Technique | Spontaneous pregnancy rate (%) | Recurrence rate (%) | Hydrocele formation rate (%) | Advantages | Disadvantages |
Palomo28–31 | 37.69 | 14.97 | 8.24 | Good for pain relief, shorter surgery time. | Highest recurrence rate and hydrocele formation rate. |
Laparoscopic varicocelectomy28 30–32 | 30.07 | 4.3 | 2.84 | Suitable for bilateral varicocele and recurrent varicocele. Less invasive surgery, faster recovery and fewer complications. | May cause damage to intestines and blood vessels. Requires high level of surgical skills, anaesthesia and is more expensive. |
Radiologic embolisation28 31 33 34 | 33.2 | 12.7 | 0–12 | Less damage and faster recovery. No accidental injury to the internal spermatic artery. | Potential risks of radiation exposure, misplaced embolism and displacement of embolic agents. |
Microscopic inguinal (Ivanissevich)28 35–37 | 36 | 2.63 | 7.3 | More effective in improving sperm concentration. | Increased chance of arterial and lymphatic vessel damage, requiring more surgical skill. |
Microsurgical varicocelectomy10 28 32 38 39 | 41.97 | 1.05–2.60 | 0.44 | Relatively good efficacy and low recurrence and complication rates. Better control of post-operative pain. | Less than 40% of infertile couples achieve spontaneous pregnancy after microsurgical varicocelectomy, and most of them still require additional interventions such as ARTs. |
Subinguinal microsurgical varicocelectomy1 34 37 | 42.8 | 0.8 | 0.6 | The ‘gold standard’ for the treatment of varicocele. | Most patients still need the help of advanced ARTs, such as the costly ICSI. |
ARTs, advanced assisted reproductive technologies; ICSI, intracytoplasmic sperm injection.