What are the current guidelines for the management of varicocele in men with infertility?

Current guidelines for managing varicocele in men presenting with infertility recommend against surgical intervention solely for fertility improvement. Specifically, NICE guidance states that men should not be offered surgery for varicoceles as a form of fertility treatment because it does not improve pregnancy rates ¹. This position reflects the evidence that varicocele repair has not demonstrated consistent benefit in enhancing natural conception outcomes.

However, recent literature, particularly in pediatric and adolescent populations, discusses best practices in diagnosis and treatment of varicocele, emphasizing individualized assessment. While (Macey et al., 2018) focus on children and adolescents, they highlight that varicocele management should be tailored based on clinical findings and fertility potential, suggesting that in some cases, intervention may be considered to preserve future fertility (Macey et al., 2018). Nonetheless, this does not override the current UK guideline stance for adult men presenting with infertility.

In clinical practice, men presenting with infertility should undergo thorough assessment including semen analysis and evaluation for other causes of infertility. Medical management options such as gonadotrophin therapy are reserved for specific conditions like hypogonadotrophic hypogonadism, but idiopathic semen abnormalities should not be treated with anti-oestrogens, androgens, or other drugs due to lack of efficacy ¹.

Therefore, the primary approach remains comprehensive fertility assessment and addressing identifiable causes rather than varicocele surgery for fertility enhancement.