title: Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair.
abstract: BACKGROUND
  Varicocele is a common condition, found in many men who present for infertility evaluation.
  
  
  OBJECTIVE
  To assess the effect of varicocelectomy on male infertility.
  
  
  METHODS
  A literature search was performed using Embase and Medline. Literature reviewed included meta-analyses and randomized and nonrandomized prospective (controlled and noncontrolled) studies. In addition, a new meta-analysis was performed.
  
  
  RESULTS
  Four randomized controlled trials reporting on pregnancy outcome after repair of clinical varicoceles in oligozoospermic men were identified. Using the random effect model, the combined odds ratio was 2.23 (95% confidence interval [CI], 0.86-5.78; p=0.091), indicating that varicocelectomy is moderately superior to observation, but the effect is not statistically significant. We identified 22, 17, and 5 prospective studies reporting on sperm concentration, total motility, and progressive motility, respectively, before and after repair of clinical varicocele. The random effect model combined improvement in sperm concentration was 12.32 million sperm per milliliter (95% CI, 9.45-15.19; p<0.0001). The random effect model combined improvement in sperm total and progressive motility were 10.86% (95% CI, 7.07-14.65; p<0.0001) and 9.69% (95% CI, 4.86-14.52; p=0.003), respectively. These results indicate that varicocelectomy is associated with a significant increase in sperm concentration as well as total and progressive motility. Prospective studies also show that varicocelectomy reduces seminal oxidative stress and sperm DNA damage as well as improving sperm ultramorphology. Studies indicate that a microsurgical approach to a varicocele repair results in less recurrence and fewer complications than other techniques.
  
  
  CONCLUSIONS
  Although there is no conclusive evidence that a varicocele repair improves spontaneous pregnancy rates, varicocelectomy improves sperm parameters (count and total and progressive motility), reduces sperm DNA damage and seminal oxidative stress, and improves sperm ultramorphology. The various methods of repair are all viable options, but microsurgical repair seems to be associated with better outcomes.
authors: Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia. theurologist@gmail.com
authors: Abdulaziz
authors: A
authors: Baazeem
authors: Eric
authors: E
authors: Belzile
authors: Antonio
authors: A
authors: Ciampi
authors: Gert
authors: G
authors: Dohle
authors: Keith
authors: K
authors: Jarvi
authors: Andrea
authors: A
authors: Salonia
authors: Wolfgang
authors: W
authors: Weidner
authors: Armand
authors: A
authors: Zini
mesh_terms: D004249:DNA Damage; D006801:Humans; D007248:Infertility, Male / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D009845:Oligospermia / Q000601:surgery; D018384:Oxidative Stress; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013076:Sperm Count; D013081:Sperm Motility; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*