Varicocele is a common male condition. Male infertility often coexists with varicocele. Semen quality and testicular histological abnormalities are associated with varicocele in 20 to 50% of patients, and consequently affect male fertility. Surgery has previously been recognized as the only effective treatment for varicocele, eliminating the localized swelling and painful discomfort associated with the disease and improving semen quality. Previously, widely accepted indications for surgery included: 1) varicocele causing significant swelling and discomfort on the affected side that is intolerable to the patient; and 2) male infertility combined with abnormal semen quality. Some researchers are now questioning the reliance on surgical treatment of varicocele to improve male fertility. It is believed that only those who do not find other obvious abnormalities but have progressive aggravation of semen quality and varicocele severity are highly suspected of having varicocele affecting male fertility, and active intervention at this time is more likely to achieve more satisfactory results. With the recent advances in medical technology, the treatment of male infertility with varicocele has undergone fundamental changes. The most fundamental aim of the choice of treatment is to restore fertility to the patient, and the solution to fertility is not only surgical. We should first of all monitor dynamically (several consecutive examinations every 2-3 months) the progressive decrease of semen quality, especially in case of combined hypoplasticity (smaller size and softer texture) of the affected testis, which is highly suggestive of a causal relationship between varicocele and infertility, with a higher probability of benefit from surgical treatment. The current study concluded that the improvement of semen routine examination in patients with varicocele can reach 50-70% within 1-2 years after surgery, and 30-40% of spouses get pregnant naturally, and postoperative treatment with appropriate medication can increase the rate of semen quality improvement and spouses’ natural pregnancy rate. The effectiveness of surgical treatment depends mainly on the severity of the disease and the specific timing of surgery, but there is no definite conclusion yet. In general, it takes 3 to 24 months to improve semen quality and to achieve a spontaneous pregnancy with surgery and postoperative medication. Male infertility with varicocele in patients who have not regained fertility after 2 years of elective surgical treatment suggests treatment failure. Many of the factors associated with male infertility, including varicocele, are induced by increased levels of oxidative stress in the testes. At present, Myzlin can effectively assist other drugs to improve infertility with varicocele with some degree of retraction, and it can be one of the treatment options for male infertility with varicocele. For patients who are very unlikely to regain natural fertility with surgical treatment, who are older and need to solve their fertility problems as soon as possible, it is relatively easy to choose IVF technology.
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