[Varicocele and infertility. Facts, uncertainties and hypotheses].

The association between varicocele and male subfertility would seem to be borne out by its incidence in the subfertile male population and the presence of disturbances in spermatogenesis, as well as a description of the different physiopathological mechanisms based on renospermatic venous reflux, and the improvement in the sperm and the obtaining of pregnancy after surgical cure of the reflux. The literature on the subject, and the number of successful case reports, have greatly increased in recent years. There is a tendency to extend the surgical indications to include infraclinical forms of varicocele, and even to perform preventive procedures, against male sterility in varicocele-carrying adolescents. In fact, however, there are wide variations in the estimates of the incidence of varicocele, not only in the general population, but also in the female subfertile population. The relationship between sperm characteristics and fertility is difficult to define. While the presence of renospermatic venous reflux is, in most cases, unquestionable, the exact mechanism or mechanisms of its action are uncertain. The efficacy of surgical management itself is variously assessed, and the methodology employed in many studies is open to question. Only an approach based on fertility epidemiological data and comparative studies employing a methodology which is not open to criticism, will ultimately enable us to define the role of varicocele in male subfertility and the role of surgical management in its treatment.