Varicoceles are abnormally dilated testicular veins (pampiniform plexus) in the scrotum. Varicocele is found in approximately 15% of the general population, 35% of men with primary infertility and in 75-80% of men with secondary infertility. It is more common on the left side. In adolescents, the incidence of varicocele is approximately 15%; the abnormality is extremely rare in pre-pubertal boys. Varicocele repair is by far the most commonly performed operation for the treatment of male infertility.
Although most men with varicoceles are able to father children, there is abundant evidence that varicoceles are detrimental to male fertility. A study by the World Health Organization (WHO) on over 9,000 men showed that varicoceles are commonly accompanied by decreased testicular volume, impaired sperm quality, and a decline in Leydig cell (the cells that manufacture the male hormone testosterone) function. Another report by Johnson and colleagues showed that 70% of healthy, asymptomatic military recruits with palpable varicoceles had abnormal semen analyses.
Furthermore, studies in animals and human suggest that varicoceles cause progressive testicular damage over time. It appears that surgical repair of varicoceles not only halts this declines in testicular function but often reverses it. Whether the improvements in semen parameters, seen in 70 - 80% of men after varicocelectomy, translate into improved pregnancy and delivery rates had previously been a matter of controversy. Recent controlled studies clearly indicate that varicocelectomy improves pregnancy rates. The potentially important role of urologists in preventing future infertility and/or androgen (testosterone) deficiency underscores the importance of utilizing a varicocelectomy technique that minimizes the risk of complications and recurrence.