More research needed into the safest and most effective treatment for varicoceles in men affected by subfertility

Any treatment (surgical or radiologi­cal) may be more effective in increasing pregnancy rates than delayed or no treatment. Although both surgical and radiological treatments each improved pregnancy rates in participants with abnormal se­men parameters and clinical varicocele, it is not yet clear if this translates into increased live birth rates.

When comparing surgical with radiological treat­ment, no valid conclusions could be drawn on which treatment modality was superior. The evidence on varicocele recurrence and adverse events (hydrocele formation, pain, epididymitis, haematoma and su­ture granuloma) was also inconclusive. Evidence on quality of life was lacking for this comparison.

When comparing surgical treatments with each other, microscopic subinguinal surgical treatment showed higher pregnancy rates and lower varicocele recurrence rates than other surgical treatments.