Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective From a Randomized, Controlled Trial

Hamoda, Taha Abo-Almagd Abdel-Meguid; Al-Sayyad, Ahmad; Tayib, Abdulmalik M.; Farsi, Hasan M.

doi:10.1016/j.eururo.2010.12.008

Cited by 229 publications

(125 citation statements)

References 27 publications

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“…In a recently performed prospective, randomized clinical trial, subinguinal MV resulted in improved semen analysis parameters, as well as enhanced rates of spontaneous pregnancies when compared to observation (13.9% vs. 32.9%) with a number needed to treat of 5.27. 27 A meta-analysis performed by Cayan and colleagues in 2009 28 is currently the benchmark for comparison. The authors analyzed 36 studies from 1980 to 2008 and showed that spontaneous pregnancy rates using MV were 41.97%.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Kovac

Fantus

Lipshultz

et al. 2014

CUAJ

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Introduction: Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility. Methods: A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes. Results: Primary treatment with MV was the most cost-effective strategy at $5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about $7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >$4100 CAD/pregnancy. Conclusions: MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Kovac

Fantus

Lipshultz

et al. 2014

CUAJ

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“…Although varicocele is the most common male factor in cases of infertility, 85% of adolescents with uncorrected varicoceles have been able to achieve paternity [2]. However, a small subset of adult males with varicocele may ultimately require surgical repair, which has been shown to improve not only semen parameters [3–5] but also spontaneous pregnancy rates [4,6]. …”

Section: Introductionmentioning

confidence: 99%

The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: A retrospective cohort study

Chu

Zderic

Shukla

et al. 2017

Journal of Pediatric Urology

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Summary Introduction Adolescent males with varicoceles present a dilemma for surveillance and treatment. Testicular volumetrics have not been shown to predict SA outcomes. Serial SAs are thus recommended in asymptomatic adolescent males with varicoceles and normal testicular development, but the natural history of semen parameters is unknown. Objective To explore the natural history of semen parameters in adolescent boys with a left varicocele under active surveillance. Study design Adolescents with an asymptomatic unilateral left varicocele, Tanner V development, normal testicular volumes, and an initial SA were retrospectively reviewed in a single-institution prospectively followed cohort. Total motile count (TMC) was calculated. A cutoff of TMC Z 20 million was used to dichotomize SA results into “normal” or “poor.” Those with poor SA were offered repeat SA. Cumulative probabilities of normal TMC over successive rounds of SA were calculated. Bivariate models were used to explore associations of a second consecutive poor TMC with age and varicocele grade. Results A total of 216 patients provided an initial SA between 1992 and 2015. We excluded 17 for a history of cryptorchidism or incomplete SA data for a final cohort of 199 patients with median follow-up of 3.3 years (interquartile range 1.5–5.6 years). The mean age at initial SA was 17.9 years (range 14.8–21.8 years). One hundred and nine out of 199 had an initial normal TMC. Of the 90 out of 199 with an initially poor TMC, 51 had repeat SA and 24 of the 51 patients improved to normal TMC. Of the 27 patients with two consecutive poor TMCs, 15 had a third SA and five out of 15 improved to normal TMC. Thus, cumulatively, 55%, 67%, and 69% of all patients had a normal TMC after an initial, second, and third SA, respectively. However, fewer patients in each round of SA normalized their TMC (Figure). Neither age nor varicocele grade was associated with a second consecutive poor TMC. Discussion Two-thirds of Tanner V boys with an uncorrected varicocele and normal testicular volumes achieve a normal TMC regardless of varicocele grade or age. Despite Tanner V development, 47% with an initial “poor” SA will improve to normal status without surgery. However, a small subgroup of patients will have persistently poor TMC and thus should be targeted in future research for timely intervention. Conclusion Semen parameters improve over time. SA should be followed and repeated at least once in symptomatic Tanner V boys with varicoceles.

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“…Recently, a well-designed randomized clinical trial (RCT) was introduced in 2011 and, subsequently, a novel meta-analysis was provided in 2012 [12,13,14]. These studies could be important evidence that varicocele repair in men from couples with otherwise unexplained subfertility may improve pregnancy outcome [13].…”

Section: Introductionmentioning

confidence: 99%

Effect of Varicocelectomy on Male Infertility

Seo

2014

Korean J Urol

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Varicocele is the most common cause of male infertility and is generally correctable or at least improvable by various surgical and radiologic techniques. Therefore, it seems simple and reasonable that varicocele should be treated in infertile men with varicocele. However, the role of varicocele repair for the treatment of subfertile men has been questioned during the past decades. Although varicocele repair can induce improvement of semen quality, the obvious benefit of spontaneous pregnancy has not been shown through several meta-analyses. Recently, a well-designed randomized clinical trial was introduced, and, subsequently, a novel meta-analysis was published. The results of these studies advocate that varicocele repair be regarded as a standard treatment modality in infertile men with clinical varicocele and abnormal semen parameters, which is also supported by current clinical guidelines. Microsurgical varicocelectomy has been regarded as the gold standard compared to other surgical techniques and radiological management in terms of the recurrence rate and the pregnancy rate. However, none of the methods has been proven through well-designed clinical trials to be superior to the others in the ability to improve fertility. Accordingly, high-quality data from well-designed studies are needed to resolve unanswered questions and update current knowledge. Upcoming trials should be designed to define the best technique and also to define how to select the best candidates who will benefit from varicocele repair.

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Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective From a Randomized, Controlled Trial

Cited by 229 publications

References 27 publications

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

The natural history of semen parameters in untreated asymptomatic adolescent varicocele patients: A retrospective cohort study

Effect of Varicocelectomy on Male Infertility

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