Would you perform varicocelectomy in a non-obstructive azoospermic patient with grade 3 varicocele or proceed straight to sperm retrieval?

Assuming no Y chromosomal microdeletions, no karyotypic anomalies, and no testosterone use, yes, I would. About 25% or so will achieve some level of spermatogenesis 4 months later for use with ICSI, and that would obviate the need for a TESE. If no sperm have returned to the ejaculate, at least you ...

It depends on the initial diagnosis. If it is secondary infertility, I will perform the varicocelectomy and then reassess with a semen analysis after 3 months. I will be hesitant to go ahead with the varicocelectomy if it is primary infertility. This is all after the chromosomal analysis, and the Y-...

Addressing this varicocele is a very reasonable pathway, given that data show that ~10% (some studies higher) will have spontaneous return of sperm to the ejaculate after varicocele ligation in the setting of nonobstructive azoospermia (NOA). This is a very meaningful outcome, as it spares microdiss...