Varicocele
ICD-10 I86.1 · ICD-11 BD75.1

Treatment of Varicocele in Male Infertility with Abnormal Semen Parameters

This protocol applies to infertile men with a clinically evident varicocele and abnormal semen parameters where infertility is otherwise unexplained and the female partner has good ovarian reserve.

Clinical scenario

Male infertility with a clinical varicocele, abnormal semen parameters, and otherwise unexplained infertility in a couple where the female partner has good ovarian reserve.

Approach: Surgical repair of the varicocele — varicocelectomy — is the intervention of choice in this setting. Microsurgical technique is the preferred approach, with a range of procedural alternatives available depending on clinical circumstances. The complete technique-selection criteria, candidacy assessment, and procedural algorithm are in the full protocol.
Treatment targets

Improvement in semen parameters within up to two spermatogenic cycles, with spontaneous pregnancy expected between 6 and 12 months after the procedure.

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References

Treat infertile men with a clinical varicocele, abnormal semen parameters and otherwise unexplained infertility in a couple where the female partner has good ovarian reserve to improve fertility rates.

Current evidence indicates that microsurgical varicocelectomy is the most effective among the different varicocelectomy techniques.

A Cochrane review reported that microsurgical subinguinal varicocelectomy probably improves pregnancy rates slightly more compared to other surgical treatments.

Microscopic approach (inguinal/subinguinal) may have lower recurrence and complications rates than non-microscopic approaches (retroperitoneal and laparoscopic), although no RCTs are available yet.

Average time to improvement in semen parameters is up to two spermatogenic cycles with spontaneous pregnancy occurring between six and 12 months after varicocelectomy.

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