Clinical Dilemmas and Controversies in Varicocele Management

Varicocele is a common clinical entity that may negatively affect male’s reproductive function. This rather common disorder is involved in the pathogenesis of reproductive dysfunction in patients with primary and secondary infertility, in nearly 30% and 80% of them, respectively. There are many controversies and dilemmas about the diagnosis and management of varicocele. Diagnosis of varicocele remains crucial, with many clinicians relying on ultrasonography, while others gauge their practice by following scientific societies which advocate clinical evaluation. This chapter assesses the impact of varicocele repair on natural pregnancy, conventional semen parameters, and assisted reproductive technique (ART)-based pregnancy. Additionally, we also discuss some controversial indications including elevated sperm DNA fragmentation (SDF) prior to ART, nonobstructive azoospermia (NOA) prior to sperm retrieval, and hypogonadism disorders. Finally, this chapter discusses the surgical management, elaborating on the gold standard method of repair, and the management of special situations such as subclinical, bilateral, and recurrent varicoceles.