Varicoceles exert deleterious effect on testicular function. The condition has been associated with
male infertility, testicular hypotrophy and
pain. These comprises the common indications for
varicocele repair currently. Significant improvement in semen parameters and pregnancy outcomes had been suggested by reports decades ago. However, selection of the best candidates remains an issue since not all patients respond positively to treatment. Consensus has been reached in recent decade after the publication of a series of meta-analyses. Significant improvement in pregnancy outcomes were reported in patients with clinical
varicocele and abnormal semen parameters. Varicocelectomy in adolescents with testicular hypotrophy was supported by the positive implication on catch-up growth and semen parameters. However, little is known about the treatment effect of adolescence varicocelectomy on long term fertility and paternity rate. Recent studies on outcome of
varicocele repair for
pain consistently demonstrated a resolution rate of approximately 90% and support
varicocele-associated
pain as an indication for surgery. Alternate indications for
varicocele repair have been proposed in recent decade. Despite the encouraging preliminary data, most studies were uncontrolled retrospective series. Although varicocelectomy may not obviate the need for assisted reproductive techniques in patients with non-obstructive
azoospermia, it potentially increases sperm retrieval rate. The significant increase in serum
testosterone after varicocelectomy in patients with
androgen deficiency may open an alternative treatment for
hypogonadism. The adjunctive role of varicocelectomy before assisted reproduction and the significant decrease in sperm DNA fragmentation after
varicocele repair deserve further well-designed controlled studies.