Varicocele Repair in Infertile Men Increases Pregnancy and Live Birth Rate

4 Jan, 21

Introduction

Varicocele is one of the most common treatable causes of male infertility. The sperm retrieval success rate might improve with management of varicocele. Although varicocele repair has been known to increase the semen quality in infertile men, including those with azoospermia, the decision to perform varicocelectomy before starting a fertility program remains controversial.

Aim

This study was conducted to thoroughly review and evaluate the benefit of varicocele repair and its impact on the success rate of a fertility program.

Method

Study Design

Systematic review and meta-analysis of randomized controlled trials (RCTs) or observational studies including cohort and case-control.

Treatment Strategy

A systematic literature search was performed using MEDLINE, Cochrane Library, and Wiley Library.
Studies comparing varicocelectomy and untreated varicocele in adult men with varicocele and infertility regardless of the semen analysis results were included
The outcome of the study was either one or more of the following: the pregnancy rate; live birth rate; and sperm retrieval success rate.
The pooled analysis data are presented as odds ratios (OR) with 95% confidence intervals.

Endpoints

Primary Endpoint

Pregnancy rate

Secondary Endpoints

Live birth rate
Surgical sperm retrieval success rate

Results

The meta-analysis included a total of 31 articles
The varicocele treated group showed significantly higher pregnancy rate (OR = 1.82; 95% confidence interval: 1.37–2.41; p < 0.0001)
Results of the subgroup analysis were similar and demonstrated higher pregnancy rate in treated men treated men with azoospermia, subnormal semen parameters, and normozoospermia (p = 0.04, p = 0.0005, and p = 0.002, respectively)
The treated group also had higher live birth rate (OR = 2.80; 95% confidence interval: 1.67–4.72; p = 0.0001)
Subgroup analysis revealed that varicocele repair significantly increased the live birth rate in the treated men with subnormal semen parameters and normozoospermia (p = 0.001 and p < 0.0001) respectively
Higher sperm retrieval rate was reported in azoospermic patients in the treated group (OR = 1.69; 95% confidence interval: 1.16–2.45; p = 0.006).

Conclusion

Varicocele repair increased the pregnancy and live birth rates irrespective of the semen analysis result
Varicocele treated azoospermic men had higher sperm retrieval success rate
Varicocele repair might benefit infertile men prior to joining a fertility program.

Heliyon. 2020 Nov; 6(11), e05439.