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

Approximately 15% of couples in the United States are considered infertile, after being unsuccessful at achieving a pregnancy for 1 year with unprotected intercourse.  Of these couples, a male factor is solely responsible for 20% of these cases, while it is a contributing factor in combination with female infertility factors in an additional 40%, suggesting that 60% of infertile couples include a male factor involvement.1

Varicoceles are abnormally dilated scrotal veins, which are found in approximately 15% of men in the general population and in 40% of men presenting for infertility evaluations, making varicoceles the most common diagnosis in infertile men.2  Varicoceles adversely affect the function of the testicle and spermatogenesis.3-9  The majority of data indicate that varicoceles impair testicular function by increasing intratesticular temperatures owing to interruption of the counter-current heat exchange in the pampiniform plexus with opposing blood flows in a central arterial and venous system.10-12  A previous meta-analysis revealed that varicocele repair results in significant improvement in semen quality in 60-80% of men, with reported pregnancy after varicocele repair ranging from 20%-60%.13

The current study is a comprehensive, up-to-date review of the medical literature in the form of a systemic review and meta-analysis assessing the impact of varicocele repair on semen parameters in infertile men.14  Most importantly, this is the first systemic review and meta-analysis on the response of semen parameters to varicocele repair that evaluates the change in parameters after varicocele repair compared to untreated controls to elevate the level of evidence included in such a review.  This offers a major advantage over meta-analyses that have compared semen parameters before and after varicocele repair, without a control group for comparison.  This current meta-analysis provides a high level of evidence that varicocele repair improves conventional semen parameters in infertile men with a clinical varicocele over changes seen in a control group.

Written by: Parviz K. Kavoussi, MD, FACS, Austin Fertility and Reproductive Medicine/Westlake, Adjunct Assistant Professor, Department of Urology, University of Texas Health Science Center at San Antonio, Assistant Professor, University of Texas at Austin

References:

  1. Thonneau P, Marchand S, Tallec A, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Hum Reprod. 1991;6(6):811-816.
  2. Nagler HM, Luntz, R.K., Martinis, F.G.. Varicocele. Infertility in the male. 1997; St. Louis, MO.  Mosby Year Book. :336-359.
  3. Smith R, Kaune H, Parodi D, et al. Increased sperm DNA damage in patients with varicocele: relationship with seminal oxidative stress. Hum Reprod. 2006;21(4):986-993.
  4. Bertolla RP, Cedenho AP, Hassun Filho PA, Lima SB, Ortiz V, Srougi M. Sperm nuclear DNA fragmentation in adolescents with varicocele. Fertil Steril. 2006;85(3):625-628.
  5. Baccetti BM, Bruni E, Capitani S, et al. Studies on varicocele III: ultrastructural sperm evaluation and 18, X and Y aneuploidies. J Androl. 2006;27(1):94-101.
  6. Enciso M, Muriel L, Fernandez JL, et al. Infertile men with varicocele show a high relative proportion of sperm cells with intense nuclear damage level, evidenced by the sperm chromatin dispersion test. J Androl. 2006;27(1):106-111.
  7. Agarwal A, Makker K, Sharma R. Clinical relevance of oxidative stress in male factor infertility: an update. Am J Reprod Immunol. 2008;59(1):2-11.
  8. Blumer CG, Fariello RM, Restelli AE, Spaine DM, Bertolla RP, Cedenho AP. Sperm nuclear DNA fragmentation and mitochondrial activity in men with varicocele. Fertil Steril. 2008;90(5):1716-1722.
  9. Wu GJ, Chang FW, Lee SS, Cheng YY, Chen CH, Chen IC. Apoptosis-related phenotype of ejaculated spermatozoa in patients with varicocele. Fertil Steril. 2009;91(3):831-837.
  10. Zorgniotti AW, Macleod J. Studies in temperature, human semen quality, and varicocele. Fertil Steril. 1973;24(11):854-863.
  11. Goldstein M, Eid JF. Elevation of intratesticular and scrotal skin surface temperature in men with varicocele. J Urol. 1989;142(3):743-745.
  12. Masson P, Brannigan RE. The varicocele. Urol Clin North Am. 2014;41(1):129-144.
  13. Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007;88(3):639-648.
  14. Agarwal A, Cannarella R, Saleh R, et al. Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis. World J Mens Health. 2022.
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