Is varicocele repair justified in infertile men with clinical varicocele, normal conventional semen parameters and elevated sperm DNA fragmentation (SDF)?

Varicocele is a prevalent cause of male infertility, with sperm DNA fragmentation (SDF) identified as a key factor. Although varicocele repair (VR) has been associated with improved fertility outcomes, its effectiveness in men who have a palpable varicocele, normal conventional semen analysis, and high SDF levels is still not fully understood. This review summarizes existing evidence regarding the connection between varicocele and SDF, the effect of VR on both SDF and fertility outcomes and focuses on infertile men experiencing these specific conditions. Current literature indicates that VR can significantly improve SDF and reproductive success following surgery, independent of the surgical approach, SDF testing method, or preoperative SDF levels. Nonetheless, additional research is necessary to validate these results and to establish the best management strategies for these individuals. We recommend that organizations engaged in the area of male infertility take into account the significance of SDF testing in the decision-making process concerning VR, particularly for men who present with a palpable varicocele and demonstrate normal findings in conventional semen analysis.