High prevalence of bilateral varicoceles confirmed with ultrasonography

Objective: To determine the incidence of bilateral varicoceles in men presenting to a single infertility clinic. Subjects and methods: From March 1999 to March 2000, 60 men presenting with an inability to initiate pregnancy (consecutive and unselected), were determined by clinical exam to have varicoceles. These men were sent for color Doppler ultrasound to evaluate the incidence of varicocele bilaterality. Two men with a solitary testis were excluded from the study. Results: Of the 58 men, 45 (77.5%) had ultrasound verified bilateral varicoceles. In the 13 remaining patients, 8 (13.8%) had a unilateral left varicocele, 4 (6.9%) had no varicoceles demonstrated by ultrasound, and a single patient (1.7%) was reported to have a unilateral right varicocele. Conclusions: Routine scrotal ultrasound provides valuable information in the diagnostic evaluation of infertile men. Based on advancements in diagnostic techniques, investigators have recently observed that the incidence of bilateral varicoceles to be significantly greater than the previously reported. Our study demonstrated the incidence of bilaterality in infertile men to be a substantial 77.5%. An overlooked right varicocele (whether subclinical or not) may be detrimental to future fertility and needs further investigation.