Surgery Day Symposium - Additional Indications for Varicocele Repair

Presenters

Needs Assessment and Description
While various studies have shown that correction of clinically significant varicoceles can improve the fertility status of men, controversies remain in its treatment efficacy and clinical values for infertile couples in the era when ICSI is widely available. In fact, in addition to fertility status improvement, there are other indications to correct varicoceles to improve the overall health and quality of life of a man. Currently, varicocele is the most commonly diagnosed specific cause of male factor infertility. The decision of varicocele correction can potentially affect a large number of men suffering from this condition. Clearly there is a need to evaluate these additional indications to allow clinicians to better counsel men with clinically significant varicoceles. This live session is designed for physicians, nurses, and other clinicians involved in the care of men.

Learning Objectives
At the conclusion of this session, participants should be able to: 

1. Outline the current evidence of varicocele correction in improving male fertility status as measured by semen parameters or other biochemical or molecular genetic assays. 
2. Assess other non-fertility related issues associated with clinically significant varicoceles and the management options. 
3. Formulate a comprehensive counselling strategy for men and adolescents with clinically significant varicoceles.

ACGME Competency
Patient Care

TEST QUESTION:
A 54-year-old male with two children from a prior marriage, ages 22 and 24, is planning to remarry. His fiancé is 36 years old, and the couple would like to have two children. His primary complaint is decreased libido, energy level and muscle strength. A serum testosterone on two occasions in the morning were 213 ng/dL and 235 ng/dL. On physical examination, he has a 12 mL volume, soft left testis associated with a grade III left varicocele and a 15 mL, slightly soft right testis associated with a grade II right varicocele. A semen analysis revealed a volume of 2 mL with a sperm concentration of 8 million per mL with 40% motility with poor progression and 8 % normal morphology by WHO standards. After participating in this session, in my practice I will recommend the following treatment for this patient: 

1. Testosterone replacement therapy 
2. Clomiphene citrate therapy 
3. Bilateral microsurgical varicocelectomy 
4. Immediate IVF/ICSI 
5. Intrauterine insemination 
6. Not applicable to my area of practice.