Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis
The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia (NOA). The surgically obtained sperm retrieval rate (SRR) and pregnancy rates following assisted reproductive technology (ART) with the use of retrieved...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2016-01-01
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| Series: | Asian Journal of Andrology |
| Subjects: | |
| Online Access: | http://www.ajandrology.com/article.asp?issn=1008-682X;year=2016;volume=18;issue=2;spage=246;epage=253;aulast=Esteves |
| _version_ | 1818945157368643584 |
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| author | Sandro C Esteves Ricardo Miyaoka Matheus Roque Ashok Agarwal |
| author_facet | Sandro C Esteves Ricardo Miyaoka Matheus Roque Ashok Agarwal |
| author_sort | Sandro C Esteves |
| collection | DOAJ |
| description | The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia (NOA). The surgically obtained sperm retrieval rate (SRR) and pregnancy rates following assisted reproductive technology (ART) with the use of retrieved testicular sperm were the primary outcomes. The secondary outcomes included the presence of viable sperm in postoperative ejaculate to avoid the testicular sperm retrieval and pregnancy rates (both assisted and unassisted) using postoperative ejaculated sperm. An electronic search to collect the data was performed using the MEDLINE and EMBASE databases until April 2015. Eighteen studies were included in this systematic review and accounted for 468 patients who were diagnosed with NOA and varicocele. These patients were subjected to either surgical varicocele repair or percutaneous embolization. Three controlled studies evaluating sperm retrieval outcomes indicated that in patients who underwent varicocelectomy, SRR increased compared to those without varicocele repair (OR: 2.65; 95% CI: 1.69-4.14; P< 0.001). Although pregnancy rates with the use of testicular sperm favored the varicocelectomy group, results were not statistically significant (clinical pregnancy rate OR: 2.07; 95% CI: 0.92-4.65; P= 0.08; live birth rate OR: 2.19; 95% CI: 0.99-4.83; P= 0.05). The remaining fifteen studies reported postoperative semen analysis results. In 43.9% of the patients (range: 20.8%-55.0%), sperm were found in postoperative ejaculates. Pregnancy rates for unassisted and assisted (after IVF/ICSI) were 13.6% and 18.9% in the group of men with sperm in postoperative ejaculates, respectively. Our findings indicate that varicocelectomy in patients with NOA and clinical varicocele is associated with improved SRR. In addition, approximately 44% of the treated men will have enough sperm in the ejaculate to avoid sperm retrieval. Limited data on pregnancy outcomes with both postoperative ejaculated sperm and harvested testicular sperm preclude any firm conclusion with regard to the possible increased fertility potential in treated individuals. In conclusion, the results of our study indicate that infertile men with NOA and clinical varicocele benefit from varicocelectomy. Given the low/moderate quality of evidence available, it is advisable that doctors discuss with their patients with NOA the risks and benefits of varicocele repair. |
| first_indexed | 2024-12-20T07:54:39Z |
| format | Article |
| id | doaj.art-40e58b3ce8614d72ba08084704f44e5e |
| institution | Directory Open Access Journal |
| issn | 1008-682X 1745-7262 |
| language | English |
| last_indexed | 2024-12-20T07:54:39Z |
| publishDate | 2016-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Asian Journal of Andrology |
| spelling | doaj.art-40e58b3ce8614d72ba08084704f44e5e2022-12-21T19:47:45ZengWolters Kluwer Medknow PublicationsAsian Journal of Andrology1008-682X1745-72622016-01-0118224625310.4103/1008-682X.169562Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysisSandro C EstevesRicardo MiyaokaMatheus RoqueAshok AgarwalThe objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia (NOA). The surgically obtained sperm retrieval rate (SRR) and pregnancy rates following assisted reproductive technology (ART) with the use of retrieved testicular sperm were the primary outcomes. The secondary outcomes included the presence of viable sperm in postoperative ejaculate to avoid the testicular sperm retrieval and pregnancy rates (both assisted and unassisted) using postoperative ejaculated sperm. An electronic search to collect the data was performed using the MEDLINE and EMBASE databases until April 2015. Eighteen studies were included in this systematic review and accounted for 468 patients who were diagnosed with NOA and varicocele. These patients were subjected to either surgical varicocele repair or percutaneous embolization. Three controlled studies evaluating sperm retrieval outcomes indicated that in patients who underwent varicocelectomy, SRR increased compared to those without varicocele repair (OR: 2.65; 95% CI: 1.69-4.14; P< 0.001). Although pregnancy rates with the use of testicular sperm favored the varicocelectomy group, results were not statistically significant (clinical pregnancy rate OR: 2.07; 95% CI: 0.92-4.65; P= 0.08; live birth rate OR: 2.19; 95% CI: 0.99-4.83; P= 0.05). The remaining fifteen studies reported postoperative semen analysis results. In 43.9% of the patients (range: 20.8%-55.0%), sperm were found in postoperative ejaculates. Pregnancy rates for unassisted and assisted (after IVF/ICSI) were 13.6% and 18.9% in the group of men with sperm in postoperative ejaculates, respectively. Our findings indicate that varicocelectomy in patients with NOA and clinical varicocele is associated with improved SRR. In addition, approximately 44% of the treated men will have enough sperm in the ejaculate to avoid sperm retrieval. Limited data on pregnancy outcomes with both postoperative ejaculated sperm and harvested testicular sperm preclude any firm conclusion with regard to the possible increased fertility potential in treated individuals. In conclusion, the results of our study indicate that infertile men with NOA and clinical varicocele benefit from varicocelectomy. Given the low/moderate quality of evidence available, it is advisable that doctors discuss with their patients with NOA the risks and benefits of varicocele repair.http://www.ajandrology.com/article.asp?issn=1008-682X;year=2016;volume=18;issue=2;spage=246;epage=253;aulast=Estevesazoospermia; male infertility; meta-analysis; sperm retrieval; systematic review; varicocele; varicocelectomy |
| spellingShingle | Sandro C Esteves Ricardo Miyaoka Matheus Roque Ashok Agarwal Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis Asian Journal of Andrology azoospermia; male infertility; meta-analysis; sperm retrieval; systematic review; varicocele; varicocelectomy |
| title | Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis |
| title_full | Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis |
| title_fullStr | Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis |
| title_full_unstemmed | Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis |
| title_short | Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis |
| title_sort | outcome of varicocele repair in men with nonobstructive azoospermia systematic review and meta analysis |
| topic | azoospermia; male infertility; meta-analysis; sperm retrieval; systematic review; varicocele; varicocelectomy |
| url | http://www.ajandrology.com/article.asp?issn=1008-682X;year=2016;volume=18;issue=2;spage=246;epage=253;aulast=Esteves |
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