Predictive parameters of the efficacy of varicocele repair: a review

Abstract

Varicocele has a prevalence of 15% in the population and represents a primary cause of infertility in 40% of cases and a secondary cause in approximately 80% of cases. It is considered the major correctable cause of male infertility. Despite its high prevalence in the infertile population, a large number of patients with varicocele do not experience reproductive difficulties. For this reason, it is still highly debated which parameters could be used to predict which patients with varicocele will be most likely to benefit from its repair. The main international and European guidelines state that treatment should only be considered in infertile patients with abnormal sperm quality. However, these guidelines do not help physicians to identify which of these patients may benefit from the treatment. Therefore, this narrative review collects the evidence in the literature on the usefulness of some factors as predictors of improvement, highlighting how some of them may be effective in an initial selection of patients to be treated, while others are promising but further studies are needed. Finally, a brief consideration on the possible role of artificial intelligence is proposed.

Figure 1

Proposed parameters for the prediction of a positive response to varicocele repair and the possible role of artificial intelligence in combining these parameters to achieve greater sensitivity and specificity. FSH: follicle-stimulating hormone; LH: luteinizing hormone; SWE: shear wave elastosonography; TMSC: total motile sperm count; SDF: sperm DNA fragmentation.