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Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

September 11, 2023

Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data.

Authors: Rossella Cannarella, Rupin Shah,
Taha Abo-Almagd Abdel-Meguid Hamoda. et al, World J Men’s Health, Published online Jun 22, 2023
https://doi.org/10.5534/wjmh.230034

Preamble:
Varicocele Repair: Necessary or unnecessary? An endless debate!! While varicocele is observed in approximately 15% of the general male population, this rate increases to 19% to 41% in primary male infertility and to 80% in secondary male infertility. Varicocele is accepted as the most common correctable cause of male infertility. However, fertility and non-fertility indications for varicocele repair have not been clearly defined and the debate is still ongoing. Some of these are the role of varicocelectomy in the treatment of infertile men with varicocele and azoospermia or those with subclinical varicocele, or in the management of infertile men with varicocele recurrence and predictive factors of outcome of varicocelectomy in infertile men. 
The true benefit of varicocele repair on reproductive hormone levels, pregnancy and live birth rates is also controversial. However, the main problem here is that the effect of varicocele repair on semen parameters is still not fully understood. Therefore, this metaanalysis aimed to examine the effect of varicocele repair on conventional semen parameters. This unique research project lasted for about 24 months and could be easily called the most comprehensive meta-analysis to date in the world.

CAPSULE: This meta-analysis compared the different sperm parameters before and after varicocelectomy in 351 studies including more than 32,000 patients. The results showed significant improvement of semen parameters namely, semen volume, sperm concentration, total sperm count, total motile sperm count, progressive sperm motility, total sperm motility, and sperm morphology. By virtue of being the largest metaanalysis to date, comparing sperm parameters before and after varicocelectomy, this study validated the beneficial role of varicocelectomy in patients with male infertility.

Recommendation:
This meta-analysis provides strong support for the role of varicocele repair in infertile male with clinical varicoceles. Infertile patients with varicocele should be advised about the benefits of varicocelectomy due to strong evidence of improved semen parameters.

Acknowledgment: This commentary was co-written by Tuncay Toprak, MD and Ahmed M. Harraz,
MD and reviewed by Rupin Shah, MD.
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