Would you offer varicocele repair to a man with elevated DNA fragmentation but otherwise normal semen parameters?

I would offer a varicocele repair to this patient, but would also carefully assess other risk factors for elevated DNA fragmentation, including lifestyle/occupational exposures like tobacco/vaping, obesity, alcohol/drug use, including cannabis, et cetera. If there are additional exposures, I would counsel him about lifestyle modification along with varicocele repair. In general, this is one scenario where DNA fragmentation testing is indicated (others being failed IVF or recurrent pregnancy loss).