Varicocele: red flag or red herring?

The debate concerning the relationship between varicocele and male infertility has been ongoing for several decades, and correction of varicocele for the treatment of male infertility remains controversial. Proponents of varicocele repair believe that there is an association between the two conditions and point to the many studies showing improvements in semen parameters and other markers of fertility after surgery as evidence of such a relationship. Opponents argue that the mere presence of dilated testicular veins does not necessarily imply that these lesions are the cause of a man's subfertility and that incontrovertible pregnancy outcome data after varicocele repair remains to be shown. To shed some light on this topic, we have reviewed the most current data concerning the impact of varicocele on male fertility and have analyzed the literature on the value of varicocele repair in the setting of male infertility. We have determined that whereas there is a definite association between varicocele and male infertility, a cause and effect relationship between varicocele and infertility has not been established conclusively. A critical review of the available pregnancy outcome data does support varicocelectomy as a viable option for infertile couples with a clinical varicocele.