Varicocele repair not recommended for male infertility
MedWire News: There is insufficient evidence to show that subclinical varicocele repair should be considered a treatment possibility for male factor infertility, show study results.
Although the procedure significantly improves sperm parameters including motility and concentration, it does not improve spontaneous pregnancy rates for men who, with their partners, are trying to conceive, say the researchers.
Abdulaziz Baazeem (Umm Al-Qura University, Makkah, Saudi Arabia) and colleagues explain that "there continues to be a need for simple and effective treatments for male factor infertility." Furthermore, international guidelines concerning the benefit of treating varicocele for this condition are conflicting, they remark.
Thus, the team carried out a meta-analysis of studies reporting on pregnancy outcomes and semen parameters after repair of clinical varicoceles in oligozoospermic men by various methods.
Four randomized controlled trials reported on pregnancy outcome, including 380 couples, of whom 192 were randomly assigned to treatment (varicocele repair) and 188 to observation.
The combined odds ratio for successful pregnancy after treatment was 2.23, indicating that treatment outperformed observation. However, this was not a statistically significant association, says the research team.
Baazeem et al identified 22 studies reporting on sperm concentration before and after varicocele repair, which showed a mean improvement in concentration of −4.0 to 60.0 x 106 sperm/ml: a statistically significant improvement in 15 of the studies.
Of the 17 studies reporting on percent total sperm motility before and after varicocele repair, the mean improvement ranged from 2.7% to 21.4%, a statistically significant difference in 12 of these studies.
A similar trend was noted for sperm motility in the five studies that reported it.
"Generally, it appears that varicocelectomy has a significant effect on improving sperm concentration as well as total and progressive motility," writes the research team in the journal European Urology.
However, "its positive effects on improving spontaneous pregnancy rates is less clear," they say, adding that the studies included in their analysis were considerably heterogeneous in terms of patient characteristics.
Further analysis of the studies with available data showed that microsurgical repair results in fewer complications and lower varicocele recurrence rates compared with other surgical techniques.
Baazeem and co-investigators note that one of the proposed mechanisms by which varicocele could affect sperm function is an increase in semen oxidative stress, and one of the studies in their analysis confirmed this.
However, despite the improvement in semen parameters revealed in their analysis, the lack of evidence for an ultimate improvement in pregnancy rates leads the researchers to conclude that presently, "subclinical varicocele repair for male factor infertility is not beneficial."
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By Sarah Guy