Varicoceles in the pediatric and adolescent population: threat to future fertility?

The effect of pediatric/adolescent varicocele on future fertility is unclear. Proxy measures (e.g., testicular asymmetry) are common indications for varicocelectomy, but paternity data are conflicting.

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Volume 108, Issue 3, Pages 370–377

Authors: 

Deborah L. Jacobson, M.D., Emilie K. Johnson, M.D., M.P.H.

Abstract:

Determining the effect of varicoceles on future fertility is challenging owing to multiple issues in children/adolescents, including: limitations in obtaining and interpreting semen analyses; potential for unequal differential testicular growth during puberty regardless of varicocele presence; and the potential for a lengthy interval between surgical intervention for varicocele in adolescence and attempts at paternity. This review presents a summary and evaluation of the available evidence relating to future fertility among children and adolescents with varicoceles. Data relating to proxy fertility measures in children/adolescents, including testicular size asymmetry and semen analysis abnormalities, demonstrate that these proxy measures are imperfect predictors of future fertility. Two large, recently published series of adolescents undergoing varicocele treatment showed conflicting paternity outcomes. Pediatric and adolescent varicocele will remain a clinical conundrum, subject to both over- and under-treatment, until more definitive prospective data are available.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Mary Samplaski
Mary Samplaski about 3 years ago

This is certainly a topic that needs more research and ideally a practice guideline statement. We know that not all varicoceles result in sub fertility, but we do not have a means to identify which will ultimately have this effect. Finally long term series data, ideally taking the same group of adolescents with varicoceles, and checking semen parameters over time, are lacking.