Figure 2.

Algorithm proposed for the management of infertile males with varicocele using sperm DNA damage and oxidative stress tests. Testing is recommended at initial workup to all men with conventional semen analysis results within normal ranges. Abnormal test results identify couples at higher risk of remaining childless if an expectant management is taken. Interventions aimed to overcome OS and sperm DNA damage in patients with varicocele include varicocele repair and assisted reproductive techniques. Oral antioxidants and life-style modifications (cessation of smoking, weight loss) can be combined to varicocelectomy. Monitoring is carried out with same tests at 3-month intervals after varicocele treatment. ART are recommended for patients with persistent abnormal sperm function markers after varicocele repair. Testicular spermatozoa may be considered for sperm injections in ART treatment.