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A scrotal varicocele is the most common causative finding in infertile men. It results from backflow of blood secondary to incompetent or absent valves in the spermatic veins. This valvular deficiency combined with the long vertical course of the internal spermatic vein on the left side, leads to the formation of most varicoceles on the left side (90%). Varicoceles are not as commonly seen on the right side because of the oblique course of the right internal spermatic vein from the vena cava. A unilateral right-sided varicocele suggests venous thrombosis/tumor or situs inversus. Newer diagnostic tests have shown the incidence of bilateral varicoceles to be greater than 40%. The incidence of varicoceles in the adult male population is approximately 20% and in the infertile population approximately 40%. 50% of men with varicoceles will have impaired semen quality, but many men varicoceles are fertile. To explain the abnormalities in spermatogenesis with varicocele, the following theories have been proposed:

1. elevation of testicular temperature due to venous stasis
2. retrograde flow of toxic metabolites from the adrenal or kidney
3. blood stagnation with germinal epithelial hypoxia; and
4. alterations in the hypothalamic-pituitary-gonadal axis.