This protocol applies to males attempting to conceive who have a palpable varicocele, confirmed male infertility, and abnormal semen parameters — and who do not have azoospermia.
The evidence-based approach in this setting is surgical varicocelectomy. The protocol specifies multiple operative techniques; the complete selection criteria and recommended procedure are detailed in the full regimen.
Clinicians should consider surgical varicocelectomy in males attempting to conceive who have palpable varicocele(s), infertility, and abnormal semen parameters, except for azoospermic males.
For palpable varicoceles, the meta-analysis by Wang et al. observed the calculated estimated pregnancy rates to be 52% (95% CI: 24% to 83%) for subinguinal micro-varicocelectomy, 53% (95% CI: 18% to 90%) for inguinal micro-varicocelectomy, 55% (95% CI: 27% to 88%) for inguinal open surgery, and 52% (95% CI: 18% to 90%) for laparoscopic surgery.
Bulk seminal parameters including sperm concentration and sperm motility were also observed to be improved with surgery.
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