title: Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach.
abstract: OBJECTIVE
  To determine the efficacy of varicocelectomy in improving semen parameters.
  
  
  METHODS
  A meta-analysis was performed to evaluate both randomized controlled trials and observational studies using a new scoring system. This scoring system was developed to adjust and quantify for various potential sources of bias, including selection bias, follow-up bias, confounding bias, information or detection bias, and other types of bias, such as misclassification. Of 136 studies identified through the electronic and hand search of references, only 17 studies met our inclusion criteria. The study population was infertile men with clinically palpable unilateral or bilateral varicocele and at least one abnormal semen parameter who had undergone surgical varicocelectomy (high ligation or inguinal microsurgery). Only those studies that had at least three semen analyses (ie, sperm count, motility, and morphology) per patient, before and after surgical varicocelectomy, were included.
  
  
  RESULTS
  The combined analysis demonstrated that the sperm concentration increased by 9.71 x 10(6)/mL (95% confidence interval [CI] 7.34 to 12.08, P <0.00001) and motility increased by 9.92% (95% CI 4.90 to 14.95, P = 0.0001) after microsurgical varicocelectomy. Similarly, the sperm concentration increased by 12.03 x 10(6)/mL (95% CI 5.71 to 18.35, P = 0.0002) and motility increased by 11.72% (95% CI 4.33 to 19.12, P = 0.002) after high ligation varicocelectomy. The improvement in World Health Organization sperm morphology was 3.16% (95% CI 0.72 to 5.60, P = 0.01) after both microsurgery and high ligation varicocelectomy.
  
  
  CONCLUSIONS
  Surgical varicocelectomy significantly improves semen parameters in infertile men with palpable varicocele and abnormal semen parameters.
authors: Reproductive Research Center, Glickman Urological Institute, Department of Obstetrics Gynecology, Cleveland Clinic, Cleveland, Ohio 44195, USA. agarwaa@ccf.org
authors: Ashok
authors: A
authors: Agarwal
authors: Fnu
authors: F
authors: Deepinder
authors: Marcello
authors: M
authors: Cocuzza
authors: Rishi
authors: R
authors: Agarwal
authors: Robert A
authors: RA
authors: Short
authors: Edmund
authors: E
authors: Sabanegh
authors: Joel L
authors: JL
authors: Marmar
mesh_terms: D000328:Adult; D015982:Bias; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000601:surgery; D008026:Ligation; D008297:Male; D008866:Microsurgery; D011184:Postoperative Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D016037:Single-Blind Method; D013076:Sperm Count; D013081:Sperm Motility; D013094:Spermatozoa / Q000648:ultrastructure*; D014646:Varicocele / Q000150:complications / Q000601:surgery*