Should the current guidelines for the treatment of varicoceles in infertile men be re-evaluated?

Yan, Sylvia; Shabbir, Majed; Yap, Tet; Homa, Sheryl T.; Ramsay, Jonathan; McEleny, Kevin; Minhas, Suks

doi:10.1080/14647273.2019.1582807

Cited by 20 publications

(16 citation statements)

References 84 publications

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“…In the past several years there has been some evidence that increased DNA fragmentation, often defined as a DNA fragmentation index (DFI) >30%, may result in failure of implantation during IUI or ART cycles. [47][48][49][50] Additionally, several studies have shown that sperm DNA fragmentation can be improved in men with varicoceles, as Wang et al in their meta-analysis found that post-varicocelectomy DFI improved by a mean difference of 3.37% (95% CI: 2.65% to 4.09%). 51 Given this improvement in DFI after varicocele correction, there has been some discussion as to whether elevated DNA fragmentation should also be an indication to correct a clinical varicocele.…”

Section: Special Considerations: the Effect Of Varicocele On Dna Fragmentioning

confidence: 99%

<p>Varicocele Repair Prior to Assisted Reproductive Technology: Patient Selection and Special Considerations</p>

Kohn

Haney

Nichols

et al. 2020

RRU

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Clinical varicoceles are one of the most commonly identified physical exam abnormalities in men presenting with infertility. Clinical varicoceles can cause impaired spermatogenesis and surgical correction can improve semen parameters in select men. Increasingly, andrologists are performing varicocele repairs prior to intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) to boost male fertility potential. In this review, we evaluated the available literature 1) to determine if varicocelectomy prior to IUI or assisted reproductive technologies proved to improve sperm production or pregnancy outcomes; and 2) to identify who may be the ideal candidate for pre-IUI/ART varicocelectomy. Overall, few studies have explored this topic and little can be concluded about the impact of varicocelectomy prior to IUI. The evidence, however, does support that correcting a clinical varicocele can increase pregnancy outcomes in couples who plan to pursue IVF or ICSI. When selecting patients for varicocelectomy prior to IUI or ART, clinicians should evaluate female age as improvement in semen parameters can take 6 months after varicocelectomy and this duration of time may be deleterious in cases of advanced maternal age when each cycle becomes increasingly important. Overall, the currently limited literature regarding clinical varicoceles correction demonstrates that pregnancy rates can be increased when comparing patients who have undergone varicocelectomy prior to ART with those who had clinical varicocele but did not undergo surgery.

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Section: Special Considerations: the Effect Of Varicocele On Dna Fragmentioning

confidence: 99%

<p>Varicocele Repair Prior to Assisted Reproductive Technology: Patient Selection and Special Considerations</p>

Kohn

Haney

Nichols

et al. 2020

RRU

View full text Add to dashboard Cite

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“…There are many topics which lend themselves to a lively debate in reproductive medicine and we have covered many of these over the years in the pages of Human Fertility. In this issue we touch on a long-standing debate about the role of varicocele in male infertility, with a review article by Yan et al (2021) which proposes that it is now time to re-evaluate the current guidelines.…”

Section: Varicoceles and Other Controversiesmentioning

confidence: 99%

Varicoceles and other controversies

Pacey

2021

Human Fertility

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“…A good example is the severe male factor infertility due to presence of varicocele. Surgical or radiological varicocelectomy can lead to improvement in semen parameters and an increase in chances of natural conception, or reduction in the need for surgical sperm retrieval 24 . Treatment of varicocele has also been associated with a reduction in the risk of pregnancy loss in couples with recurrent miscarriages (13.3% versus 69.2%, P=0.001) 25 .…”

Section: The Era Of Big Data Is Enabling Better Prevention Diagnosis and Treatmentsmentioning

confidence: 99%

Big Data and Artificial Intelligence (AI) are Poised to Transform Infertility Healthcare

Santiago¹,

Polański²

2020

Preprint

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Advances in machine learning (ML) and artificial intelligence (AI) are transforming the way we treat patients in ways not even imagined a few years ago. Cancer research is at the forefront of this movement. Infertility, though not a life-threatening condition, affects around 15% of couples trying for a pregnancy. Increasing availability of large datasets from various sources creates an opportunity to introduce ML and AI into infertility prevention and treatment. At present in the field of assisted reproduction, very little is done in order to prevent infertility from arising, with the main focus put on treatment when often advanced maternal age and low ovarian reserve make it very difficult to conceive. A shift from this disease-centric model to a health centric model in infertility is already taking place with more emphasis on the patient as an active participator in the process. Poor quality and incomplete data as well as biological variability remain the main limitations in the widespread and reliable implementation of AI in the field of reproductive medicine. That said, one of the areas where this technology managed to find a foothold is identification of developmentally competent embryos. More work is required however to learn about ways to improve natural conception, the detection and diagnosis of infertility, and improve assisted reproduction treatments (ART) and ultimately, develop clinically useful algorithms able to adjust treatment regimens in order to assure a successful outcome of either fertility preservation or infertility treatment. Progress in genomics, digital technologies and advances in integrative biology has had a tremendousimpact on research and clinical medicine. With the rise of ‘big data’, artificial intelligence, and the advances in molecular profiling, there is an enormous potential to transform not only scientific research progress, but also clinical decision making towards predictive, preventive, and personalized medicine. In the field of reproductive health, there is now an exciting opportunity to leverage these technologies and develop more sophisticated approaches to diagnose and treat infertility disorders. In this review, we present a comprehensive analysis and interpretation of different innovation forces that are driving the emergence of a system approach to the infertility sector. Here we discuss recent influential work and explore the limitations of the use of Machine Learning models in this rapidly developing area.

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Should the current guidelines for the treatment of varicoceles in infertile men be re-evaluated?

Cited by 20 publications

References 84 publications

<p>Varicocele Repair Prior to Assisted Reproductive Technology: Patient Selection and Special Considerations</p>

<p>Varicocele Repair Prior to Assisted Reproductive Technology: Patient Selection and Special Considerations</p>

Varicoceles and other controversies

Big Data and Artificial Intelligence (AI) are Poised to Transform Infertility Healthcare

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