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Comparison of sperm parameters and fertility rate in subclinical varicocele patients treated with varicocelectomy versus no varicocelectomy: a systematic review

  • Afdal ,
  • Fakhri Zuhdian Nasher ,

Abstract

Introduction: Subclinical varicocele is defined as non-palpable varicocele which diagnosed solely through imaging examination, namely ultrasonography. Despite the current high prevalence of subclinical varicocele as one of the most common cause of men infertility, there is still lack of evidence regarding the need to perform varicocelectomy among these patients. This systematic review aims to evaluate and compare the sperm parameters and fertility rate of subclinical varicocele patients treated with varicocelectomy versus no treatment. 

Methods: A systematic literature search was conducted on the international databases PubMed, Scopus, Cochrane, EMBASE, EBSCOHost, and Google Scholar published in the last ten years up to August 21st, 2022. Risk of bias assessment was performed using the Newcastle-Ottawa Scale tools for cohort study and converted regarding the AHRQ standards.

Results: Three cohort studies were conducted in three different countries with 363 patients. The risk of bias assessment revealed that all of the three studies included in this review have good quality and low risk of bias. Varicocelectomy significantly improves sperm parameters in terms of sperm concentration (p<0.05) and sperm motility (p<0.05) while its effects on sperm morphology are not significant (p>0.05). The effects of varicocelectomy on fertility rate are reported by one study by Cantoro et al. as significant (p=0.011).

Conclusion: Varicocelectomy correction has been proved to significantly improve sperm parameters in terms of sperm concentration and motility, while its effect on fertility rate remains unclear and no conclusion can be drawn yet. Therefore, this study recommends further randomized controlled studies with larger sample size in the future to prove the effectiveness of varicocelectomy in subclinical varicocele patients before its implementation in clinical settings.

References

  1. Alsaikhan B, Alrabeeah K, Delouya G, Zini A. Epidemiology of varicocele. Asian J Androl [Internet]. 2016;18(2):179–81. Available from: https://pubmed.ncbi.nlm.nih.gov/26763551
  2. Kroese ACJ, de Lange NM, Collins J, Evers JLH. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev [Internet]. 2012; Available from: http://dx.doi.org/10.1002/14651858.cd000479.pub5
  3. Kohn TP, Kohn JR, Pastuszak AW. Varicocelectomy before assisted reproductive technology: are outcomes improved? Fertil Steril [Internet]. 2017;108(3):385–91. Available from: http://dx.doi.org/10.1016/j.fertnstert.2017.06.033
  4. Tiseo BC, Esteves SC, Cocuzza MS. Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men. Asian J Androl [Internet]. 2016;18(2):239–45. Available from: https://pubmed.ncbi.nlm.nih.gov/26806080
  5. Dubin L, Amelar RD. Varicocele Size And Results of Varicocelectomy in Selected Subfertile Men with Varicocele*. Fertil Steril [Internet]. 1970;21(8):606–9. Available from: http://dx.doi.org/10.1016/s0015-0282(16)37684-1
  6. Patil V, Shetty SMC, Das SK. Redefining the Criteria for Grading Varicoceles Based on Reflux Times. Ultrasound Q [Internet]. 2016;32(1):82–5. Available from: http://dx.doi.org/10.1097/ruq.0000000000000168
  7. Belay RE, Huang GO, Shen JKC, Ko EYK. Diagnosis of clinical and subclinical varicocele: how has it evolved? Asian J Androl [Internet]. 2016;18(2):182–5. Available from: https://pubmed.ncbi.nlm.nih.gov/26780869
  8. Yarborough MA, Burns JR, Keller FS. Incidence and Clinical Significance of Subclinical Scrotal Varicoceles. J Urol [Internet]. 1989;141(6):1372–4. Available from: http://dx.doi.org/10.1016/s0022-5347(17)41311-5
  9. Schlegel PN, Sigman M, Collura B, De Jonge CJ, Eisenberg ML, Lamb DJ, et al. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I. J Urol [Internet]. 2021;205(1):36–43. Available from: http://dx.doi.org/10.1097/ju.0000000000001521
  10. Choksi A, Harnisch B, Honig S. What Every Provider Should Know About the 2020–2021 Updated AUA/ASRM Guidelines on Male Factor Infertility. Curr Sex Heal Reports [Internet]. 2022;14(2):31–8. Available from: http://dx.doi.org/10.1007/s11930-022-00325-y
  11. Cochrane Handbook for Systematic Reviews of Interventions [Internet]. John Wiley & Sons, Ltd; 2008. Available from: http://dx.doi.org/10.1002/9780470712184
  12. García-Peiró A, Ribas-Maynou J, Oliver-Bonet M, Navarro J, Checa MA, Nikolaou A, et al. Multiple determinations of sperm DNA fragmentation show that varicocelectomy is not indicated for infertile patients with subclinical varicocele. Biomed Res Int [Internet]. 2014/05/20. 2014;2014:181396. Available from: https://pubmed.ncbi.nlm.nih.gov/24967335
  13. Cantoro U, Polito M, Muzzonigro G. Reassessing the Role of Subclinical Varicocele in Infertile Men With Impaired Semen Quality: A Prospective Study. Urology [Internet]. 2015;85(4):826–30. Available from: http://dx.doi.org/10.1016/j.urology.2015.01.015
  14. J. Hammadi I, Th. Saeed G, How. Abed Tawney R. Evaluation of the Effects of Surgical Varicocelectomy on the Seminal Fluid Parameters in Patients with Clinical and Subclinical Varicocele. J Fac Med [Internet]. 2015;57(1):40–4. Available from: http://dx.doi.org/10.32007/med.1936/jfacmedbagdad.v57i1.10
  15. Kim HJ, Seo JT, Kim KJ, Ahn H, Jeong JY, Kim JH, et al. Clinical significance of subclinical varicocelectomy in male infertility: systematic review and meta-analysis. Andrologia [Internet]. 2015;48(6):654–61. Available from: http://dx.doi.org/10.1111/and.12495
  16. Hai-ling J, Li-fu Z, Hang Y, Xiao-ping C, Shu-dong W, Xue-ke L, et al. Comparison of accuracy and stability of estimating winter wheat chlorophyll content based on spectral indices [Internet]. 2014 IEEE Geoscience and Remote Sensing Symposium. IEEE; 2014. Available from: http://dx.doi.org/10.1109/igarss.2014.6947104
  17. Wang Q, Liu Y, Wang L. Open, Laparoscopic, and Microsurgical Varicocelectomy for Male Infertility: a Systematic Review and Meta-analysis. Indian J Surg [Internet]. 2019;82(4):478–85. Available from: http://dx.doi.org/10.1007/s12262-019-02011-1
  18. Mehta A, Goldstein M. Microsurgical varicocelectomy: a review. Asian J Androl [Internet]. 2012/11/12. 2013 Jan;15(1):56–60. Available from: https://pubmed.ncbi.nlm.nih.gov/23147467
  19. Tan SM, Ng FC, Ravintharan T, Lim PHC, Chng HC. Laparoscopic varicocelectomy: technique and results. Br J Urol [Internet]. 1995;75(4):523–8. Available from: http://dx.doi.org/10.1111/j.1464-410x.1995.tb07276.x
  20. Tang Q, Pan F, Wu X, Nichols CE, Wang X, Xia Y, et al. Semen quality and cigarette smoking in a cohort of healthy fertile men. Environ Epidemiol (Philadelphia, Pa) [Internet]. 2019 Aug 13;3(4):e055–e055. Available from: https://pubmed.ncbi.nlm.nih.gov/31538136
  21. Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem [Internet]. 2018;62:2–10. Available from: http://dx.doi.org/10.1016/j.clinbiochem.2018.03.012

How to Cite

Afdal, & Fakhri Zuhdian Nasher. (2022). Comparison of sperm parameters and fertility rate in subclinical varicocele patients treated with varicocelectomy versus no varicocelectomy: a systematic review. Bali Medical Journal, 11(3), 1085–1091. https://doi.org/10.15562/bmj.v11i3.3685

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