[Varicocele correction in treatment of male subfertility: is it time to change paradigms?]

We have analyzed the recent literature regarding varicocelectomy in men from infertile couples. The specific pathogenesis of testicular dysfunction in some men with varicocele is still unclear. Recent European and American urological guidelines suggest treatment of varicocele in infertile men with "abnormal" sperm parameters. Although, according to the 6th edition of WHO laboratory manual for the examination and processing of human semen the threshold values between normal and abnormal semen parameters are not given. It is also still unclear why approximately a third of patients do not experience improvement in fertility after varicocelectomy. According to a recent analysis, the total progressive motile sperm count (TPMSC) and sperm concentration may be important predictors of improved ejaculate quality and pregnancy after varicocelectomy. However, it should be noted that the quality of the published studies was low to moderate. All of these issues point to the need for further large-scale, multicenter, randomized clinical trials.