[Varicocele and male infertility: AFU 2006 guidelines].

The routine assessment of an infertile man with varicocele must comprise complete clinical interview including the patient's medical and reproductive history, physical examination and at least two sperm counts. Imaging examinations are not indicated to characterize the varicocele, except when physical examination is inconclusive. However; scrotal ultrasound can be useful in infertile men to detect concomitant diseases, especially testicular tumours. Treatment of varicocele must be proposed when all of the following conditions are present: 1) the varicocele is palpable; 2) the couple's infertility is documented; 3) there is no female infertility problem or this problem is potentially curable; 4) there is at least one abnormality of spermatic parameters on the sperm count. Treatment can also be proposed in men with palpable varicocele and spermatic abnormalities on the sperm count, even when they do not have any immediate plans to have a child. Young men with varicocele and a normal sperm count must be followed by sperm counts every one or two years. Treatment of varicocele must also be proposed to adolescents with varicocele and ipsilateral a reduction of testicular volume. Adolescents with varicocele associated with a normal-sized testis must be reviewed annually to measure testicular volume and/or sperm count when it can be performed. Surgery or percutaneous embolization are two possible treatment options for varicocele provided they are performed by a well trained and experienced operator. The treatment of varicocele can be considered to be first-line treatment in a patient with moderate oligo-astheno-teratospermia with no associated female infertility factor. IVF with or without ICSI can be considered to be first-line treatment in the presence of an independent female infertility factor requiring the use of these techniques. Concomitant treatment of varicocele can be considered to improve semen fertility. Persistence or relapse of varicocele can be treated by surgery or percutaneous embolization provided spermatic venography is performed to identify the site of persistent venous reflux. After treatment of varicocele, a sperm count must be performed approximately every three months for one year or until pregnancy is achieved.