Varicocele Repair in Azoospermia
A varicocele is a dilatation of the veins of the pampiniform (venous) plexus in the spermatic cord in the male. It is a very common finding in infertile men being associated with 15% of men with primary infertility and 80% of men with secondary infertility. Though varicocele repair in infertility has always been a point of semantics, it has been proven that repair can improve pregnancy rates. Azoospermia due to testicular failure is classified as non obstructive Azoospermia (NOA) and the tteatment usually entails testicular sperm extraction(TESE) with ICSI. Though varicocelectomy can produce motile sperm in these patients the benefits remain unclear.
Various researchers have been studying the effects of Microsurgical varicocelectomy in NOA patients. Most findings concluded that if Azoospermia is not too long standing, then the effects of Varicocelectomy may produce motile sperm and also may reduce the need for a TESE during an ICSI procedure. It is important to note that none of these researchers included a control group which may make interpretation of these studies very difficult.
Also the contention that the effects of varicocelectomy may reverse over time has always been there. Researchers many a time have said that men with Azoospermia may exhibit intermittent sperm production and may not be related to the repair. Also Azoospermic men may exhibit chromosome i.e. Karyotype anomalies and Y chromosome microdeletions .The reults of varicocele repair in these patients is variable.
To conclude, in Non Obstructive Azoopsermia, the effects of varicocele repair are proven only in a few small studies without a control group. There is a need for randomised controlled trials and then a meta analysis of these before conclusive reports are drawn and then applied to patients.