Nonsurgical treatment of varicocele-associated male infertility: Current scenario, understanding of mechanisms, and future prospects

Varicocele (VC) leads to high scrotal temperatures and inadequate testicular perfusion, resulting in pathological processes such as heat stress, oxidative stress, NO stress, and cellular ionic imbalance in the testicular microenvironment, which further lead to inflammation in the testicular microenvironment, damage to testicular somatic cells, and thereby adversely affecting sperm development. Varicocele repair, which is the current primary treatment for VC, has limitations in terms of clinical indications, efficacy assessment, and treatment decision-making in the adolescent population; therefore, conservative treatment options for VC are still necessary. The nonsurgical therapies for VC compiled in this review mainly include Western medicine, Traditional Chinese medicine, physical therapy, and lifestyle modifications. Among these, Western medicine can be further categorized into antioxidant, hormone, and anti-inflammatory therapies. These nonsurgical therapies are effective in relieving clinical symptoms, improving semen parameters, restoring testicular function, and increasing pregnancy rates in patients with VC. However, the detailed mechanisms of many of these treatments are unclear, and the therapeutic efficacy is not adequately supported by clinical data; therefore, further studies are needed to confirm their efficacy.