Korean J Urol.  2013 Oct;54(10):703-709.

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

• Kim KH
• Lee JY
• Kang DH
• Lee H
• Seo JT
• Cho KS

Abstract

PURPOSE
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.
MATERIALS AND 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.

Keyword

Infertility; Meta-analysis; Treatment outcome; Varicocele

MeSH Terms

Bias (Epidemiology)
Female
Humans
Infertility
Infertility, Male
Male
Odds Ratio
Pregnancy
Pregnancy Outcome
Pregnancy Rate
Semen
Semen Analysis
Treatment Outcome
Varicocele

Figure

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  FIG. 1 Flow diagram of screened, excluded, and analyzed publications.

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  FIG. 2 Methodological quality graph. Two researchers' judgments about each methodological quality item are presented as percentages across all included studies.

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  FIG. 3 Forest plots. (A) Overall meta-analysis of surgical varicocele repair versus control. (B) Subanalysis for 3 studies that included men with clinical varicocele and impaired semen quality. Squares represent study-specific risk estimates (size of square reflects the study statistical weight); horizontal lines represent 95% confidence intervals (CIs); diamonds represent summary relative risk estimate with its corresponding 95% CI. OR, odds ratio.

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  FIG. 4 Radial plots of variables with regard to heterogeneity after selection of effect models for all seven studies (A) and three studies (B) that included men with clinical varicocele and impaired semen quality.

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  FIG. 5 Funnel plots depicting publication bias for all seven studies (A) and three studies (B) that included men with clinical varicocele and impaired semen quality.

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