Treatment of Varicocele in Subfertile Men: The Cochrane Review – A Contrary Opinion

Ficarra, Vincenzo; Cerruto, Maria Angela; Liguori, Giovanni; Mazzoni, G; Minucci, Sergio; Tracia, Angelo; Gentile, Vincenzo

doi:10.1016/j.eururo.2005.11.023

Cited by 175 publications

(129 citation statements)

References 20 publications

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“…20 Reviews of randomised clinical trials have raised doubts about the benefit of varicocele treatment in infertile men, and therefore the couple should be informed about the uncertainties of treatment benefit. 21,22 According to the EAU guidelines 2010, 23 varicocele treatment is recommended for symptomatic cases and for adolescents who have progressive failure of testicular development documented by serial clinical examinations. 24,25 Cryptorchidism…”

Section: Varicocelementioning

confidence: 99%

Male infertility: Pathogenesis and clinical diagnosis

Krausz¹

2011

Best Practice & Research Clinical Endocrinology & Metab

413

315

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Section: Varicocelementioning

confidence: 99%

Male infertility: Pathogenesis and clinical diagnosis

Krausz¹

2011

Best Practice & Research Clinical Endocrinology & Metab

413

315

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“…We agree that the meta-analytic interpretation of these data does not provide information based on evidence that is useful in improving clinical practice (16). In particular, the high rate of patients who dropped out and/or were lost to follow-up calls into question the propriety of randomized studies comprised of an untreated arm that may appear unethical in such patients.…”

Section: Discussionmentioning

confidence: 90%

Efficacy of spermatic vein ligation in patients affected by high grade left varicocele

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Purpose: To study the effect of high grade varicocele treatment in infertile patients. Materials and Methods: Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility--related disease; no obvious causes of infertility in the subject's partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period. Results: Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple). The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012). Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10 6 /mL compared to 19.7x10 6 /mL in the postoperative period (p < 0.0001). Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001). Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001). Conclusion: Surgical treatment of high grade varicocele proved to effectively treat associated infertility by improving seminal parameters and pregnancy rate in our patient cohort.

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“…However, a meta-analysis of seven randomized, controlled trials of varicocele repair for male subfertility concluded that treatment of varicocele in men from couples with otherwise unexplained subfertility could not be recommended [48]. The study by Evers and Collins [48] was challenged by Ficcara et al (2006), who argued that less than half of the studies of this Cochrane meta-analysis included patients with abnormal semen analysis and palpable varicocele. Moreover, Ficcara and colleagues [49] demonstrated that the methodology and statistical power of the Cochrane review were poor, thereby minimizing the significance of the conclusions against varicocele repair.…”

Section: Microsurgical Repair Of Clinical Varicocelementioning

confidence: 97%

“…The study by Evers and Collins [48] was challenged by Ficcara et al (2006), who argued that less than half of the studies of this Cochrane meta-analysis included patients with abnormal semen analysis and palpable varicocele. Moreover, Ficcara and colleagues [49] demonstrated that the methodology and statistical power of the Cochrane review were poor, thereby minimizing the significance of the conclusions against varicocele repair. The most recent meta-analysis on varicocelectomy by Marmar and colleagues (2007) unequivocally demonstrated the benefit of the surgical treatment of clinical varicoceles in infertile men with abnormal semen analyses [50].…”

Section: Microsurgical Repair Of Clinical Varicocelementioning

confidence: 99%

What is New in the Clinical Assessment and Treatment of the Infertile Male

Esteves¹

2011

TORSJ

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Male infertility is a fast-evolving area. Recently published evidence has challenged several established concepts and added to the knowledge in the field. Traditionally, the clinical assessment of the subfertile male includes a history and physical examination, hormonal evaluation and semen analyses. Regarding the latter, the World Health Organization has established new reference values that in general include lower limits than those of previous editions. Specialized sperm function assays, such as sperm DNA integrity and measurements of oxidative stress, are now clinically available and may be integrated to the conventional semen analysis to provide a more comprehensive evaluation of a man's fertility status. Also, molecular biology genetic testing involving the Y-chromosome can correctly identify oligozoospermic and azoospermic men misdiagnosed as having idiopathic infertility and be of prognostic value for sperm retrieval in non-obstructive azoospermia. In the field of treatment, emerging evidence suggests that antioxidant therapy along with life-style modifications improve the male reproductive health. Microsurgery has increased the success rates for both varicocele treatment and sperm retrieval for assisted conception. Microsurgical treatment of clinical varicoceles may optimize reproductive outcome of couples undergoing intracytoplasmic sperm injection or microsurgical testicular sperm extraction. Men with non-obstructive azoospermia, elevated follicle-stimulating hormone levels and small testes may no longer be considered sterile. Modern retrieval techniques are used to collect testicular sperm that can be used to produce a healthy biological offspring via assisted conception. This article reviews what is new in the clinical assessment and treatment of the infertile male, including the implications of this increased knowledge in the management of the infertile couple and assisted reproduction technology outcomes.

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Treatment of Varicocele in Subfertile Men: The Cochrane Review – A Contrary Opinion

Cited by 175 publications

References 20 publications

Male infertility: Pathogenesis and clinical diagnosis

Male infertility: Pathogenesis and clinical diagnosis

Efficacy of spermatic vein ligation in patients affected by high grade left varicocele

What is New in the Clinical Assessment and Treatment of the Infertile Male

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