The Committee defined varicoceles as abnormally dilated scrotal veins that are present in 50% of the normal male population and in approximately 40% of men presenting with infertility. The committee made many recommendations and they are summarized as follows:

1. Adolescents who have a varicocele and objective evidence of reduced ipsilateral testicular size should be offered varicocele repair. Adolescents who have a varicocele but normal ipsilateral testicular size should be offered follow-up, monitoring with annual objective measurements of testicular size and/or semen analyses.

2. Young men who have a varicocele and normal semen analyses should be followed with semen analyses every one to two years.

3. Adult men who have a palpable varicocele and abnormal semen analyses but who are not currently attempting to conceive should be offered varicocele repair.

4. Routine evaluation of infertile men with varicocele should include a medical and reproductive history, physical examination, and a minimum of 2 semen analyses. Imaging studies are not indicated for the standard evaluation unless physical exam is inconclusive.

5. Varicocele treatment should be offered to the male partner of a couple attempting to conceive when all of the following are present: a) a varicocele is palpable; b) the couple has documented infertility; c) the woman has normal fertility or potential correctable fertility; and d) the man has one or more abnormal semen parameters or sperm function test results.

6. Varicocele repair may be considered as the primary treatment option when a man with a varicocele has suboptimal semen quality and a normal female partner. IVF with or without ICSI may be considered the primary treatment option when such treatment is required to treat a female factor, regardless of the presence of varicocele and reduced semen quality.

7. Persistence or recurrence of a varicocele may be treated by whether surgical ligation or percutaneous embolization of the refluxing veins. After treatment of a varicocele, semen analysis should be performed at approximately 3 month intervals for at least one year or until pregnancy occurs.

8. The treating physicians experience and expertise, together with the options available, should determine their approach to varicocele treatment.

The Practice Committee of the American Society for Reproductive Medicine

Fertility and Sterility 86(4):S93-S95, November 2006.

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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