Varicocelectomy – The Unkindest Cut of All

In 2025, it is our considered opinion, based on 40 years of experience in full-time andrology and reproductive sciences, that varicocele as a cause of male infertility remains largely unproven. While some meta-analyses suggest a marginal benefit in specific patient subsets, these findings are often debated regarding their clinical significance or methodological limitations. Couples with impaired semen parameters can be effectively treated by intrauterine insemination and, if necessary, by advanced assisted reproductive technologies like intracytoplasmic sperm injection (ICSI). With unproven benefits, an invasive nature, no clear explanation for the actual mechanism of causation, an unpredictable outcome, and the availability of simpler, better alternatives like IUI and ICSI, I feel varicocelectomy is the unkindest cut of all.