Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis.
OBJECTIVE
To determine the efficacy of varicocelectomy as a treatment for male factor infertility by improving the chance of spontaneous pregnancy.


METHODS
Meta-analysis.


METHODS
Cleveland Clinic's Glickman Urological Institute.


METHODS
Infertile men with abnormal results on semen analyses and a palpable varicocele.


METHODS
Surgical varicocelectomy.


METHODS
Spontaneous pregnancy outcome.


RESULTS
The odds of spontaneous pregnancy after surgical varicocelectomy, compared with no or medical treatment for palpable varicocele, were 2.87 (95% confidence interval [CI], 1.33-6.20) with use of a random-effects model or 2.63 (95% CI, 1.60-4.33) with use of a fixed-effects model. The number needed to treat was 5.7 (95% CI, 4.4-9.5).


CONCLUSIONS
Surgical varicocelectomy in infertile men with palpable lesions and at least one abnormal semen parameter improves the odds of spontaneous pregnancy in their female partners. Five studies were included (two randomized, three observational). All were scored for bias. Our study suggests that varicocelectomy in selected patients does indeed have beneficial effects on fertility status.
Marmar
Joel L
JL
Division of Urology, Robert Wood Johnson Medical School at Camden, Camden, New Jersey, USA.
Agarwal
Ashok
A
Prabakaran
Sushil
S
Agarwal
Rishi
R
Short
Robert A
RA
Benoff
Susan
S
Thomas
Anthony J
AJ
D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000628:therapy*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D014646:Varicocele / Q000601:surgery*