There are different studies about the effect of varicocelectomy in patients with azoospermia which had controversial results. Do you have any experience about these patients?
There is no sufficient RCT evidence to support the role of varicocele in NOA
Urologists will always argue that varicocelectomy should be considered before SSR, however I personally do not believe that varicocole could be the solo cause of NOA and if I am going to offer the patient the procedure I would have to be convinced first that life style modification would be beneficial in his particular case
Based on consensus of the most recent studies on the issue at hand, I agree that prime level evidence in support of varicocelectomy for NOA is missing. However until an effective medical intervention for this presentation comes about, in the current setting of reimbursement for fees of infertility treatments in this country and many others, varicocelectomy is my preferential suggestion for palpable varicoceles prior to ART.
About what fertility concerns, to be pragmatic, azoospermia has first to be explored and documented : genetic abnormalities , such Ymicrodeletions AZFa or AZFb, Klinefelter, or CFTR mutations (CBAVD) mean the futility of varicocele treatment ... Moreover, severe hypergonadotrophic hypogonadism, with low level inhibine B is associated with bad recovery prognosis, and central primary hypogonadism should first be treated before planing varicocelectomy => endocrine exploration should be done also ! As varicocele is usually unilateral, the assessment of the right testis can modify our attitude, especially if a right epididymal obstruction is suspected, or significant atrophy, enhancing the specific value of left testis function, and the need to treat. Finally, the fertility status of the female partner is mandatory : no need to treat if she is more than forty ... In my 28 years experience, I do not remember a sperm recovery sufficient to avoid IVF in initially azoospermic patient.
To be complete, motivation of the consultation is quite important : pain relief is an excellent indication te treat
I can not find any evidence based data in literature, concerning positive influence of varicocellectomy on fertility status in NOA, so my answer is no: varicocellectomy has not any influence on NOA patients.
I have not big experience about the results of varicocelectomy in patients with azoospermia but I think that in young patients with clinical varicocele the varicocelectomy can be a surgical option. In this case we perform a microsurgical varicocelectomy (Marmar technique) and needle aspiration testicular cytology (Foresta technique).
Yes. We obviously perform operation Marmar before all another procedures (IVF, micro-TESE, injection of stem cells). It increase succes of next treatment.
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