The benefits of varicocele repair for achieving pregnancy in male infertility: A systematic review and meta-analysis

Abstract

Introduction: Varicocele is one of the most common treatable causes of male infertility. However, the decision to perform varicocelectomy before starting a fertility program remains controversial. This study aimed to thoroughly review and analyze the benefit of varicocele repair and its impact on the success rate of a fertility program. Materials and methods: A systematic literature search was performed using MEDLINE, Cochrane Library, and Wiley Library. The primary outcome was the pregnancy rate, and the secondary outcomes were live birth rate and surgical sperm retrieval success rate. Outcomes were compared between men who underwent treatment for a varicocele and those that did not. The pooled analysis data are presented as odds ratios with 95% confidence intervals. Results: A total of 31 articles were included in the meta-analysis. The pregnancy rate was significantly higher in the treated group (odds ratio ¼ 1.82; 95% confidence interval: 1.37-2.41; P < 0.0001) along with the live birth rate (odds ratio ¼ 2.80; 95% confidence interval: 1.67-4.72; P ¼ 0.0001). The further subgroup analysis revealed a higher pregnancy rate in treated men with azoospermia, subnormal semen parameters, and normozoospermia (P ¼ 0.04, P ¼ 0.0005, and P ¼ 0.002, respectively), while the live birth rate was only significantly higher in the treated men with subnormal semen parameters and normozoospermia (P ¼ 0.001 and P < 0.0001). Treated varicocele also led to a higher sperm retrieval rate in azoospermic patients (odds ratio ¼ 1.69; 95% confidence interval: 1.16-2.45; P ¼ 0.006). Conclusions: Varicocele repair increased the pregnancy and live birth rates regardless the semen analysis result, along with the sperm retrieval success rate in azoospermic men. Thus, varicocele repair may be beneficial prior to joining a fertility program.

Improvement of sperm morphology after surgical varicocele repair

“…Although pregnancy and live birth rates are clearly the strongest end points in this setting, semen parameters remain the most reliable variable to evaluate the efficacy of a male factor treatment, including varicocele correction. Accordingly, many original articles measured the clinical benefit induced by varicocele surgical correction in male infertility through the potential improvement in conventional semen analysis parameters 25,34 . However, no studies so far applied the detailed morphologic microscopic sperm evaluation as primary end point of the surgical treatment.…”

“…In brief, ten of 12 studies reported that none of the participants had SARS-CoV-2 RNA benefit induced by varicocele surgical correction in male infertility through the potential improvement in conventional semen analysis parameters. 25,34 However, no studies so far applied the detailed morphologic microscopic sperm evaluation as primary end point of the surgical treatment. Indeed, our results demonstrated for the first time a microstructural sperm improvement after surgery, sustained by a reduction in head (ie microcephaly, macrocephaly and cytoplasmic appendix) and tail (ie agenesis and coiled form) abnormalities.…”

“…However, the results are controversial. For example, some researchers have reported that SARS-CoV-2 was not detected in the male reproductive tract, [25][26][27][28][29][30][31][32][33][34] while others reported that SARS-CoV-2 RNA was found in the semen or testes of COVID-19 patients. 35,36 There are also unknown factors regarding COVID-19 and male reproduction.…”

Improvement of Sperm Morphology After Surgical Varicocele Repair

“…Although pregnancy and live birth rates are clearly the strongest end-points in this setting, semen parameters remain the most reliable variable to evaluate the e cacy of a male factor treatment, including varicocele correction. Accordingly, many original articles measured the clinical bene t induced by varicocele surgical correction in male infertility through the potential improvement in conventional semen analysis parameters 25,33 . However, no studies so far applied the detailed morphologic microscopic sperm evaluation as primary endpoint of the surgical treatment.…”

Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization

“…It has been shown that embolization successfully corrects varicocele, whether with coils or glue, in an average of 92% of cases [9]. Furthermore, varicocele correction has an important impact on the treatment of infertility [10] since it has been found to lead to clinical reproductive outcome improvement of parameters, such as sperm quality and pregnancy rate, when comparing patients undergoing varicocele correction with those with the untreated condition [2,11,12].…”