Scholar 

  • Cayan S, Acar D, Ulger S, et al. Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital. J Urol 2005; 174(5): 2003–2007

    Article  PubMed  Google Scholar 

  • Chakraborty J, Sinha Hikim AP, Jhunjhunwala JS. Stagnation of blood in the microcirculatory vessels in the testes of men with varicocele. J Androl 1985; 6: 117–126

    PubMed  CAS  Google Scholar 

  • Cohen MS, Plaine L, Brown JS. The role of internal spermatic vein plasma catecholamine determination in subfertile men with varicocele. Fertil Steril 1975; 26: 1243–1249

    PubMed  CAS  Google Scholar 

  • Comhaire F, Vermeulen A. Varicocele sterility: cortisol and catecholamines. Fertil Steril 1974; 25: 88–95

    PubMed  CAS  Google Scholar 

  • Comhaire F, Vermeulen A. Plasma testosterone in patients with varicocele and sexual inadequacy. J Clin Endocrinol Metab 1975; 40: 824–829

    Article  PubMed  CAS  Google Scholar 

  • Comhaire F, Kunnen M, Nahoum C. Radiological anatomy of the internal spermatic vein(s) in 200 retrograde venograms. Int J Androl 1981; 4: 379–387

    Article  PubMed  CAS  Google Scholar 

  • Comhaire F, Simons M, Kunnen M, Vermeulen L. Testicular arterial perfusion in varicocele: the role of rapid sequence scintigraphy with technetium in varicocele evaluation. J Urol 1983; 130: 923–926

    PubMed  CAS  Google Scholar 

  • Comhaire F, Zalata A, Mahmoud A, Depuydt C. Pathophysiological effect of varicocele treatment. Der Urologe A 1998; 37: 251–253

    Article  CAS  Google Scholar 

  • Daitch JA, Bedaiwy MA, Pasqualotto EB, Hendin BN, Hallak J, Falcone T, et al. Varicocelectomy improves intrauterine insemination success rates among men with varicocele. J Urol 2001; 165: 1510–1513

    Article  PubMed  CAS  Google Scholar 

  • De Rose AF, Gallo F, Giglio M, Parisini B, Carmignani G. Early use of menotropin in the treatment of varicocele. Arch Ital Urol Androl 2003; 75(1): 53–57

    PubMed  Google Scholar 

  • Diamond D. Adolescente varicocele. Curr Opin Urol 2007; 17(4): 263–267

    Article  PubMed  Google Scholar 

  • Donkol RH, Salem T. Paternity after varicocelectomy: preoperative parameters of success. J Ultrasound Med 2007; 26: 953–959

    Google Scholar 

  • Dubin R, Amelar RD. Varicocele size and results of varicocelectomy in selected subfertile men with varicocele. Fertil Steril 1970; 21: 606–609

    PubMed  CAS  Google Scholar 

  • Dubin L, Amelar RD. Varicocelectomy: 986 cases in a twelve-year study. Urology 1977; 10: 446–449

    Article  PubMed  CAS  Google Scholar 

  • Dubin L, Hotchkiss RS. Testis biopsy in subfertile men with varicocele. Fertil Steril 1969; 20: 51–57

    PubMed  CAS  Google Scholar 

  • Evers JL, Collins JA. Surgery or embolisation in subfertile men: The Cochrane Library, Issue 1, 2007

    Google Scholar 

  • Evers JL, Collin JA, Vandekerckhove P. Surgery or embolisation for varicocele in subfertile men. Cochrane Database Syst Rev 2001; 1: CD0000479

    Google Scholar 

  • Ficarra V, Cerruto MA, Liguori G, Mazzoni G, Minucci S, Tracia A, Gentile V. Treatment of varicocele in subfertile men: the Cochrane Review – a contrary opinion. Eur Urol 2006; 49(2): 217–219

    Article  Google Scholar 

  • Fisher LM, Sandlow JI. The role of varicocele treatment in the era of assisted reproductive technology. Braz J Urol 2001; 27: 19–25

    Google Scholar 

  • Fretz PC, Sandlow JI. Varicocele: current concepts in patho-physiology, diagnosis, and treatment. Urol Clin North Am 2002; 29: 921–937

    Article  PubMed  Google Scholar 

  • Galarneau GJ, Nagler HM. Cost-effective infertility therapies in the ‘90s: to treat or to cure? Contemp Urol 1999; 11: 32–45

    Google Scholar 

  • Gat Y, Zukerman ZV, Bachar GN, Feldberg DO, Gornish M. Adolescent varicocele: is it a unilateral disease? Urology 2003; 62: 742–746

    Article  PubMed  Google Scholar 

  • Gat Y, Bachar GN, Zukerman Z, Belenky A, Gorenish M. Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities. J Urol 2004; 172(4 Pt 1): 1414–1417

    Article  PubMed  Google Scholar 

  • Gat Y, Bachar GN, Everaert K, Levinger U, Gornish M. Induction of spermatogenesis in azoospermic men after internal spermatic vein embolization for the treatment of varicocele. Hum Reprod 2005; 20: 1013–1017

    Article  PubMed  Google Scholar 

  • Geatti O, Gasparini D, Shapiro B. A comparison of scintigraphy, thermography, ultrasound and phlebography in grading of clinical varicocele. J Nucl Med 1991; 32(11): 2092–2097

    PubMed  CAS  Google Scholar 

  • Goldstein M, Eid JF. Elevation of intratesticular and scrotal skin surface temperature in men with varicocele. J Urol 1989; 142: 743–745

    PubMed  CAS  Google Scholar 

  • Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol 1992; 148: 1808–1811

    PubMed  CAS  Google Scholar 

  • Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril 1993; 59: 613–616

    PubMed  CAS  Google Scholar 

  • 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 Int 2000; 85(3): 305–307

    Article  PubMed  CAS  Google Scholar 

  • Guzick DS, Overstreet JW, Factor-Litvak P, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 2001; 345: 1388–1393

    Article  PubMed  CAS  Google Scholar 

  • Handel LN, Shetty R, Sigman M. The relationship between varicoceles and obesity. J Urol 2006; 176: 2138–2140

    Article  PubMed  Google Scholar 

  • Hendin BN, Kolettis PN, Sharma RK, Thomas AJ, Agarwal A. Varicocele is associated with elevated spermatozoal reactive oxygen species production and diminished seminal plasma antioxidant capacity. J Urol 1999; 161(6): 1831–1834

    Article  PubMed  CAS  Google Scholar 

  • Host E, Gabrielsen A, Lindenberg S, et al. Apoptosis is human cumulus cells in relation to zona pellucida thickness variation, maturation stage and cleavage of the corresponding oocyte after intracytoplasmic sperm injection. Fertil Steril 2002; 77: 511–515

    Article  PubMed  Google Scholar 

  • Ibrahim AA, Awad HA, El-Haggar S, Mitawi BA. Bilateral testicular biopsy in men with varicocele. Fertil Steril 1977; 28: 663–667

    PubMed  CAS  Google Scholar 

  • Jarow JP, Coburn M, Sigman M. Incidence of varicoceles in men with primary and secondary infertility. Urology 1996; 47: 73–76

    Article  PubMed  CAS  Google Scholar 

  • Jarow J, Sharlip ID, Belker AM, Lipshultz LY, Sigman M, Thomas AJ Jr., et al. Best practice policies for male infertility. J Urol 2002; 167: 2133–2144

    Article  Google Scholar 

  • Johnsen SG, Agger P. Quantitative evaluation of testicular biopsies before and after operation for varicocele. Fertil Steril 1978; 29: 58–63

    PubMed  CAS  Google Scholar 

  • Kass EJ, Stork BR, Steinert BW. Varicocele in adolescence induces left and right testicular volume loss. BJU Int 2001; 87(6): 499–501

    Article  PubMed  CAS  Google Scholar 

  • Kattan S. Incidence and pattern of varicocele recurrence after laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery. Scand J Urol Nephrol 1998; 32: 335–340

    Article  PubMed  CAS  Google Scholar 

  • Kefer JC, Agarwal A, Sabanegh role of antioxidants in the treatment of male infertility. Int J Urol 2009; 16(5): 449–457

    Article  PubMed  CAS  Google Scholar 

  • Kibar U, Seckin B, Erduran D. The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters. J Urol 2002; 168: 1071–1074

    Article  PubMed  Google Scholar 

  • Kim ED, Leibman BB, Grinblat DM, Lipshultz LI. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 1999; 162: 737–740

    Article  PubMed  CAS  Google Scholar 

  • Kolettis PN, Sharma RK, Pasqualotto FF, Nelson D, Thomas AJ, Agarwal A. Effect of seminal oxidative stress on fertility after vasectomy reversal. Fertil Steril 1999; 71(2): 249–255

    Article  PubMed  CAS  Google Scholar 

  • 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): 164–171

    Article  PubMed  CAS  Google Scholar 

  • Ku JH, Kim SW, Park K, Paick J-S. Benefits of microsurgical repair of adolescent varicocele: comparison of semen para­meters in fertile and infertile adults with varicocele. Urology 2005; 65: 554–558

    Article  PubMed  Google Scholar 

  • Kursh ED. What is the incidence of varicocele in a fertile population? Fertil Steril 1987; 48: 510–511

    PubMed  CAS  Google Scholar 

  • Laven JS, Haans LC, Malli WP, Te Velde ER, Wensing CJ, Eimers JM. Effects of varicocele treatment in adolescents: a randomized study. Fertil Steril 1992; 58: 756–762

    PubMed  CAS  Google Scholar 

  • Levinger U, Gornish M, Gat Y, Bachar GN. Is varicocele prevalence increasing with age? Andrologia 2007; 39: 77–80

    Article  PubMed  CAS  Google Scholar 

  • Libman J, Jarvi K, Lo K, Zini A. Beneficial effect of microsurgical varicocelectomy is superior for men with bilateral versus unilateral repair. J Urol 2006; 176: 2602–2605

    Article  PubMed  Google Scholar 

  • Liguori G, Trombetta C, Garaffa G, Bucci S, Gattuccio I, Salamè L, Belgrano E. Color Doppler ultrasound investigation of varicocele. World J Urol 2004; 22: 378–381

    Article  PubMed  Google Scholar 

  • Lipshultz LI, Corriere JN Jr. Progressive testicular atrophy in the varicocele patient. J Urol 1977; 117: 175–176

    PubMed  CAS  Google Scholar 

  • 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). J Androl 2002; 23: 799–805

    PubMed  Google Scholar 

  • Luigi L, Gentile V, Pigozzi F, Parisi A, Giannetti D, Romanelli F. Physical activity as a possible aggravating factor for athletes with varicocele: impact on the semen profile. Hum Reprod 2001; 16: 1180–1184

    Article  PubMed  Google Scholar 

  • MacLeod J. Seminal cytology in the presence of varicocele. Fertil Steril 1965; 16: 735–757

    PubMed  CAS  Google Scholar 

  • Madgar I, Weissenberg R, Lunenfeld B, Karasik A, Goldwasser B. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril 1995; 63: 120–124

    PubMed  CAS  Google Scholar 

  • Magdar I, Weissemberg R, Lunenfeld B, Karasik A, Goldwasser B. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril 1995; 63: 120–124

    Google Scholar 

  • Mahmoud AM, Comhaire FH, Depuydt CE. The clinical and biological significance of serum inhibins in subfertile men. Reprod Toxicol 1998; 12: 591–599

    Article  PubMed  CAS  Google Scholar 

  • Marks JL, McMahon R, Lipshultz LI. Predictive parameters of successful varicocele repair. J Urol 1986; 136: 609–612

    PubMed  CAS  Google Scholar 

  • Marmar JL, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol 1994; 152: 1127–1132

    PubMed  CAS  Google Scholar 

  • Marmar JL, Agarwal A, Prabakaran S, Agarwal R, Short RA, Benoff S, Thomas AJ Jr. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril 2007; 88: 639–648

    Article  PubMed  Google Scholar 

  • Matthews GJ, Matthews ED, Goldstein M. Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil Steril 1998; 70: 71–75

    Article  PubMed  CAS  Google Scholar 

  • Micic S, Tilic C, Dotlic R. Kallikrein therapy of infertile men with varicocele and impaired sperm motility. Andrologia 1990; 22(2): 179–183

    Article  PubMed  CAS  Google Scholar 

  • Mieusset R, Bujan L, Plantavid M, Grandjean H. Increased levels of serum follicle-stimulating hormone and luteinizing hormone associated with intrinsic testicular hyperthermia in oligospermic infertile men. J Clin Endocrinol Metab 1989; 68: 419–425

    Article  PubMed  CAS  Google Scholar 

  • Nagler HM, Luntz RK, Martinis FG. Varicocele. In: Lipshultz LI, Howards SS (eds.) Infertility in the male, 3rd ed. Mosby-Year Book, St. Louis, MO, 1977, p. 343

    Google Scholar 

  • Nagler HM, Luntz RK, Martinis F. Varicocele. In: Lipshultz LI, Howards SS (eds.) Infertility in the male, 3rd ed. Mosby-Year Book, St. Louis, MO, 1997

    Google Scholar 

  • Nallella KP, Allamaneni SSR, 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: 1010–1013

    Article  PubMed  Google Scholar 

  • Nieschlag E, Behre HM, Schlingheider A, Nashan D, Pohl J, Fischedick AR. Surgical ligation vs. angiographic embolization of the vena spermatica: a prospective randomized study for the treatment of varicocele-related infertility. Andrologia 1993; 25: 233–237

    Article  PubMed  CAS  Google Scholar 

  • Nistal M, Gonzalez-Peramato P, Serrano A, Regadera J. Physiopathology of the infertile testicle. Etiopathogenesis of varicocele. Arch Esp Urol 2004; 57: 883–904

    PubMed  Google Scholar 

  • Noske HD, Weidner W. Varicocele – a historical perspective. World J Urol 1999; 17: 151–157

    Article  PubMed  CAS  Google Scholar 

  • Onur R, Semercioz A, Orhan I, et al. The effects of melatonin and the antioxidant defence system on apoptosis regulator proteins (Bax and Bcl-2) in experimentally induced varicocele. Urol Res 2004; 32: 204–208

    Article  PubMed  CAS  Google Scholar 

  • Paduch DA, Skoog SJ. Current management of adolescent varicocele. Rev Urol 2001; 3: 120–133

    PubMed  CAS  Google Scholar 

  • Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992; 340: 17–18

    Article  PubMed  CAS  Google Scholar 

  • Pasqualotto FF. O papel do estresse oxidativo em pacientes inférteis com varicocele. Dissertação de Mestrado apresentada à Faculdade de Medicina da Universidade de São Paulo, 2001, São Paulo, Brazil

    Google Scholar 

  • Pasqualotto FF. Relação do estresse oxidativo, características seminais e diagnósticos clínicos em homens submetidos à investigação infertilidade masculina. Tese de Doutorado apresentada à Faculdade de Medicina da Universidade de São Paulo, 2002, São Paulo, Brazil

    Google Scholar 

  • Pasqualotto FF, Sharma RK, Nelson DR, Thomas AJ, Agarwal A. Relationship between oxidative stress, semen characteristics, and clinical diagnosis in men undergoing infertility investigation. Fertil Steril 2000; 73(3): 459–464

    Article  PubMed  CAS  Google Scholar 

  • Pasqualotto FF, Sharma RK, Nelson DR, Thomas AJ Jr., Agarwal A. Oxidative stress in normospermic men undergoing infertility evaluation. J Androl 2001; 22(2): 316–322

    PubMed  CAS  Google Scholar 

  • Pasqualotto FF, Lucon AM, Góes PM, Hallak J, Pasqualotto EB, Arap S. The effect of varicocelectomy on serum hormonal levels in infertile men with clinical varicoceles. Fertil Steril 2003a; 80: S29

    Article  Google Scholar 

  • Pasqualotto FF, Lucon AM, Hallak J, Goes PM, Saldanha LB, Arap S. Induction of spermatogenesis in azoospermic men undergoing varicocele repair. Hum Reprod 2003b; 18: 108–112

    Article  PubMed  Google Scholar 

  • Pasqualotto FF, Lucon AM, de Goes PM, et al. Semen profile, testicular volume, and hormonal levels in infertile patients with varicocele compared with fertile men with and without varicocele. Fertil Steril 2005a; 83: 74–77

    Article  PubMed  Google Scholar 

  • Pasqualotto FF, Lucon AM, de Goes PM, Sobreiro BP, Pasqualotto EB, Arap S. Is it worthwhile to operate on subclinical right varicocele in patients with grade II–III varicocele in the left testicle? J Assist Reprod Genet 2005b; 22: 227–231

    Article  PubMed  Google Scholar 

  • Pasqualotto FF, Sobreiro BP, Hallak J, Pasqualotto EB, Lucon AM. Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update. Fertil Steril 2006; 85: 635–639

    Article  PubMed  Google Scholar 

  • Pasqualotto FF, Umezu FM, Salvador M, Borges E Jr., Sobreiro BP, Pasqualotto EB. Effect of cigarette smoking on antioxidant levels and presence of leukocytospermia in infertile men: a prospective study. Fertil Steril 2008; 90: 278–283

    Article  PubMed  Google Scholar 

  • Penson DF, Paltiel DA, Kramholz HM, Palter S. The cost effectiveness of treatment for varicocele related infertility. J Urol 2002; 168: 2490–2494

    Article  PubMed  Google Scholar 

  • Pinto KJ, Kroovand RL, Jarow JP. Varicocele related testicular atrophy and its predictive effect upon fertility. J Urol 1994; 152(2 Pt 2): 788–790

    PubMed  CAS  Google Scholar 

  • Pirke KM, Vogt H-J, Sintermann R, Spyra B. Testosterone in peripheral plasma, spermatic vein and in testicular tissue under basal conditions and after HCG-stimulation in patients with varicocele. Andrologia 1983; 15: 637–641

    Article  PubMed  CAS  Google Scholar 

  • Podesta ML, Gottlieb S, Medel R, Ropelato G, Bergada C, Quesada E. Hormonal parameters and testicular volume in children and adolescents with unilateral varicocele: preoperative and postoperative findings. J Urol 1994; 152: 794–797

    PubMed  CAS  Google Scholar 

  • Practice Committee of the American Society for Reproductive Medicine. Report on varicocele and infertility. Fertil Steril 2006; 86(Suppl 4): S93–S95

    Google Scholar 

  • Pryor JL, Howards SS. Varicocele. Urol Clin North Am 1987; 14: 499–513

    PubMed  CAS  Google Scholar 

  • Raman JD, Walmsley K, Goldstein M. Inheritance of varicoceles. Urology 2005; 65: 1186–1189

    Article  PubMed  Google Scholar 

  • Santoro G, Romeo C. Normal and varicocele testis in adolescents. Asian J Androl 2001; 3: 259–262

    PubMed  CAS  Google Scholar 

  • Sayfan J, Halevy A, Oland J, Nathan H. Varicocele and left renal vein compression. Fertil Steril 1984; 41: 411–417

    PubMed  CAS  Google Scholar 

  • Sayfan J, Siplovich L, Koltun L, Benyamin N. Varicocele treatment in pubertal boys prevents testicular growth arrest. J Urol 1997; 157: 1456–1457

    Article  PubMed  CAS  Google Scholar 

  • Scaramuzza A, Tavana R, Marchi A. Varicoceles in young soccer players. Lancet 1996; 348: 1180–1181

    Article  PubMed  CAS  Google Scholar 

  • Schatte EC, Hirshberg SJ, Fallick ML, Lipshultz LI, Kim ED. Varicocelectomy improves sperm strict morphology and motility. J Urol 1998; 160: 1338–1340

    Article  PubMed  CAS  Google Scholar 

  • Schiff J, Kelly C, Goldstein M, et al. Managing varicoceles in children: results with microsurgical varicocelectomy. BJU Int 2005; 95(3): 399–402

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Schlegel PN, Kaufmann J. Role of varicocelectomy in men with nonobstructive azoospermia. Fertil Steril 2004; 81: 1585–1588

    Article  PubMed  Google Scholar 

  • Shafik A, Bedeir GA. Venous tension patterns in cord veins. I. In normal and varicocele individuals. J Urol 1980; 123: 383–385

    PubMed  CAS  Google Scholar 

  • Sharma RK, Pasqualotto FF, Nelson DR, Thomas AJ, Agarwal A. The reactive oxygen species – total antioxidant capacity score is a new measure of oxidative stress to predict male infertility. Hum Reprod 1999; 14(11): 2801–2807

    Article  PubMed  CAS  Google Scholar 

  • Shlansky-Goldberg RD, Van Arsdalen KN, Rutter CM, Soulen MC, Haskal ZJ, Baum RA, Redd DC, Cope C, Pentecost MJ. Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes. J Vasc Interv Radiol 1997; 8: 759–767

    Article  PubMed  CAS  Google Scholar 

  • Sigman M, Jarow JP. Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles. J Urol 1997; 158: 605–607

    Article  PubMed  CAS  Google Scholar 

  • Steeno O, Knops J, Declerck L, Adimoelja A, Van de Voorde H. Prevention of fertility disorders by detection and treatment of varicocele at school and college age. Andrologia 1976; 8: 47–53

    Article  PubMed  CAS  Google Scholar 

  • Sylvester SR, Griswold MD. The testicular iron shuttle: a “nurse” function of the Sertoli cells. J Androl 1994; 15: 381–385

    PubMed  CAS  Google Scholar 

  • Terquem A, Dadoune JP. Morphological findings in varicocele: an ultrastructural study of 30 bilateral testicular biopsies. Int J Androl 1981; 4: 515–531

    Article  PubMed  CAS  Google Scholar 

  • Trum JW, Gubler FM, Laan R, van der Veen F. The value of palpation, varicoscreen contact thermography and colour Doppler ultrasound in the diagnosis of varicocele. Hum Reprod 1996; 11(6): 1232–1235

    Article  PubMed  CAS  Google Scholar 

  • Tulloch WS. Varicocele in subfertility; results of treatment. Br Med J 1955; 2: 356–358

    Article  PubMed  CAS  Google Scholar 

  • Turkyilmaz Z, Gulen S, Sonmez K, et al. Increased nitric oxide is accompanied by lipid oxidation in adolescent varicocele. Int J Androl 2004; 27: 183–187

    Article  PubMed  Google Scholar 

  • Unal D, Yeni E, Verit A, Karatas OF. Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: a prospective randomized study. Int J Urol 2001; 8(5): 227–230

    Article  PubMed  CAS  Google Scholar 

  • Vazquez-Levin MH, Friedmann P, Goldberg SI, Medley NE, Nagler HM. Response of routine semen analysis and critical assessment of sperm morphology by Kruger classification to therapeutic varicocelectomy. J Urol 1997; 158: 1804–1807

    Article  PubMed  CAS  Google Scholar 

  • Wang YX, Lei C, Dong SG, et al. Study of bilateral histology and meiotic analysis in men undergoing varicocele ligation. Fertil Steril 1991; 55: 152–155

    PubMed  CAS  Google Scholar 

  • Weidner W, Colpi GM, Hargreave TB, Papp GK, Pomerol JM. EAU guidelines on male infertility. Eur Urol 2002; 42: 313–322

    Article  PubMed  CAS  Google Scholar 

  • Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology 1993; 42: 541–543

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril 1992; 57(6): 1289–1293

    Google Scholar 

  • Wright EJ, Young GP, Goldstein M. Reduction in testicular temperature after varicocelectomy in infertile men. Urology 1997; 50: 257–259

    Article  PubMed  CAS  Google Scholar 

  • Yaman O, Soygur T, Zumrutbas AE, Resorlu B. Results of microsurgical subinguinal varicocelectomy in children and adolescents. Urology 2006; 68: 410–412

    Article  PubMed  Google Scholar 

  • Yavetz H, Levy R, Papo J, Yogev L, Paz G, Jaffa AJ, Homonnai ZT. Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality. Int J Androl 1992; 15: 338–344

    Article  PubMed  CAS  Google Scholar 

  • Yoshida K, Kitahara S, Chiba K, et al. Predictive indicators of successful varicocele repair in men with infertility. Int J Fertil Womens Med 2000; 45: 279–284

    PubMed  CAS  Google Scholar 

  • Zini A, Girardi SK, Goldstein M. Varicocele. In: Hellstrom WJG (ed.) Male infertility and sexual dysfunction. Springer, New York, 1997a, pp. 201–218

    Chapter  Google Scholar 

  • Zini A, Buckspan M, Berardinucci D, Jarvi K. The influence of clinical and subclinical varicocele on testicular volume. Fertil Steril 1997b; 68: 671–674

    Article  PubMed  CAS  Google Scholar 

  • Zini A, Buckspan M, Jamal M, Jarvi K. Effect of varicocelectomy on the abnormal retention of residual cytoplasm by human spermatozoa. Hum Reprod 1999; 14: 1791–1793

    Article  PubMed  CAS  Google Scholar 

  • Zini A, Boman J, Jarvi K, et al. Varicocelectomy for infertile couples with advanced paternal age. Urology 2008; 72: 109–113

    Article  PubMed  Google Scholar 

  • Zorgniotti AW, Macleod J. Studies in temperature, human semen quality, and varicocele. Fertil Steril 1973; 24: 854–863

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Caxias do Sul, Caxias do Sul, RS, Brazil

    Fábio Firmbach Pasqualotto

  2. Institute of Biotechnology, University of Caxias do Sul, Caxias do Sul, RS, Brazil

    Fábio Firmbach Pasqualotto

  3. Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasilia, Brazil

    Fábio Firmbach Pasqualotto

  4. CONCEPTION – Center for Human Reproduction, Caxias do Sul, RS, Brazil

    Fábio Firmbach Pasqualotto

  5. Rua Pinheiro Machado, 2569, sl 23/24, Bairro São Pelegrino, Caxias do Sul, RS, Brazil

    Fábio Firmbach Pasqualotto

  6. Fertility – Center for Assisted Fertilization, São Paulo, SP, Brazil

    Edson Borges

  7. Institute Sapientiae – Center of Post-Graduation in Human Assisted Reproduction, São Paulo, Brazil

    Edson Borges

  8. CONCEPTION – Center for Human Reproduction, Caxias do Sul, RS, Brazil

    Felipe Roth & Luana Venturin Lara

  9. CONCEPTION – Center for Advanced Research in Human Reproduction, Infertility & Sexual Function, Center for Biological and Health Sciences, University of Caxias do Sul, Caxias do Sul, RS, Brazil

    Eleonora Bedin Pasqualotto

  10. Department of Obstetrics–Gynecology, General Hospital, University of Caxias do Sul, Caxias do Sul, RS, Brazil

    Eleonora Bedin Pasqualotto

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  1. Fábio Firmbach Pasqualotto
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  2. Edson Borges
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  3. Felipe Roth
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  4. Luana Venturin Lara
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  5. Eleonora Bedin Pasqualotto
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Editors and Affiliations

  1. Glickman Urologic Institute, Cleveland Clinic Foundation, Euclid Ave. 9500, Cleveland, 44195, Ohio, USA

    Edmund S. Sabanegh

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Pasqualotto, F.F., Borges, E., Roth, F., Lara, L.V., Pasqualotto, E.B. (2011). Varicocele: To Fix or Not to Fix. In: Sabanegh, E. (eds) Male Infertility. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-193-6_8

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