World J Mens Health.
2025 Apr;43(2):344-348. 10.5534/wjmh.240132.
Impact of Varicocele Repair on Assisted Reproductive Technique Outcomes in Infertile Men: A Systematic Review and Meta-Analysis
- Palani A1,2
- Cannarella R2,3,4
- Saleh R2,5,6
- Salvio G2,7
- Harraz AM2,8,9,10
- Crafa A2,3
- Bahar F2,11,12
- Bocu K2,13
- Kumar N2,14
- Kothari P2,15
- Pinggera GM2,16
- Cayan S2,17
- Colpi GM2,18
- Atmoko W2,19
- Shah R2,20
- Agarwal A
2,21
- Affiliations
-
- 1College of Medicine, University of Garmian, Kalar, Iraq
- 2Global Andrology Forum, Moreland Hills, OH, USA
- 3Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- 4Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- 5Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
- 6Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt
- 7Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
- 8Mansoura University Urology and Nephrology Center, Mansoura, Egypt
- 9Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- 10Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
- 11Guest Lecturer, Faculty of Medicine, Muhammadiyah Palembang University, Palembang, Indonesia
- 12Siloam Sriwijaya Hospital, Palembang, Indonesia
- 13Department of Urology, Faculty of Medicine, Niğde Omer Halisdemir University, Niğde, Türkiye
- 14Department of Urology, All India Institute of Medical Sciences, Patna, India
- 15Department of Urology, B.Y.L Nair Ch Hospital, Mumbai, India
- 16Department of Urology, Medical University Innsbruck, Innsbruck, Austria
- 17Department of Urology, University of Mersin School of Medicine, Mersin, Türkiye
- 18Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
- 19Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- 20Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
- 21Cleveland Clinic Foundation, Cleveland, OH, USA
- KMID: 2565975
- DOI: http://doi.org/10.5534/wjmh.240132
Abstract
- Purpose
In this systematic review and meta-analysis, we investigated assisted reproductive technology (ART) success in infertile men with clinical varicocele and abnormal semen parameters who underwent varicocele repair (VR) before the ART procedure as compared to those who did not.
Materials and Methods
A comprehensive search of the Scopus, PubMed, Embase, and Cochrane Library databases was conducted using a specific query string to identify studies examining the impact of VR on ART outcomes, including fertilization rate, clinical pregnancy, pregnancy loss, and live-birth rate, until October 2023. Outcomes were analyzed based on the type of ART. Studies on VR in infertile men with non-obstructive azoospermia and those who underwent ART only due to female factor infertility were excluded from the study.
Results
Out of 1,554 articles reviewed, only 9 met the inclusion criteria for the study. All the included articles were observational studies. The variability in study quality in the included literature resulted in a moderate overall risk of bias. Data analysis showed that for intrauterine insemination, there was no difference in the clinical pregnancy rate (odds ratio [OR] 1.01, 95% confidence interval [CI]: 0.42, 2.45; p=0.97). However, for intracytoplasmic sperm injection (ICSI), men with VR showed a significant improvement in fertilization rate (mean difference 10.9, 95% CI: 5.94, 15.89; p<0.01), clinical pregnancy rate (OR 1.38, 95% CI: 1.07, 1.78; p=0.01) and live-birth rate (OR 2.07, 95% CI: 1.45, 2.97; p<0.01), compared to men who did not undergo VR.
Conclusions
The findings of this systematic review and meta-analysis suggest that VR has a positive impact on pregnancy and live birth rates after ICSI. However, biases like small sample sizes and heterogeneous populations highlight the need for larger, well-designed prospective studies to validate these findings.
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