Although the presence of varicocele can be associated with normal semen parameters and normal fertility, most men with varicocele and presumptive infertility have abnormal semen parameters, including low sperm concentration and abnormal sperm morphology. However, data on the efficacy of varicocele repair for improved fertility are conflicting, and we do not recommend routine varicocele repair in subfertile couples. In a World Health Organization (WHO) study of over 9000 men who were partners in an infertile couple, a varicocele was much more common in men with abnormal semen (25.4 versus 11.7 percent with normal semen).
The causal relationship between varicocele and male infertility has been ascribed to increased testicular temperature, delayed removal of endogenously derived toxic materials and metabolites, hypoxia, and stasis. For many years, it has been controversial whether high…
