Title: The varicocele and male infertility.

POPLINE Document Number: 018207

Author(s):

Belker AM

Source citation:

Urologic Clinics of North America, 1981 Feb;8(1):41-51.

Abstract:

Varicocele, found in 8-22% of the general population but in 21-39% of men attending infertility clinics, is now accepted as an important cause of male infertiltiy. The mechanisms by which varicocele affects fertility remain undetermined; however, decreased testicular size, abnormal testicular histology, and abnormal semen parameters have been noted in patients with varicocele. Sinc the size of the varicocele is not related to the degree of fertility impairment, care must be taken to detect subclinical varicocele. The presence of a small varicocele is suggested by an equivocal venous thrill during the Valsalva maneuver. This can be confirmed by noninvasive diagnostic tests in which the Doppler stethoscope is utilized. Before surgical intervention, other possible causes of subfertility (including factors in the female partner) should be excluded. If no other abnormality is found, and if both decreased sperm motility and increased numbers of tapered sperm and immature germinal cells in the semen are noted, varicocelectomy is indicated. The suprainguinal and high inguinal approaches are currently used for ligation and division of the internal spermatic vein. The safety of the suprainguinal division of the internal spermatic artery in the absence of prior dissection of the spermatic cord at a lower level has been demonstrated by experimental and clinical data. Reviews of the results of varicocele ligation in subfertile men have noted improved semen quality in 55-85% and pregnancy in 25-55% of wives.

Keywords:

Spermatogenesis
Reproduction
Testis
Infertility
Surgery
Men
Genitalia, Male
Genitalia
Urogenital System
Physiology
Biology
Treatment
Demographic Factors
Population