Varicocele and Male Factor Infertility Treatment: A New Meta-analysis and Review of the Role of Varicocele Repair

Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia.
European Urology (Impact Factor: 13.94). 07/2011; 60(4):796-808. DOI: 10.1016/j.eururo.2011.06.018
Source: PubMed


Varicocele is a common condition, found in many men who present for infertility evaluation.
To assess the effect of varicocelectomy on male infertility.
A literature search was performed using Embase and Medline. Literature reviewed included meta-analyses and randomized and nonrandomized prospective (controlled and noncontrolled) studies. In addition, a new meta-analysis was performed.
Four randomized controlled trials reporting on pregnancy outcome after repair of clinical varicoceles in oligozoospermic men were identified. Using the random effect model, the combined odds ratio was 2.23 (95% confidence interval [CI], 0.86-5.78; p=0.091), indicating that varicocelectomy is moderately superior to observation, but the effect is not statistically significant. We identified 22, 17, and 5 prospective studies reporting on sperm concentration, total motility, and progressive motility, respectively, before and after repair of clinical varicocele. The random effect model combined improvement in sperm concentration was 12.32 million sperm per milliliter (95% CI, 9.45-15.19; p<0.0001). The random effect model combined improvement in sperm total and progressive motility were 10.86% (95% CI, 7.07-14.65; p<0.0001) and 9.69% (95% CI, 4.86-14.52; p=0.003), respectively. These results indicate that varicocelectomy is associated with a significant increase in sperm concentration as well as total and progressive motility. Prospective studies also show that varicocelectomy reduces seminal oxidative stress and sperm DNA damage as well as improving sperm ultramorphology. Studies indicate that a microsurgical approach to a varicocele repair results in less recurrence and fewer complications than other techniques.
Although there is no conclusive evidence that a varicocele repair improves spontaneous pregnancy rates, varicocelectomy improves sperm parameters (count and total and progressive motility), reduces sperm DNA damage and seminal oxidative stress, and improves sperm ultramorphology. The various methods of repair are all viable options, but microsurgical repair seems to be associated with better outcomes.

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    • "Varicocele has a harmful effect on spermatogenesis [3,4]. Although the influence of varicocele treatment on fertility remains controversial, there is clear evidence that varicocelectomy improves the semen parameters that serve as surrogate markers for potential fertility [5,6]. Microsurgical varicocelectomy has been shown to be the most effective method among the surgical techniques available to treat varicocele and produces the least morbidity in patients [7]. "
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    ABSTRACT: Purpose In the present study, we aimed to identify the incidence of fever in patients after subinguinal microsurgical varicocelectomy and to evaluate the clinical factors associated with the occurrence of the fever. Materials and Methods We retrospectively reviewed the cases of patients who underwent subinguinal microsurgical varicocelectomy (group A) under spinal anesthesia. In addition, we reviewed the cases of patients who underwent microsurgical vasovasostomy under spinal anesthesia as a control group (group B). The incidence of fever in each group was compared. We investigated the clinical factors influencing the occurrence of fever in the patients of group A. Results The incidence of fever in group A was significantly higher than that in group B (32.5% [53/163] vs. 0.4% [1/284]; p<0.001). Clinical factors such as age, varicocele grade, weight, height, operation time, number of ligated veins, usage of immediate postoperative analgesics, presence of postoperative hematoma, and duration of hospital stay were not significantly associated with the occurrence of fever. Conclusions We found that one-third of the patients developed transient fever after subinguinal microsurgical varicocelectomy, and therefore, this information should be provided during preoperative counseling.
    04/2014; 32(1):56-60. DOI:10.5534/wjmh.2014.32.1.56
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    • "More recently, Abdel-Meguid in a prospective randomized trial demonstrated Spontaneous pregnancies in 13.9% of the controls compared with 32.9% of the treated patients, with an odds ratio of 3.04 (Abdel-Meguid et al., 2011). Moreover, Bazeem performed an update of the review of the literature (Baazeem et al., 2011); in addition, a new meta-analysis was performed. "
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    ABSTRACT: We reviewed a large number of patients from 2000 to 2010 that underwent varicocoele correction using the retrograde sclerotization approach. Three hundred and seventy-six of them were included in the study, as they met the inclusion criteria. Mean age at the time of surgery was 32 years (SD: 6.5); 32% of them were 35 years and older. Patients were classified according to the clinical classification (GC) and Sarteschi's Doppler ultrasound classification (GS). The patients showed up at the clinic after an average time of 30 months of referred infertility related (SD: 28.54). Patients underwent pre-operative assessment with physical examination, sperm analysis and Doppler ultrasound, and again the same assessment at least 3 months after surgery. We evaluated the following parameters: sperm concentration (millions/mL, CONC), percentage motility (a+b, MOT) and the percentage of morphologically typical spermatozoa (MOR). Univariate and Multivariate analysis were performed. The research of Pearson's coefficients was performed to test the correlation between sperm parameters and age, SG, CG. Semen specimens were evaluated according to WHO 1999 criteria. Mean CONC varied from 34.5 to 47.0 millions/mL (+12.5; p < 0.001); MOT from 27.2 to 34.5% (+7.3%; p < 0.001); and MOR from 44.0 to 47.6% (+3.6%; p = 0.001). Univariable and multivariable analysis of variance related to age showed no significant difference of parameters improvement. Pearson's correlation coefficient for pre-operative and post-operative sperm MOT related to patients' age was respectively −0.11 (p < 0.001) and −0.18 (p = 0.04). No other significance was found. Usefulness of treating infertile patients affected by varicocoele is confirmed: varicocoele correction leads to significant sperm parameters improvement. There is no evidence of different improvement related to patients' age. The decline in sperm motility related to age of the patients seems to be only age-dependent: the usefulness of treating patients affected by varicocoele is not influenced by their age: treatment should also be offered to older patients.
    Andrology 03/2014; 2(3). DOI:10.1111/j.2047-2927.2014.00197.x · 2.30 Impact Factor
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    • "Recently, Baazeem et al. [27] reported a new meta-analysis. Included were 380 couples (192 randomized to treatment and 188 randomized to observation) from four RCTs that reported pregnancy outcomes after repair of clinical varicocele in oligospermic men. "
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    ABSTRACT: To elucidate the impact of surgical varicocele repair on the pregnancy rate through new meta-analyses of randomized clinical trials that compared surgical varicocele repair and observation. The PubMed and Embase online databases were searched for studies released before December 2012. References were manually reviewed, and two researchers independently extracted the data. To assess the quality of the studies, the Cochrane risk of bias as a quality assessment tool for randomized controlled trials was applied. Seven randomized clinical trials were included in our meta-analyses, all of which compared pregnancy outcomes between surgical varicocele repair and control. There were differences in enrollment criteria among the studies. Four studies included patients with clinical varicocele, but three studies enrolled patients with subclinical varicocele. Meanwhile, four trials enrolled patients with impaired semen quality only, but the other three trials did not. In a meta-analysis of all seven trials, a forest plot using the random-effects model showed an odds ratio (OR) of 1.90 (95% confidence interval [CI], 0.77 to 4.66; p=0.1621). However, for subanalysis of three studies that included patients with clinical varicocele and abnormal semen parameters, the fixed-effects pooled OR was significant (OR, 4.15; 95% CI, 2.31 to 7.45; p<0.001), favoring varicocelectomy. Varicocelectomy for male subfertility is proven effective in men with clinical varicocele and impaired semen quality. Therefore, surgical repair should be offered as the first-line treatment of clinical varicocele in subfertile men.
    Korean journal of urology 10/2013; 54(10):703-9. DOI:10.4111/kju.2013.54.10.703
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