الفهرس 
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Abstract
V
aricoceles are very common in infertile males and lead to progressive pathology. Azoospermia is the absence of sperm in the semen. Varicocele which leads to azoospermia is a challenging of the infertility management. Although the role of varicocelectomy in non obstructive azoospermia patients was evaluated in several studies, but still the value of varicocelectomy in these cases remains unclear.
15% of the population have varicocele, 35% of men with primary infertility, and 75% to 81% with secondary infertility also have varicocele. A lot of studies detected that varicocele is associated with a progressive and duration decline in testicular function
There is multiple pathophysiological effect of varicocele-related infertility by which dilated scrotal veins impair spermatogenesis and cause infertility. A temperature of testes that may be identical to teprature of core body is associated with a decrease in the sperm count and sperm quality. Reflux of catecholamines from adrenal gland into left varicoceles will cause vasoconstriction and decreased in testicular function. Another theory is antisperm-antibody formation for explaining varicocele-related male infertility. Also varicoceles negatively affect the hypothalamic-pituitary-gonadal axis.
All theses theories differ on the effect of varicocele related male infertililty and there is no any theory proved by the researchers.
According to theses multiple theories, some researchers of urology found that the varicocele repair may -In men with non-obstructive azoospermia- lead to the pesence of sperm in the ejaculate. There may be enough sperm in the ejaculate to avoid testicular or epididymal sperm retrieval for in vitro fertilization.
On the other hand, another group of researchers denied theses results of presence of sperms in the ejaculate by varicocele repair, and also to cause any spontaneous pregnancy.
In our study varicocele repair can’t successfully reverse the negative effects of varicoceles on testicular function. No statistical significant difference was detected in sperm retrieval between primary and secondary infertile patients. Men with clinical varicoceles that are associated with non obstructive azoospermia will not have sperm in the ejaculate after varicocele repair.
In our study we can not find any clear association between varicocele repair and sperm retrieval in nonobstructive azoospermic patients associated with varicocele.
We do for each patient FSH, LH, Testosterone and prolactin levels and also we do testicular biopsy before the operation but we can not find any significant relation associated with varicocele that is reversed with thw varicocele repair.
from this study we find that there is no significant benefit from varicocelectomy in patients with non obstructive azoospermia associated with varicocele.