{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:34:38Z","timestamp":1790174078217,"version":"4.1.0"},"reference-count":115,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:00:00Z","timestamp":1754092800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Varicocele is a common, potentially correctable condition associated with impaired male fertility. Despite being frequently encountered in clinical andrology, its pathophysiological mechanisms, diagnostic criteria, and therapeutic approaches remain areas of active investigation and debate. The authors conducted a comprehensive literature search, using the PubMed database, covering clinical studies, systematic reviews, meta-analyses, and current international guidelines from the past ten years. Emphasis was placed on studies investigating novel diagnostic modalities, therapeutic innovations, and prognostic markers. Emerging evidence supports the multifactorial pathophysiology of varicocele, involving oxidative stress, hypoxia, inflammatory pathways, and potential genetic predisposition. Biomarkers, including microRNAs, antisperm antibodies, and sperm DNA fragmentation, offer diagnostic and prognostic utility, though their routine clinical implementation requires further validation. Advances in imaging, such as shear wave elastography, may improve diagnostic accuracy. While microsurgical subinguinal varicocelectomy remains the gold standard, technological refinements and non-surgical alternatives are being explored. Indications for treatment have expanded to include selected cases of non-obstructive azoospermia, hypogonadism, and optimization for assisted reproduction, though high-level evidence is limited.<\/jats:p>","DOI":"10.3390\/jcm14155445","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T08:46:55Z","timestamp":1754383615000},"page":"5445","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Recent Trends in the Management of Varicocele"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0340-8864","authenticated-orcid":false,"given":"Tam\u00e1s","family":"Tak\u00e1cs","sequence":"first","affiliation":[{"name":"Centre of Andrology, Department of Urology, Semmelweis University, 1082 Budapest, Hungary"},{"name":"Centre of Assisted Reproduction, Department of Obstetrics and Gynaecology, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anett","family":"Szab\u00f3","sequence":"additional","affiliation":[{"name":"Centre of Andrology, Department of Urology, Semmelweis University, 1082 Budapest, Hungary"},{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5670-8647","authenticated-orcid":false,"given":"Zsolt","family":"Kopa","sequence":"additional","affiliation":[{"name":"Centre of Andrology, Department of Urology, Semmelweis University, 1082 Budapest, Hungary"},{"name":"Centre of Assisted Reproduction, Department of Obstetrics and Gynaecology, Semmelweis University, 1082 Budapest, Hungary"},{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"179","DOI":"10.4103\/1008-682X.172640","article-title":"Epidemiology of varicocele","volume":"18","author":"Alsaikhan","year":"2016","journal-title":"Asian J. Androl."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.eururo.2025.02.026","article-title":"European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Infertility","volume":"87","author":"Minhas","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wang, K., Gao, Y., Wang, C., Liang, M., Liao, Y., and Hu, K. (2022). Role of Oxidative Stress in Varicocele. Front. Genet., 13.","DOI":"10.3389\/fgene.2022.850114"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1111\/andr.12502","article-title":"European Academy of Andrology guideline Management of oligo-astheno-teratozoospermia","volume":"6","author":"Colpi","year":"2018","journal-title":"Andrology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1097\/JU.0000000000004180","article-title":"Updates to Male Infertility: AUA\/ASRM Guideline","volume":"212","author":"Brannigan","year":"2024","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1016\/j.urology.2004.12.057","article-title":"Inheritance of varicoceles","volume":"65","author":"Raman","year":"2005","journal-title":"Urology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"288","DOI":"10.2164\/jandrol.109.008698","article-title":"Hereditary behavior of varicocele","volume":"31","author":"Davarci","year":"2010","journal-title":"J. Androl."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"920","DOI":"10.21037\/tau.2018.09.02","article-title":"The role of inheritance in the development of adolescent varicoceles","volume":"7","author":"Griffiths","year":"2018","journal-title":"Transl. Androl. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101318","DOI":"10.1016\/j.tice.2019.101318","article-title":"The effect of experimental varicocele on the apelin and APJ expressions in rat testis tissue","volume":"63","author":"Akkan","year":"2020","journal-title":"Tissue Cell"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.fertnstert.2020.08.004","article-title":"Molecular characteristics of varicocele: Integration of whole-exome and transcriptome sequencing","volume":"115","author":"Yang","year":"2021","journal-title":"Fertil. Steril."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e14542","DOI":"10.1111\/and.14542","article-title":"Transcriptome and genome sequencing investigating the molecular characteristics of patients with varicocele infertility","volume":"54","author":"Zhang","year":"2022","journal-title":"Andrologia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.ijbiomac.2020.07.159","article-title":"Estimation of varicocele associated human ARG2 and NOS1 proteins and computational analysis on the effect of its nsSNPs","volume":"164","author":"Karthikeyan","year":"2020","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1080\/14647273.2021.1983214","article-title":"Genetic variants in varicocele-related male infertility: A systematic review and future directions","volume":"26","author":"Mostafa","year":"2023","journal-title":"Hum. Fertil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1093\/humupd\/dmae034","article-title":"The epigenetic approach of varicocele: A focus on sperm DNA and m6A-RNA methylation","volume":"31","author":"Naderi","year":"2025","journal-title":"Hum. Reprod. Update"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106448","DOI":"10.1016\/j.prostaglandins.2020.106448","article-title":"Relevance of seminal F(2)-dihomo-IsoPs, F(2)-IsoPs and F(4)-NeuroPs in idiopathic infertility and varicocele","volume":"149","author":"Longini","year":"2020","journal-title":"Prostaglandins Other Lipid Mediat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1080\/13685538.2018.1548590","article-title":"Seminal and serum leptin levels in male patients with varicocele and isolated asthenozoospermia before and after repair","volume":"23","author":"Hegazy","year":"2020","journal-title":"Aging Male"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e13244","DOI":"10.1111\/and.13244","article-title":"Seminal plasma miR-210-3p is a biomarker for screening dyszoospermia caused by varicocele","volume":"51","author":"Xu","year":"2019","journal-title":"Andrologia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1111\/andr.12913","article-title":"Seminal exosomal miR-210-3p as a potential marker of Sertoli cell damage in Varicocele","volume":"9","author":"Ma","year":"2021","journal-title":"Andrology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"60","DOI":"10.5534\/wjmh.240003","article-title":"Anti-sperm Antibody Positivity in Men with Varicocele: A Systematic Review and Meta-Analysis","volume":"43","author":"Falcone","year":"2025","journal-title":"World J. Men\u2019s Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.fertnstert.2021.12.012","article-title":"The sixth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen: Ensuring quality and standardization in basic examination of human ejaculates","volume":"117","year":"2022","journal-title":"Fertil. Steril."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Szab\u00f3, A., V\u00e1ncsa, S., Hegyi, P., V\u00e1radi, A., Forintos, A., Filipov, T., \u00c1cs, J., \u00c1cs, N., Szarvas, T., and Nyir\u00e1dy, P. (2023). Lifestyle-, environmental-, and additional health factors associated with an increased sperm DNA fragmentation: A systematic review and meta-analysis. Reprod. Biol. Endocrinol., 21.","DOI":"10.1186\/s12958-023-01054-0"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Szab\u00f3, A., V\u00e1ncsa, S., Hegyi, P., K\u00f3i, T., \u00c1cs, J., Herm\u00e1nn\u00e9, R.J., \u00c1cs, N., Szarvas, T., Nyir\u00e1dy, P., and Kopa, Z. (2025). Assessing the efficacy of varicocelectomy, antioxidants, FSH treatment, and lifestyle modifications on sperm DNA fragmentation: A systematic review and meta-analysis. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-93267-z"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e14275","DOI":"10.1111\/and.14275","article-title":"Effect of varicocele on sperm DNA damage: A systematic review and meta-analysis","volume":"54","author":"Zhang","year":"2022","journal-title":"Andrologia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"360","DOI":"10.4081\/aiua.2022.3.360","article-title":"Microsurgical varicocelectomy effects on sperm DNA fragmentation and sperm parameters in infertile male patients: A systematic review and meta-analysis of more recent evidence","volume":"94","author":"Soetandar","year":"2022","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.fertnstert.2021.04.003","article-title":"Effect of varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele: A systematic review and meta-analysis","volume":"116","author":"Roque","year":"2021","journal-title":"Fertil. Steril."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e13885","DOI":"10.1111\/and.13885","article-title":"Efficacy of varicocelectomy for sperm DNA integrity improvement: A meta-analysis","volume":"53","author":"Qiu","year":"2021","journal-title":"Andrologia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1007\/s00345-004-0421-0","article-title":"Color Doppler ultrasound investigation of varicocele","volume":"22","author":"Liguori","year":"2004","journal-title":"World J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1464-410X.1980.tb02919.x","article-title":"The Doppler assessment of varicoceles and internal spermatic vein reflux in infertile men","volume":"52","author":"Hirsh","year":"1980","journal-title":"Br. J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/andr.13260","article-title":"The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: An overview on male genital tract ultrasound reference ranges","volume":"10","author":"Lotti","year":"2022","journal-title":"Andrology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00330-019-06280-y","article-title":"Ultrasound evaluation of varicoceles: Guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading","volume":"30","author":"Freeman","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1007\/s00330-024-10964-5","article-title":"The role of the radiologist in the evaluation of male infertility: Recommendations of the European Society of Urogenital Radiology-Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for scrotal imaging","volume":"35","author":"Lotti","year":"2025","journal-title":"Eur. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1111\/andr.12797","article-title":"Diagnostic accuracy of physical examination compared with color Doppler ultrasound in the determination of varicocele diagnosis and grading: Impact of urologists\u2019 experience","volume":"8","author":"Cocuzza","year":"2020","journal-title":"Andrology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1093\/humupd\/dmu042","article-title":"Ultrasound of the male genital tract in relation to male reproductive health","volume":"21","author":"Lotti","year":"2015","journal-title":"Hum. Reprod. Update"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1111\/andr.13053","article-title":"Varicocoele. Classification and pitfalls","volume":"9","author":"Bertolotto","year":"2021","journal-title":"Andrology"},{"key":"ref_35","first-page":"e62848","article-title":"Advanced Sonographic Techniques in the Comprehensive Evaluation and Diagnosis of Male Infertility","volume":"16","author":"Jain","year":"2024","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kayra, M.V., \u015eahin, A., Toks\u00f6z, S., Serindere, M., Alt\u0131nta\u015f, E., \u00d6zer, H., and G\u00fcl, M. (2024). Machine learning-based classification of varicocoele grading: A promising approach for diagnosis and treatment optimization. Andrology.","DOI":"10.1111\/andr.13776"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1159\/000322825","article-title":"Predictive factors of successful varicocelectomy in infertile patients","volume":"86","author":"Chen","year":"2011","journal-title":"Urol. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jprot.2019.01.019","article-title":"Molecular pathways of varicocele and its repair\u2014A paired labelled shotgun proteomics approach","volume":"196","author":"Camargo","year":"2019","journal-title":"J. Proteom."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4987","DOI":"10.21037\/qims-24-8","article-title":"The role of testicular stiffness derived from shear wave elastography in the assessment of spermatogenesis in men with varicocele","volume":"14","author":"Fu","year":"2024","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_40","first-page":"9136","article-title":"Evaluation of testicular spermatogenic function by ultrasound elastography in patients with varicocele-associated infertility","volume":"13","author":"Li","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e13699","DOI":"10.1111\/ijcp.13699","article-title":"Shear wave elastography in varicocele patients: Prospective study to investigate correlation with semen parameters and histological findings","volume":"75","author":"Fuschi","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1080\/2090598X.2021.1964256","article-title":"The usefulness of elastography in the evaluation and management of adult men with varicocele: A systematic review","volume":"19","author":"Bello","year":"2021","journal-title":"Arab. J. Urol."},{"key":"ref_43","first-page":"Cd000479","article-title":"Surgery or embolization for varicoceles in subfertile men","volume":"10","author":"Kroese","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_44","first-page":"Cd000479","article-title":"Surgery or embolisation for varicoceles in subfertile men","volume":"3","author":"Evers","year":"2008","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"234","DOI":"10.4103\/1008-682X.169985","article-title":"Percutaneous embolization of varicocele: Technique, indications, relative contraindications, and complications","volume":"18","author":"Halpern","year":"2016","journal-title":"Asian J. Androl."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/j.jvir.2022.03.013","article-title":"Comparing Endovascular and Surgical Treatments for Varicocele: A Systematic Review and Meta-Analysis","volume":"33","author":"Liu","year":"2022","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"289","DOI":"10.5534\/wjmh.220142","article-title":"Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis","volume":"41","author":"Agarwal","year":"2023","journal-title":"World J. Men\u2019s Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.euf.2022.08.014","article-title":"The Effect of Varicocele Treatment on Fertility in Adults: A Systematic Review and Meta-analysis of Published Prospective Trials","volume":"9","author":"Fallara","year":"2023","journal-title":"Eur. Urol. Focus."},{"key":"ref_49","first-page":"Cd000479","article-title":"Surgical or radiological treatment for varicoceles in subfertile men","volume":"4","author":"Persad","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2164\/jandrol.108.005967","article-title":"Treatment of palpable varicocele in infertile men: A meta-analysis to define the best technique","volume":"30","author":"Cayan","year":"2009","journal-title":"J. Androl."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"164","DOI":"10.5534\/wjmh.220048","article-title":"Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations","volume":"41","author":"Shah","year":"2023","journal-title":"World J. Men\u2019s Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1159\/000473005","article-title":"Preoperative parameters related to the improvement of semen characteristics after surgical repair of varicocele in subfertile men","volume":"14","author":"Okuyama","year":"1988","journal-title":"Eur. Urol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/j.1439-0272.2008.00882.x","article-title":"Predictors of improved seminal characteristics by varicocele repair","volume":"41","author":"Kondo","year":"2009","journal-title":"Andrologia"},{"key":"ref_54","first-page":"E27","article-title":"Preoperative follicle-stimulating hormone: A factor associated with semen parameter improvement after microscopic subinguinal varicocelectomy","volume":"14","author":"Madhusoodanan","year":"2020","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"100339","DOI":"10.1016\/j.clinsp.2024.100339","article-title":"Relationship between semen parameters, serum InhB, and INSL-3 levels, and the degree of varicocele","volume":"79","author":"Liu","year":"2024","journal-title":"Clinics"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.fertnstert.2014.03.046","article-title":"Nomograms for predicting changes in semen parameters in infertile men after varicocele repair","volume":"102","author":"Samplaski","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/j.1442-2042.1996.tb00535.x","article-title":"Relationship between grade of varicocele and the response to varicocelectomy","volume":"3","author":"Takahara","year":"1996","journal-title":"Int. J. Urol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4103\/aja202248","article-title":"Intense venous reflux, quantified by a new software to analyze presurgical ultrasound, is associated with unfavorable outcomes of microsurgical varicocelectomy","volume":"25","author":"You","year":"2023","journal-title":"Asian J. Androl."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e13462","DOI":"10.1111\/and.13462","article-title":"Bilateral is superior to unilateral varicocelectomy in infertile men with bilateral varicocele: Systematic review and meta-analysis","volume":"51","author":"Ou","year":"2019","journal-title":"Andrologia"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1111\/and.12495","article-title":"Clinical significance of subclinical varicocelectomy in male infertility: Systematic review and meta-analysis","volume":"48","author":"Kim","year":"2016","journal-title":"Andrologia"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s11934-018-0798-8","article-title":"The Effect of Subclinical Varicocele on Pregnancy Rates and Semen Parameters: A Systematic Review and Meta-Analysis","volume":"19","author":"Kohn","year":"2018","journal-title":"Curr. Urol. Rep."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/j.1439-0272.2009.00919.x","article-title":"Predictors of improved seminal parameters and fertility after varicocele repair in young adults","volume":"41","author":"Alescio","year":"2009","journal-title":"Andrologia"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1038\/s41585-018-0003-3","article-title":"Genetics of male infertility","volume":"15","author":"Krausz","year":"2018","journal-title":"Nat. Rev. Urol."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Liu, X., Liu, D., Pan, C., and Su, H. (2022). Nomogram for Predicting Semen Parameters Improvement after Microscopic Varicocelectomy in Infertile Men with Abnormal Semen Parameters. J. Pers. Med., 13.","DOI":"10.3390\/jpm13010011"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"E579","DOI":"10.5489\/cuaj.2808","article-title":"Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study","volume":"9","author":"Shabana","year":"2015","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e13318","DOI":"10.1111\/aji.13318","article-title":"Infertility duration and pre-operative sperm progressive motility are significant factors of spontaneous pregnancy after varicocele repair","volume":"84","author":"Ren","year":"2020","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/j.urology.2014.01.029","article-title":"Clinical outcome of microsurgical varicocelectomy in infertile men with severe oligozoospermia","volume":"83","author":"Enatsu","year":"2014","journal-title":"Urology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e13078","DOI":"10.1111\/and.13078","article-title":"Comparison of clinical outcome of bilateral and unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: A meta-analysis of randomised controlled trials","volume":"50","author":"Niu","year":"2018","journal-title":"Andrologia"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1007\/s40618-019-01042-5","article-title":"Left spermatic vein reflux after varicocele repair predicts pregnancies and live births in subfertile couples","volume":"42","author":"Barbonetti","year":"2019","journal-title":"J. Endocrinol. Investig."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"441","DOI":"10.4103\/aja202420","article-title":"Predictive parameters of the efficacy of varicocele repair: A review","volume":"26","author":"Crafa","year":"2024","journal-title":"Asian J. Androl."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"618","DOI":"10.5534\/wjmh.210159","article-title":"Artificial Intelligence Based Machine Learning Models Predict Sperm Parameter Upgrading after Varicocele Repair: A Multi-Institutional Analysis","volume":"40","author":"Ory","year":"2022","journal-title":"World J. Men\u2019s Health"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.euros.2023.11.008","article-title":"Nomograms for Predicting Postoperative Sperm Improvements in Varicocele Patients","volume":"59","author":"Maimaitiming","year":"2024","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e14514","DOI":"10.1111\/and.14514","article-title":"Can preoperative inflammatory markers predict the success of varicocelectomy?","volume":"54","author":"Duran","year":"2022","journal-title":"Andrologia"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e13188","DOI":"10.1111\/and.13188","article-title":"Preoperative neutrophil-to-lymphocyte ratio as a new prognostic predictor after microsurgical subinguinal varicocelectomy","volume":"51","author":"Ates","year":"2019","journal-title":"Andrologia"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/03915603231192739","article-title":"The effect of systemic inflammatory index and systemic inflammatory response index on success of varicoselectomy","volume":"91","author":"Erdogan","year":"2024","journal-title":"Urologia"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Liu, L., Li, J., Liu, G., Pan, C., Bai, S., Zhan, Y., and Shan, L. (2022). Nomogram for predicting spontaneous pregnancy after microscopic varicocelectomy in infertile men with normal hormone. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-05125-9"},{"key":"ref_77","first-page":"303","article-title":"Varicocelectomy May Improve Results for Sperm Retrieval and Pregnancy Rate in Non-Obstructive Azoospermic Men","volume":"12","author":"Sajadi","year":"2019","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"246","DOI":"10.4103\/1008-682X.169562","article-title":"Outcome of varicocele repair in men with nonobstructive azoospermia: Systematic review and meta-analysis","volume":"18","author":"Esteves","year":"2016","journal-title":"Asian J. Androl."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.juro.2011.09.047","article-title":"Predictors of sperm recovery and azoospermia relapse in men with nonobstructive azoospermia after varicocele repair","volume":"187","year":"2012","journal-title":"J. Urol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"494","DOI":"10.3109\/21681805.2014.932839","article-title":"Varicocele repair in non-obstructive azoospermic men: Diagnostic value of testicular biopsy\u2014A meta-analysis","volume":"48","author":"Elzanaty","year":"2014","journal-title":"Scand. J. Urol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1080\/2090598X.2021.1956838","article-title":"Varicocele treatment in non-obstructive azoospermia: A systematic review","volume":"19","author":"Jensen","year":"2021","journal-title":"Arab. J. Urol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"628","DOI":"10.4103\/aja202426","article-title":"Varicocele repair in improving spermatozoa, follicle-stimulating hormone, and luteinizing hormone parameters in infertile males with azoospermia: A systematic review and meta-analysis","volume":"26","author":"Ramon","year":"2024","journal-title":"Asian J. Androl."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"344","DOI":"10.5534\/wjmh.240132","article-title":"Impact of Varicocele Repair on Assisted Reproductive Technique Outcomes in Infertile Men: A Systematic Review and Meta-Analysis","volume":"43","author":"Palani","year":"2025","journal-title":"World J. Men\u2019s Health"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/j.fertnstert.2016.07.1093","article-title":"Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: A systematic review and meta-analysis","volume":"106","author":"Kirby","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"254","DOI":"10.4103\/1008-682X.163269","article-title":"Outcome of assisted reproductive technology in men with treated and untreated varicocele: Systematic review and meta-analysis","volume":"18","author":"Esteves","year":"2016","journal-title":"Asian J. Androl."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.urology.2020.05.014","article-title":"Decisional Conflict and Knowledge Among Patients With Varicocele Seeking Treatment for Infertility","volume":"142","author":"Jayadevan","year":"2020","journal-title":"Urology"},{"key":"ref_87","first-page":"751","article-title":"Association between varicocele and hypogonadism, or erectile dysfunction: A systematic review and meta-analysis","volume":"48","year":"2024","journal-title":"Actas Urol. Esp. Engl. Ed."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4274\/balkanmedj.galenos.2020.2020.1.85","article-title":"Effect of Varicocele and Its Treatment on Testosterone in Hypogonadal Men with Varicocele: Review of the Literature","volume":"37","author":"Akbay","year":"2020","journal-title":"Balkan Med. J."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"e12778","DOI":"10.1111\/and.12778","article-title":"Efficacy of varicocelectomy in the treatment of hypogonadism in subfertile males with clinical varicocele: A meta-analysis","volume":"49","author":"Chen","year":"2017","journal-title":"Andrologia"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e92","DOI":"10.5534\/wjmh.240109","article-title":"Effects of Varicocele Repair on Testicular Endocrine Function: A Systematic Review and Meta-Analysis","volume":"42","author":"Cannarella","year":"2024","journal-title":"World J. Men\u2019s Health"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"15579883231199400","DOI":"10.1177\/15579883231199400","article-title":"Effects of Varicocele Surgical Repair on Serum Hormone and Inhibin B Levels for Patients with Varicocele: A Systematic Review and Meta-Analysis","volume":"17","author":"Tian","year":"2023","journal-title":"Am. J. Men\u2019s Health"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Saha, S., Roy, P., Corbitt, C., and Kakar, S.S. (2021). Application of Stem Cell Therapy for Infertility. Cells, 10.","DOI":"10.3390\/cells10071613"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"437","DOI":"10.5534\/wjmh.240059","article-title":"Therapeutic Effects of Mesenchymal Stem Cell Conditioned Medium in Rat Varicocele Model","volume":"43","author":"Serefoglu","year":"2025","journal-title":"World J. Men\u2019s Health"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Peserico, A., Barboni, B., Russo, V., Nardinocchi, D., Turriani, M., Cimini, C., Bernab\u00f2, N., Parolini, O., Silini, A.R., and Antonucci, I. (2023). AEC and AFMSC Transplantation Preserves Fertility of Experimentally Induced Rat Varicocele by Expressing Differential Regenerative Mechanisms. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24108737"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"127","DOI":"10.54847\/cp.2024.03.15","article-title":"Usefulness of indocyanine green in the laparoscopic Palomo technique: A comparative study","volume":"37","year":"2024","journal-title":"Cir. Pediatr."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"282.e1","DOI":"10.1016\/j.jpurol.2023.11.018","article-title":"Indocyanine green (ICG)-GUIDED lymphatic sparing laparoscopic varicocelectomy in children and adolescents. Is intratesticular injection of the dye safe? A mid-term follow-up study","volume":"20","author":"Esposito","year":"2024","journal-title":"J. Pediatr. Urol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"560","DOI":"10.21037\/tau-23-586","article-title":"Microscopic subinguinal varicocelectomy with video telescopic operating microscope (VITOM) telescope: Outcome analysis","volume":"13","author":"Fam","year":"2024","journal-title":"Transl. Androl. Urol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1177\/15533506241237555","article-title":"Video-Assisted Telescope Operating Monitor 3D System in Microsurgical Varicocelectomy: A Preliminary Report","volume":"31","author":"Duarsa","year":"2024","journal-title":"Surg. Innov."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"778","DOI":"10.55730\/1300-0144.5849","article-title":"Use of intraoperative microvascular Doppler during subinguinal microsurgical varicocelectomy in children reduces complications","volume":"54","author":"Kaya","year":"2024","journal-title":"Turk. J. Med. Sci."},{"key":"ref_100","first-page":"839","article-title":"Subinguinal microsurgical varicocelectomy with intraoperative microvascular Doppler ultrasound leads to the pain-free outcome after surgery","volume":"25","author":"Lv","year":"2017","journal-title":"J. Xray Sci. Technol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.urology.2006.08.1113","article-title":"Microsurgical inguinal varicocelectomy with and without testicular delivery","volume":"68","author":"Ramasamy","year":"2006","journal-title":"Urology"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1007\/s11255-021-03009-z","article-title":"Impact of testicular delivery and vasal vein ligation on clinical outcomes in men undergoing microsurgical varicocelectomy","volume":"53","author":"Wald","year":"2021","journal-title":"Int. Urol. Nephrol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e13605","DOI":"10.1111\/and.13605","article-title":"Evaluation of clinical effects of microsurgical subinguinal varicocelectomy with and without testicular delivery","volume":"52","author":"Jin","year":"2020","journal-title":"Andrologia"},{"key":"ref_104","first-page":"2261","article-title":"Comparison between Microsurgical Subinguinal Varicocelectomy with and without Testicular Delivery for Infertile Men: Is Testicular Delivery an Unnecessary Procedure","volume":"12","author":"Hou","year":"2015","journal-title":"Urol. J."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1016\/j.jpedsurg.2016.12.011","article-title":"Recurrence rates in pediatric patients undergoing microsurgical subinguinal varicocelectomy with and without testicular delivery","volume":"52","author":"Choi","year":"2017","journal-title":"J. Pediatr. Surg."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"e13363","DOI":"10.1111\/and.13363","article-title":"Comparison between microsurgical varicocelectomy with and without testicular delivery for treatment of varicocele: A systematic review and meta-analysis","volume":"51","author":"Song","year":"2019","journal-title":"Andrologia"},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Napolitano, L., Pandolfo, S.D., Aveta, A., Cirigliano, L., Martino, R., Mattiello, G., Celentano, G., Barone, B., Rosati, C., and La Rocca, R. (2022). The Management of Clinical Varicocele: Robotic Surgery Approach. Front. Reprod. Health, 4.","DOI":"10.3389\/frph.2022.791330"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/j.1745-7262.2008.00354.x","article-title":"Initial experience with robot-assisted varicocelectomy","volume":"10","author":"Shu","year":"2008","journal-title":"Asian J. Androl."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"189","DOI":"10.4103\/aja.aja_45_17","article-title":"A retrospective review of single-institution outcomes with robotic-assisted microsurgical varicocelectomy","volume":"20","author":"McCullough","year":"2018","journal-title":"Asian J. Androl."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1038\/aja.2012.131","article-title":"Robotic assisted andrological surgery","volume":"15","author":"Parekattil","year":"2013","journal-title":"Asian J. Androl."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Pyrgidis, N., Sokolakis, I., Palapelas, V., Tishukov, M., Mykoniatis, I., Symeonidis, E.N., Zachariou, A., Kaltsas, A., Sofikitis, N., and Hatzichristodoulou, G. (2021). The Effect of Antioxidant Supplementation on Operated or Non-Operated Varicocele-Associated Infertility: A Systematic Review and Meta-Analysis. Antioxidants, 10.","DOI":"10.3390\/antiox10071067"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"e14533","DOI":"10.1111\/and.14533","article-title":"Improvement in sperm quality by oral antioxidant supplementation in infertile men with varicocele who have not undergone surgical repair: Systematic review and meta-analysis","volume":"54","author":"Ioannidou","year":"2022","journal-title":"Andrologia"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"233","DOI":"10.5534\/wjmh.200196","article-title":"Utility of Antioxidants in the Treatment of Male Infertility: Clinical Guidelines Based on a Systematic Review and Analysis of Evidence","volume":"39","author":"Agarwal","year":"2021","journal-title":"World J. Men\u2019s Health"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"e13396","DOI":"10.1111\/and.13396","article-title":"Efficacy of antioxidant therapy on sperm quality measurements after varicocelectomy: A systematic review and meta-analysis","volume":"51","author":"Wang","year":"2019","journal-title":"Andrologia"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e13070","DOI":"10.1111\/and.13070","article-title":"Effect of adjuvant drug therapy after varicocelectomy on fertility outcome in males with varicocele-associated infertility: Systematic review and meta-analysis","volume":"50","author":"Chen","year":"2018","journal-title":"Andrologia"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5445\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:21:44Z","timestamp":1760034104000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,2]]},"references-count":115,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14155445"],"URL":"https:\/\/doi.org\/10.3390\/jcm14155445","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,2]]}}}