title: Impact of surgical varicocele repair on pregnancy rate in subfertile men with clinical varicocele and impaired semen quality: a meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  To elucidate the impact of surgical varicocele repair on the pregnancy rate through new meta-analyses of randomized clinical trials that compared surgical varicocele repair and observation.
  
  
  METHODS
  The PubMed and Embase online databases were searched for studies released before December 2012. References were manually reviewed, and two researchers independently extracted the data. To assess the quality of the studies, the Cochrane risk of bias as a quality assessment tool for randomized controlled trials was applied.
  
  
  RESULTS
  Seven randomized clinical trials were included in our meta-analyses, all of which compared pregnancy outcomes between surgical varicocele repair and control. There were differences in enrollment criteria among the studies. Four studies included patients with clinical varicocele, but three studies enrolled patients with subclinical varicocele. Meanwhile, four trials enrolled patients with impaired semen quality only, but the other three trials did not. In a meta-analysis of all seven trials, a forest plot using the random-effects model showed an odds ratio (OR) of 1.90 (95% confidence interval [CI], 0.77 to 4.66; p=0.1621). However, for subanalysis of three studies that included patients with clinical varicocele and abnormal semen parameters, the fixed-effects pooled OR was significant (OR, 4.15; 95% CI, 2.31 to 7.45; p<0.001), favoring varicocelectomy.
  
  
  CONCLUSIONS
  Varicocelectomy for male subfertility is proven effective in men with clinical varicocele and impaired semen quality. Therefore, surgical repair should be offered as the first-line treatment of clinical varicocele in subfertile men.
authors.affiliation: Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyu Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Joo Yong
authors.initials: JY
authors.lastname: Lee
authors.forename: Dong Hyuk
authors.initials: DH
authors.lastname: Kang
authors.forename: Hyungmin
authors.initials: H
authors.lastname: Lee
authors.forename: Ju Tae
authors.initials: JT
authors.lastname: Seo
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
keywords: Infertility; Meta-analysis; Treatment outcome; Varicocele