1- Varicocele is a cause of male infertility, and it is the most commonly encountered and likely to yield the best results with a successful microsurgical operation. Varicocele diagnosis should be made only by physical examination, not by ultrasonography. With Doppler ultrasonography, varicocele is diagnosed faultily for many people and thus unnecessary operations are performed. Varicocele that cannot be diagnosed by physical examination should under no circumstances be operated on; this will yield no results.
2- People diagnosed with varicocele should not be initially recommended assisted reproductive techniques such as IVF, ICSI, and injection. Varicocele harms the chromosal structure of the sperm cell (DNA fragmentation) and decreases the insemination power of the spouse’s egg; even if insemination occurs, it might be at a low level. It should not be forgotten that IVF application is a method to be used only as a last resort, one which raises birth anomaly and disorder risks for the baby to 30%, and has many risks for the mother as well.
3- Technically the most successful method with the least complication risk is microsurgery. In our series and the series of specializing centers, technical success rate of microsurgical varicocele operation may reach over 99%; the rate of critical complication rate might fall to 0% and insignificant complication rate might fall to 3-5%. In other operation techniques, hydrocele risk may rise to 40% and artery damage might rise to 5%. Embolisation method which is a radiological enterprise in varicocele treatment is not preferred due to its low success rate and serious complication rates.
4- When the operation is inadequate the expression "varicocele does not recur" is used in the wrong sense. If it is detected that varicocele continues due to unsatisfactory surgery, a microsurgical remedial operation could be applied. Due to techniques applied apart from microsurgery, recurrence might rise to 40% and complication rates increase noticeably.
5- Microsurgical varicocele operation is definitely not a simple surgical operation! Microsurgical technique is successful when performed by well-trained people with enough experience. As in every method, unsatisfactory and faulty applications of microsurgery can result in serious complications, even in organ loss. I have met many patients whose varicocele continues after unsuccessful varicocele operations performed with microsurgery and other old techniques. These people face problems such as hydrocele and deactivation of testicles. The patients whose sperm quality or spermiogram results get even worse to zero level, benefit from microsurgery, while some could not be helped.
6- With an inadequately applied microsurgical technique, varicocele may not disappear, and serious complications like hydrocele and organ loss might be experienced as a result of artery and lymphatic canal damage. The quality and success rate are more important than the technique applied. I recommend that people who will have varicocele operation give enough attention to this topic and prefer well-trained and experienced specialists to operate on them.
7- Varicocele might be painful, too. Even if it cannot be guaranteed that the pain will disappear, with the application of microsurgical method and operation techniques on pain, the pain ends in many cases.
8- Having returned from abroad, I started this technique in our country and applied it to more than 2500 patients and taught the technique to many assistants in İstanbul Faculty of Medicine and contributed to its application in various parts of Turkey. Microsurgical varicocele operation is especially preferred in the recent years by academicians of andrology clinics at universities and many sophisticated clinics in the world have adopted microsurgery technique in varicocele operations.
Treatment of male infertility and microsurgical varicocele operation
Nearly 15- 20% of married couples are unable to have children in the time and quantity they wish.
In the infertility problem, factors related to men only are 20% and in nearly 40% of couples, the man’s problem is added to the woman’s; in 50- 60% it is seen that a problem in man is partially responsible for infertility problem. Most of the problems in the man could be detected by examination and sperm analysis but some cases may require special examinations. 
As a result of treatments, many men are able to have children with normal sexual intercourse. Starting to treat the woman without urological examination of the man and evaluation of the spermiogram done in an unspecialized laboratory by a Urology specialist is a faulty practice. It should not be forgotten that male infertility may be the indication of an underlying critical disorder in some cases.
Examinations:
Evaluation in terms of male infertility starts with an interview with an urologist-andrologist and by giving sperm in the right way with at least two spermiograms assessed according to WHO (World Health Organization) criteria. In Turkey, as in many other fields, scientific standards are not usually adhered to especially in the field of andrology, and examinations are not done with quality control, which altogether results in faulty results in infertility examinations. For the above reasons, I only comment on the spermiogram results of the laboratories I trust and know of. Commenting on faulty, misleading and contradictory spermiograms complicate the doctor’s job and negatively affect treatment process of the patient.
After initial assessments if a problem is detected in examination and sperm test, detailed examinations will be performed. These may be more detailed examinations, hormone analyses, ultrasonography, and some other radiological and genetic tests. Upon the completion of examinations, the number of sperm cells, activation and quality may be increased and treatments that will increase insemination capacity will be started.
Some of the men with infertility problem may be treated by replacing lacking hormones or patients may be treated with drugs which increase their sperm number.
Despite special examinations in the sperm analysis, patients who have no sperm cells are assessed with detailed analyses and existence of sperm production in testicles and obstruction in semen canals may be investigated. Some of the men who do not have sperm cell according to spermiogram analyses while having sperm production in testicles, can be enabled to have children by normal intercourse.
Varicocele and its operation with microsurgical technique:
Varicocele (enlargement in testicle veins, forming of varicosis), which is detected in 15% of all men and 40% of those with infertility problem is one of the factors which spoil sperm production. Varicocele is a cause of infertility which we commonly encounter and from which we get the most successful results by means of microsurgery. As can also be seen in World Health Organization (WHO) research studies, my experience of about 2500 operations has provided scientific evidence that varicocele causes infertility and its successful treatment contributes to infertility treatment. Varicocele spoils sperm production by affecting micro circulation after heat increase in testicles and back flow of used blood in the venous blood veins to testicle; decreases insemination power as a result of its effects on number, activity, structure and chromosal structure both in normal sexual intercourse and assisted reproductive techniques like ICSI and injection, and increases miscarriage risk. I initially recommend microsurgical varicocele surgery to the patients that I have diagnosed with varicocele; I do not approve of drug treatment or test tube baby methods to those patients initially. Diagnosis of varicocele, which can be seen in varying levels must be made after a detailed analysis by a specialist of Urology-Andrology in appropriate conditions. Since operating on varicoceles that could only be detected by ultrasonography is not helpful, apart from special cases, no examinations other than a sensitive examination must be required from the patients.
Varicocele which could also be the cause of pain is not a health problem but carries importance when detected in men who want to have children. Varicocele which starts in adolescence may hinder development of testicles; its negative effects on sperm production gradually increase. In our country since young people marry early they can have children without being affected from varicocele, but in the following years when they want to have another child they may not be able to do so due to ongoing effects of varicocele.
Varicocele is a commonly encountered male infertility cause which can be treated successfully by microsurgery. In varicocele cases, which can be treated by the successful application of microsurgical methods, over 80% significant improvement is seen in spermiogram results and most of these patients may have children without needing any further treatment. Most of the rest will reach levels where they can benefit from easier and more economical methods than intrauterine injection and IVF. 
Those who have had varicocele operation earlier but not have obtained positive results are diagnosed with recurrence. In these cases where the operation is inadequate due to technical reasons, remedial microsurgery operation may be applied and positive results can be obtained.
It has been observed that if varicocele is detected before ICSI applications (microinjection), it can be operated on with microsurgical technique and the effect on chromosal structure which decreases insemination ability of sperm cells can be removed thus increasing pregnancy rates.
We are well aware that due to wrong uses of manual examination and ultrasonography methods in men with infertility problem and sometimes as a result of commercial concerns, varicocele diagnosis is frequently made and unnecessary operations are performed. Although I have performed more than 2500 surgeries since 1993, I have had to inform people applying to me for operation that in fact they did not need surgery although they said they were diagnosed with varicocele.
Varicocele does not disappear in 40% of those who had varicocele operation instead of special microsurgical methods or due to misapplication of microsurgery. In some of the operated patients, hydrocele (swelling due to high amount of liquid accumulation between membranes of the egg) may appear due to obstruction of lymph canals, and even more complicated and incurable problems such as deactivation of testicles may arise due to obstruction of arteries. Varicocele operation which has a benefit rate of over 80% in infertility, may give 20% benefit rate when used unnecessarily and faultily. For this reason, people who are recommended to have operation should take the issue seriously and consult Urology-Andrology experts with detailed examinations.
Click for frequently asked questions on male infertility.
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