Human Reproduction Update, Vol.8, No.1 pp.53-58, 2002
© European Society of Human Reproduction and Embryology 2002; all rights reserved
Varicocele–-the most common cause of male factor infertility?
1 Departments of Urologic Surgery, 420 Delaware St. SE, Minneapolis, MN 55455, USA 2 Departments of Obstetrics and Gynecology, 420 Delaware St. SE, Minneapolis, MN 55455, USA 3 University of Minnesota Medical School, 420 Delaware St. SE, Minneapolis, MN 55455, USA
To whom correspondence should be addressed at: Jon L. Pryor, Departments of Urologic Surgery and Obstetrics and Gynecology, 420 Delaware St. SE, Minneapolis, MN 55455, USA. e-mail: pryor001{at}umn.edu;
Abstract
Varicocele is often cited as the most common cause of male factor infertility. Arguments in support of this statement include reports of increased prevalence of varicocele in populations of infertile men compared with fertile or otherwise unselected men, association of varicocele with abnormal semen parameters, and improvements in semen parameters and/or pregnancy rates after varicocele repair. Logically, there would appear to be three possibilities regarding the relationship between varicocele and fertility: (i) varicocele has no association with or effect on male fertility; (ii) varicocele may be associated with, but is not the cause of, male subfertility; and (iii) varicocele is a direct cause of male subfertility. In the following, we review evidence from the literature for and against these three possibilities: at the current time, available evidence appears inadequate to confirm or deny any of these three possibilities. Since the ultimate goal of infertile couples is to conceive, it seem logical that future varicocele research should focus primarily on adequately powered, controlled clinical trials in well-characterized infertile couples, randomized to intervention or appropriate controlled observation, with pregnancy as the primary outcome.
Key words: male factor infertility / subfertility / varicocele
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