Varicoceles are the most common correctable cause of male factor infertility. Varicocele repair, therefore, has an important role in the treatment of infertility. Performing varicocelectomy prior to assisted reproductive technology has the potential to improve male fertility and increase pregnancy and live birth rates. It can also be a cost-effective treatment method in infertile men with clinical varicoceles.

Over the last few decades, cancer incidence has increased in the United States. Many patients diagnosed with cancer are young, with nearly 10 percent below the age of 45 years and 1 percent below the age of 20 years [1]. Specifically for males aged between 15 and 19 years, cancer incidence has increased annually by 0.67 percent, resulting in >25 percent increase over 40 years [2]. Despite, the rise in cancer incidence, cancer survival has also dramatically improved, largely due to earlier detection and better treatments. With a growing number of chronic cancer survivors, there is focus on a concept termed cancer survivorship. Cancer survivorship focuses on maintaining and enhancing wellness in cancer survivors and on optimizing management of long-term side effects of their cancer and cancer treatments [3, 4].

Successful transportation of sperm from their origin within the seminiferous tubules of the testis to their site of emission in the posterior urethra involves a completely patent ductal system. Emerging from the testis into the efferent ducts, sperm enter 6–7 m of the coiled epididymal tubule, which develops into the convoluted vas deferens. The convoluted vas then gradually straightens as it courses up the scrotum, progressing first through the external ring of the inguinal canal, before diving into the retroperitoneum via the internal inguinal ring. Sperm within the vas will ultimately fill the widened ampulla of the vas and join with the seminal vesicle (SV) duct (approximately 2 cm in length) to form the ejaculatory duct (ED) that courses through the prostate. Obstruction can occur anywhere along this ductal system. This chapter will focus on the three most common sites of obstruction: the ED; the vas deferens; and the epididymis. The discussion will begin distally at the ED and progress proximally towards the testis.