Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis

Kirby, E. Will; Wiener, Laura Elizabeth; Rajanahally, Saneal; Crowell, Karen; Coward, R. Matthew

doi:10.1016/j.fertnstert.2016.07.1093

Cited by 144 publications

(83 citation statements)

References 23 publications

(41 reference statements)

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“…A recent meta‐analysis has demonstrated a strong trend toward improvements in natural pregnancy rate (PR) [OR = 1.69, 95% CI (0.951, 3.020), p = 0.073] and a statistically significant increase in live birth rates (LBR) [OR = 1.699, 95% CI (1.020, 2.831), p = 0.04] following intervention. Varicocelectomy has also been associated with a statistically significant increase in PR [OR = 2.3, 95% CI (1.022, 5.342), p = 0.044] and LBR [OR = 2.2, 95% CI (0.994, 4.904), p = 0.05] in men with non‐obstructive azoospermia (Kirby et al ., ).…”

Section: Introductionmentioning

confidence: 97%

The role of artery‐preserving varicocelectomy in subfertile men with severe oligozoospermia: a randomized controlled study

et al. 2019

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Background: There is wide agreement nowadays that a clinical varicocoele should be ligated to treat male factor infertility. However, the significance of testicular artery preservation in patients with severe oligozoospermia has not been addressed before. Objectives: To assess the outcome of varicocelectomy in infertile men with severe oligozoospermia and clinical varicocoeles and to compare internal spermatic artery preservation vs. artery ligation. Materials and Methods: This prospective randomized study included 302 infertile patients with severe oligozoospermia and clinical (grade II/III) varicocoeles. Patients were randomized into two groups: group A (150 patients) underwent artery-preserving varicocelectomy (APV) and group B (152 patients) underwent artery-ligating varicocelectomy (ALV). The primary outcome was to assess the changes in sperm density and motility at 3 and 6 months postoperatively in both groups. The secondary outcome was to compare the natural pregnancy rate at 1-year of follow-up. Univariate and multivariate analyses were performed to determine factors affecting pregnancy rate. Results: In both groups, there was a statistically significant improvement in sperm density and motility at 3 and 6 months postoperatively. In group A, there was a greater improvement in sperm density (p < 0.001) and motility (p < 0.001) compared to group B. At 1-year follow-up, overall 35.1% achieved a natural pregnancy. Group A achieved a significantly higher natural pregnancy rate (40% vs. 30%, p value = 0.03) compared to group B. Smaller testicular volume and ALV were the independent predictors of lower pregnancy rate ((HR = 3.2, 95% CI 1.2-8.3, p = 0.01) and (HR = 3.2, 95% CI 1.4-7.1, p = 0.003), respectively). Conclusion: In men with severe oligozoospermia and a clinical varicocoele, APV results in improved outcomes as compared to ALV with respect to semen parameters and natural pregnancy rates. Therefore, all attempts should be made to preserve internal spermatic arteries (ISA) during varicocelectomy in men with severe oligozoospermia.

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Section: Introductionmentioning

confidence: 97%

The role of artery‐preserving varicocelectomy in subfertile men with severe oligozoospermia: a randomized controlled study

et al. 2019

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“…This point gains its support from a very recent systematic review and meta-analysis, which revealed that varicocele repair improved pregnancy and live birth rates in oligospermic and azoospermic patients with varicoceles in couples undergoing ARTs, and improved sperm retrieval rates for persistently azoospermic men requiring testicular sperm extraction after varicocele repair (Kirby, Wiener, Rajanahally, Crowell, & Coward, 2016). This point gains its support from a very recent systematic review and meta-analysis, which revealed that varicocele repair improved pregnancy and live birth rates in oligospermic and azoospermic patients with varicoceles in couples undergoing ARTs, and improved sperm retrieval rates for persistently azoospermic men requiring testicular sperm extraction after varicocele repair (Kirby, Wiener, Rajanahally, Crowell, & Coward, 2016).…”

Section: Natural History and Treatment Strategy Of Infertility Withmentioning

confidence: 95%

“…Moreover, combination of the two approaches seems to produce some extent of synergistic effect. This point gains its support from a very recent systematic review and meta-analysis, which revealed that varicocele repair improved pregnancy and live birth rates in oligospermic and azoospermic patients with varicoceles in couples undergoing ARTs, and improved sperm retrieval rates for persistently azoospermic men requiring testicular sperm extraction after varicocele repair (Kirby, Wiener, Rajanahally, Crowell, & Coward, 2016). Factors may sway couples towards ICSI rather than varicocelectomy are advanced female reproductive age, fear of surgery and its potential complications, and the perception of comparable pregnancy outcome.…”

Section: Natural History and Treatment Strategy Of Infertility Withmentioning

confidence: 96%

Microsurgical varicocelectomy for clinical varicocele: A review for potential new indications

Wan

Wang

2017

Andrologia

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Microsurgical varicocelectomy is considered the gold-standard technique treating varicocele in both adults and adolescents, due to relatively more favourable outcomes and lower post-operative recurrence and complication rates. Despite of mounting literature on this topic, several aspects are still not well defined. We summarised the most recent literature and presented findings that might extend its indications. Microsurgical varicocelectomy and intracytoplasmic sperm injection are both effective to father a child for infertile men with clinical varicocele even for those with worst condition of spermatozoa, nonobstructive azoospermia, and prior varicocele repair has substantial benefits for couples with a clinical varicocele. Microsurgical subinguinal and inguinal varicocelectomy seem to have comparable effectiveness for adolescents and infertile men with varicoceles. However, the subinguinal approach may have some advantages to deal with painful varicocele. The superior outcomes of bilateral varicocelectomy for patients with clinical left varicocele and concomitant clinical right varicocele are justified, while the benefit is still uncertain for concomitant subclinical right varicocele. Varicocelectomy may have the potential to improve sexual function along with serum testosterone. In conclusion, indications for microsurgical varicocelectomy may be extended by the concomitant right and left clinical varicocele and sexual dysfunction with varicocele.

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“…Overall, the literature examining the effectiveness of IUI after varicocelectomy is suboptimal, with all existing studies being retrospective and underpowered. No meta-analysis has specifically examined the efficacy of IUI after varicocelectomy, owing to the dearth of studies and the poor quality of existing studies, as noted by Kirby et al in a 2016 metaanalysis examining the effect of ART on pregnancy and live birth rates after varicocele repair (36). Within the existing literature, after varicocele correction, the per-couple pregnancy rate after IUI ranges from 7.7% to 50%, making it a challenge to establish the true rate, and most of the studies that compare IUI success in men with treated versus untreated varicocele fail to find a statistically significant difference.…”

Section: Intrauterine Insemination After Varicocelectomymentioning

confidence: 99%

Varicocelectomy before assisted reproductive technology: are outcomes improved?

Kohn

Pastuszak

2017

Fertility and Sterility

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Clinical varicoceles have been associated with impaired semen parameters and male-factor infertility. Varicocele repair can improve live birth rates for men with clinical varicocele. Varicocelectomy is often combined with assisted reproductive techniques (ART) such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Here we review the literature examining varicocelectomy before ART to evaluate whether improved pregnancy outcomes are realized. Although insufficient evidence exists to determine if correcting a varicocele improves IUI outcomes, a clinical benefit is observed when correcting a clinical varicocele in oligospermic and nonobstructed azoospermic men before IVF/ICSI. In couples seeking fertility with the use of ART, varicocele repair may offer improvement in semen parameters and may decrease the level of ART needed to achieve successful pregnancy.

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Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis

Cited by 144 publications

References 23 publications

The role of artery‐preserving varicocelectomy in subfertile men with severe oligozoospermia: a randomized controlled study

The role of artery‐preserving varicocelectomy in subfertile men with severe oligozoospermia: a randomized controlled study

Microsurgical varicocelectomy for clinical varicocele: A review for potential new indications

Varicocelectomy before assisted reproductive technology: are outcomes improved?

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