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Journal Articles The World Journal of Men's Health Year : 2022

Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis

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Ashok Agarwal
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Rossella Cannarella
University of Catania [Italy]
Ramadan Saleh
Sohag University
Florence Boitrelle
CHI Poissy-Saint-Germain
Biologie de la Reproduction, Environnement, Epigénétique & Développement
Murat Gül
Selcuk University
Tuncay Toprak
İstanbul Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi
Gianmaria Salvio
Polytechnic University of Marche [Ancona, Italy] / Università Politecnica delle Marche [Ancona, Italia]
Mohamed Arafa
Hamad Medical Corporation [Doha, Qatar]
Weill Cornell Medicine [Qatar]
Giorgio I Russo
University of Catania [Italy]
Ahmed M Harraz
Mansoura University [Egypt]
Rajender Singh
CSIR-Central Drug Research Institute
Nicolas Garrido
Instituo Valenciano de Infertilitad
Taha Abo-Almagd Abdel-Meguid Hamoda
King Abdul Aziz University
Minia University
Amarnath Rambhatla
Henry Ford Health System
Parviz Kavoussi
Shinnosuke Kuroda
Cleveland Clinic
Gökhan Çalik
Istanbul Medipol University
Pallavi Saini
Erman Ceyhan
Başkent University Hospital [Adana, Turkey]
Fotios Dimitriadis
Aristotle University of Thessaloniki
Ralf Henkel
Imperial College London
University of the Western Cape
Andrea Crafa
University of Catania [Italy]
Ayad Palani
University of Garmian
Mesut Berkan Duran
Pamukkale University
Evangelos Maziotis
National and Kapodistrian University of Athens
Émine Saïs
CHI Poissy-Saint-Germain
Biologie de la Reproduction, Environnement, Epigénétique & Développement
Marion Bendayan
CHI Poissy-Saint-Germain
Biologie de la Reproduction, Environnement, Epigénétique & Développement
Mahsa Darbandi
Hope Generation Foundation
Tan V Le
Pham Ngoc Thach Medical University (Ho Chi Minh city)
Sezgin Gunes
Petroula Tsioulou
National and Kapodistrian University of Athens
Pallav Sengupta
Gulf Medical University [Ajman, UAE]
Berk Hazir
Lund University [Lund]
Gökhan Çeker
Zonguldak Bülent Ecevit University
Sara Darbandi
Damayanthi Durairajanayagam
Azin Aghamajidi
Iran University of Medical Sciences [Tehran, Iran]
Noora Alkhalidi
Emrullah Sogutdelen
Abant Izzet Baysal University - Bolu Abant İzzet Baysal Üniversitesi
Kristian Leisegang
University of the Western Cape
Abdullah Alarbid
Christopher C K Ho
Taylor’s University
Vineet Malhotra
Federica Finocchi
Università Politecnica delle Marche [Ancona]
Luís Crisóstomo
Instituto de Ciências Biomédicas de Abel Salazar
Universidade do Porto = University of Porto
University of Turku
Raghavender Kosgi
Haitham Elbardisi
Hamad medical corporation
Weill Cornell Medicine [Qatar]
Armand Zini
McGill University = Université McGill [Montréal, Canada]
Ponco Birowo
Cipto Mangunkusumo Hospital [Jakarta]
Giovanni Colpi
Hyun Jun Park
Pusan National University
Ege Can Serefoglu
Biruni University
Quang Nguyen
Vietnam National University [Hanoï]
Edmund Ko
Loma Linda University
De La Rosette Jean
Istanbul University
Germar M Pinggera
Innsbruck Medical University [Austria]
Ho Vinh Phuoc Nguyen
Children's Hospital No. 2 [Ho Chi Minh City]
University of Medicine Pham Ngoc Thach
Hussein Kandil
Fakih IVF Fertility Center
Rupin Shah
Lilavati Hospital and Research Centre

Abstract

Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls. A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies). A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I²=97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I²=97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I²=98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I²=97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I²=98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI -0.242 to 0.868; I²=89.7%). This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies' practice recommendations favoring VR to improve conventional semen parameters in infertile men.

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Life Sciences [q-bio] Reproductive Biology
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Submitted on : Tuesday, November 8, 2022-5:43:08 PM

Last modification on : Friday, December 9, 2022-5:30:07 PM

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hal-03844495 , version 1 (08-11-2022)

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Ashok Agarwal, Rossella Cannarella, Ramadan Saleh, Florence Boitrelle, Murat Gül, et al.. Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis. The World Journal of Men's Health, 2022, 40, ⟨10.5534/wjmh.220142⟩. ⟨hal-03844495⟩

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