Controversy still surrounds surgical treatment

The varicocele is an enigma in the treatment of male infertility. Despite over 30 years of evidence that repair of varicoceles results in improved fertility,1 the retrospective nature of most of these reports has led to controversy regarding the utility of treatment. This is compounded by the fact that not all varicoceles cause infertility. Varicocele is present in approximately 15% of men, and, although it is the most commonly diagnosed cause of male infertility, nearly two thirds of men with varicoceles remain fertile. The reason for this discrepancy remains unknown, although it is postulated that the cause of infertility is related to both temperature and time.2 The anatomical and physiological principles of the testicular vasculature and the evidence base regarding surgical treatment are outlined here.

The blood supply to the testis, as well as the resulting counter current heat exchange, results in cooler intratesticular temperatures compared with body temperature.3 Disruption of this system can …