Does the use of hernia mesh in surgical inguinal hernia repairs cause male infertility? A systematic review and descriptive analysis

Abstract

ObjectiveThe aim of this study was to systematically review the available clinical trials examining male infertility after inguinal hernias were repaired using mesh procedures.MethodsThe Cochrane Library, PubMed, Embase, Web of Science, and Chinese Biomedical Medicine Database were investigated. The Jada score was used to evaluate the quality of the studies, “Oxford Centre for Evidence-based Medicine-Levels of Evidence” was used to assess the level of the trials, and descriptive analysis was used to evaluate the studies.ResultsTwenty nine related trials with a total of 36,552 patients were investigated, including seven randomized controlled trials (RCTs) with 616 patients and 10 clinical trials (1230 patients) with mesh or non-mesh repairs. The Jada score showed that there were six high quality RCTs and one low quality RCT. Levels of evidence determined from the Oxford Centre for Evidence-based Medicine further demonstrated that those six high quality RCTs also had high levels of evidence. It was found that serum testosterone, LH, and FSH levels declined in the laparoscopic group compared to the open group; however, the testicular volume only slightly increased without statistical significance. Testicular and sexual functions remained unchanged after both laparoscopic transabdominal preperitoneal hernia repair (TAPP) and totally extra-peritoneal repair (TEP). We also compared the different meshes used post-surgeries. VyproII/Timesh lightweight mesh had a diminished effect on sperm motility compared to Marlex heavyweight mesh after a one-year follow-up, but there was no effect after 3 years. Additionally, various open hernia repair procedures (Lichtenstein, mesh plug method, posterior pre-peritoneal mesh repair, and anterior tension-free repair) did not cause infertility.ConclusionsThis systematic review suggests that hernia repair with mesh either in an open or a laparoscopic procedure has no significant effect on male fertility.

TEP for elective primary unilateral inguinal hernia repair in men: what do we know?

“…While there are no studies on male infertility following elective primary unilateral inguinal hernia TEP repair in men, as these are available only for patients operated on for bilateral hernias, the findings for bilateral TEP can be extrapolated to unilateral repair since this involves less dissection [82,[101][102][103][104][105][106][107].…”

“…Likewise, another systematic review by Dong [104] featured the studies by Skawran [101], Peeters [102] and the study protocol by Schouten, in addition to the studies by Lal [105], Singh [106], Akbulut [107] and Peeters [82]. But these additional studies, too, included bilateral inguinal hernias.…”

“…From that systematic review, the authors concluded that inguinal hernia repair with mesh in laparoendoscopic technique had no significant effect on male fertility [104]. Although all the included studies featured bilateral inguinal hernias, it can be assumed that the conclusion drawn can also be applied to elective primary unilateral inguinal hernia repair in male patients, since the extent of dissection is less in primary unilateral inguinal hernia than in bilateral repair.…”

The impact of sociodemographic characteristics, lifestyle, work exposure and medical history on semen parameters in young Chinese men: A cross‐sectional study

“…We noted a decrease in forward progression and total motility ( β = −0.09 p = 0.016 and β = −7.28 p = 0.014) in participants with history of urological surgery. Routine urological surgery like surgical repair of varicocele increases sperm concentration and improves sperm motility (Samplaski, Lo, Grober, Zini, & Jarvi, ; Smit et al, ), but other abdominal procedures like the mesh repair have no significant effect on male fertility (Dong, Kujawa, Wang, & Zhao, ). The small number of men (6.3%) having surgical history in our study may not be sufficient to draw a final conclusion.…”

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats

“…A recent systematic review with 7 randomized clinical trials suggests that hernia repair with mesh either in an open or a laparoscopic procedure has no significant effect on male fertility 14 . It seems that mesh hernia repair causes only transitory changes in testicular blood flow and no clinically significant autoimmune reactions 15 .…”