title: 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.
abstract: OBJECTIVE
  To evaluate how varicocele repair (VR) impacts pregnancy (PRs) and live birth rates in infertile couples undergoing assisted reproduction wherein the male partner has oligospermia or azoospermia and a history of varicocele.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Azoospermic and oligospermic males with varicoceles and in couples undergoing assisted reproductive technology (ART) with IUI, IVF, or testicular sperm extraction (TESE) with IVF and intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Measurement of PRs, live birth, and sperm extraction rates.
  
  
  METHODS
  Odds ratios for the impact of VR on PRs, live birth, and sperm extraction rates for couples undergoing ART.
  
  
  RESULTS
  Seven articles involving a total of 1,241 patients were included. Meta-analysis showed that VR improved live birth rates for the oligospermic (odds ratio [OR] = 1.699) and combined oligospermic/azoospermic groups (OR = 1.761). Pregnancy rates were higher in the azoospermic group (OR = 2.336) and combined oligospermic/azoospermic groups (OR = 1.760). Live birth rates were higher for patients undergoing IUI after VR (OR = 8.360). Sperm retrieval rates were higher in persistently azoospermic men after VR (OR = 2.509).
  
  
  CONCLUSIONS
  Oligospermic and azoospermic patients with clinical varicocele who undergo VR experience improved live birth rates and PRs with IVF or IVF/ICSI. For persistently azoospermic men after VR requiring TESE for IVF/ICSI, VR improves sperm retrieval rates. Therefore, VR should be considered to have substantial benefits for couples with a clinical varicocele even if oligospermia or azoospermia persists after repair and ART is required.
authors.affiliation: Department of Urology, UNC Gillings School of Global Public Health, University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina. Electronic address: ekirby@unch.unc.edu.
authors.forename: E Will
authors.initials: EW
authors.lastname: Kirby
authors.affiliation: Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina.
authors.forename: Laura Elizabeth
authors.initials: LE
authors.lastname: Wiener
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington.
authors.forename: Saneal
authors.initials: S
authors.lastname: Rajanahally
authors.affiliation: UNC Health Sciences Library, University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina.
authors.forename: Karen
authors.initials: K
authors.lastname: Crowell
authors.affiliation: Department of Urology, UNC Gillings School of Global Public Health, University of North Carolina (UNC) School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Coward
mesh_terms: D053713:Azoospermia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D050498:Live Birth; D008297:Male; D016017:Odds Ratio; D009845:Oligospermia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects; D014646:Varicocele / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
keywords: Varicocele; assisted reproductive technology; male factor infertility; varicocele repair; varicocelectomy