Role of varicocele treatment in assisted reproductive technologies

Peer review under responsibility of Arab Association of Urology.

Figures & data

Fig. 1 Search strategy and selection process.

Table 1 Studies evaluating the effects of varicocele repair on sperm parameters.

Reference	Number of studies evaluated	Number of patients	Groups	Parameters	Outcomes
Abdel-Meguid et al. [7]	1	145	Varicocelectomy (n = 73) vs control (n = 72)	Pregnancy rate, Semen quality	Spontaneous pregnancy rate 32.9% vs 13.9% (P = 0.01). Significant recovery in semen parameters (P < 0.001)
Kroese et al. [8]	10	894	Varicocele occlusion (n = 449) vs control (n = 445)	Pregnancy rate, Semen quality	Significant recovery in treatment group (P = 0.03)
Baazeem et al. [9]	22	–	Pre-varicocelectomy vs post-varicocelectomy	Semen quality, sperm DNA damage, seminal oxidative stress	Significant recovery in sperm concentration and sperm progressive motility, decrease in sperm DNA damage and seminal oxidative stress (P < 0.001, P < 0.001, P = 0.003, respectively)
Marmar et al. [15]	5	570	Varicocelectomy (n = 396) vs control (n = 174)	Spontaneous pregnancy rate	Spontaneous pregnancy rate: 33% vs 15% (P = 0.007)
Barekat et al. [16]	1	35	Post-varicocelectomy + N-acetyl-L-cysteine vs post-varicocelectomy without N-acetyl-L-cysteine	Semen quality, sperm DNA integrity, oxidative stress	No significant difference in sperm parameters, significant decrease in DNA fragmentation and oxidative stress (P < 0.05)
Agarwal et al. [17]	10	1231	Pre-varicocelectomy vs post-varicocelectomy	Semen quality	The sperm concentration increased by 12.03 10^6/mL, motility increased by 11.72% (P = 0.002), morphology increased by 3.16% (P = 0.01)
Chen et al. [18]	1	30	Pre-varicocelectomy vs post-varicocelectomy	Semen quality, sperm mitochondrial DNA deletion	73% recovery in semen quality, significant decrease in sperm mitochondrial DNA deletion: 40% vs 13.3% (P < 0.001)
Zini et al. [19]	1	25	Pre-varicocelectomy vs post-varicocelectomy	Semen quality, sperm chromatin and DNA integrity	Sperm concentration, progressive motility, sperm chromatin and DNA integrity significant recovery (P < 0.05, P < 0.05, P < 0.001, P = 0.004, respectively)
Smit et al. [20]	1	49	Pre-varicocelectomy vs post-varicocelectomy	Semen quality, DNA fragmentation index, pregnancy rate	Sperm concentration and sperm progressive motility significant recovery (both P < 0.001), DNA fragmentation index decrease (35.2% vs 30.2% (P = 0.019), spontaneous pregnancy rate: 37%
Li et al. [21]	1	19	Pre-varicocelectomy vs post-varicocelectomy	Semen quality, DNA fragmentation index	Sperm concentration and sperm progressive motility significant recovery, DNA fragmentation index decrease (28.4% vs 22.4%) (P = 0.009, P = 0.029, P = 0.018, respectively)
Wang et al. [22]	7	476	Varicocele patients (n = 240) vs controls (n = 176)	Sperm DNA damage	In varicocele patients group, high sperm DNA damage: 9.84% more (P < 0.001)

Table 2 Studies evaluating effect of varicocelectomy on ART.

Study	Number of patients	Groups	Parameters	Outcomes
Daitch et al. [26]	58	IUI with prior varicocelectomy (n = 34) vs IUI without prior varicocelectomy (n = 24)	Live-birth and pregnancy rates	Pregnancy rate/cycle: 11.8% vs 6.3% (P = 0.04) Live-birth rate/cycle: 11.8% vs 2.1% (P = 0.007) Live-birth rate/couple: 32.4% vs 4.2% (P = 0.001)
Cayan et al. [27]	540	Pre-varicocelectomy vs post-varicocelectomy	Spontaneous pregnancy, changes in ART candidacy after varicocelectomy	Spontaneous pregnancy rate: 36.6% 31% of preoperative IVF and ICSI candidates became IUI or spontaneous pregnancy candidates after varicocelectomy 42% of IUI candidates gained the potential for spontaneous pregnancy
Esteves et al. [28]	242	ICSI with prior varicocelectomy (n = 80) vs ICSI without prior varicocelectomy (n = 162)	Live-birth, clinical pregnancy, miscarriage and fertilisation rates	Live-birth rate: 46.3% vs 1.5% (P = 0.03) Clinical pregnancy rate: 60.0% vs 45.1% (P = 0.04) Miscarriage rate: 22.9% vs 30.1% (P = 0.46) Fertilisation rate:78% vs 66% (P = 0.04)
Pasqualotto et al. [29]	248	ICSI with prior varicocelectomy (n = 169) vs ICSI without prior varicocelectomy (n = 79)	Clinical pregnancy, implantation, miscarriage and fertilisation rates	Clinical pregnancy rate: 30.9% vs 31.1% (P = 0.98) Implantation rate: 17.3% vs 22.1% (P = 0.58) Miscarriage rate: 23.9% vs 21.7% (P = 0.84) Fertilisation rate:64.9% vs 73.2% (P = 0.03)
Gokce et al. [30]	306	ICSI with prior varicocelectomy (n = 168) vs ICSI without prior varicocelectomy (n = 138)	Live-birth, clinical pregnancy and miscarriage rates	Live-birth rate: 47.6% vs 29.0% (P < 0.001) Clinical pregnancy rate: 62.5% vs 47.1% (P = 0.001) Miscarriage rate: 14.9% vs 18.1% (P = 0.057)
Zini et al. [31]	393	Varicocelectomy (n = 251) vs control (n = 142)	Pregnancy rates, ART utilisation	Spontaneous pregnancy rate: 39% vs 32% (P > 0.05) ART utilisation rate: 38% vs 54% (P = 0.002)