The Effects of Varicocele Repair on Testicular Sperm Retrieval, Sperm Recovery in the Ejaculate and Clinical Pregnancy Rates in Non-Obstructive Azoospermic Men with Clinical Varicocele: A Systematic Review and Meta-analysis
Recommended Citation
Çayan S, Pinggera GM, Alipour H, Altay B, Shah R, Giulioni C, Mostafa T, Hamoda T, Alarcon DCA, Dardmeh F, Daoud S, Fathalla N, Gunes S, Le TV, Vishwakarma RB, Harraz AM, Arafa M, Cannarella R, Rambhatla A, Zini A, Chung E, Atmoko W, Palani A, Boeri L, Calogero AE, Shatylko T, Al Hashimi M, and Agarwal A. The Effects of Varicocele Repair on Testicular Sperm Retrieval, Sperm Recovery in the Ejaculate and Clinical Pregnancy Rates in Non-Obstructive Azoospermic Men with Clinical Varicocele: A Systematic Review and Meta-analysis. World J Mens Health 2025.
Document Type
Article
Publication Date
7-8-2025
Publication Title
World J Mens Health
Abstract
PURPOSE: The role of varicocele repair (VR) in infertile men with non-obstructive azoospermia (NOA) and varicocele is controversial in the current guidelines, despite available studies. This study aims to assess the impact of VR on testicular sperm retrieval, sperm recovery from the ejaculate, and clinical pregnancy rates in infertile men with NOA and clinical varicocele through a systematic review and meta-analysis (SRMA) of controlled studies.
MATERIALS AND METHODS: A systematic literature search was conducted using the Scopus and PubMed databases up to November 2023. Among the 1,847 articles retrieved, five observational controlled studies comparing reproductive outcomes between infertile men with NOA and clinical varicocele who underwent VR, and a control group that received no treatment, met the inclusion criteria for this SRMA.
RESULTS: The selected studies included 269 men with NOA who underwent VR before the testicular sperm extraction (TESE) procedure and 364 men who did not undergo VR. The pooled estimate demonstrated a significantly higher odds ratio (OR) of 2.17 (95% confidence interval [95% CI]: 1.17-4.01, p=0.01) for surgical sperm retrieval in the VR group. VR significantly increased the likelihood of sperm appearance in the ejaculate, with an OR of 7.8 (95% CI: 3.59-16.94, p< 0.001). Besides, VR provided a significantly greater clinical pregnancy rate with intracytoplasmic sperm injection (ICSI) compared to non-operated men (OR: 2.18, 95% CI: 1.03-4.60; p=0.04).
CONCLUSIONS: This is the first SRMA, consisting of only controlled studies, to demonstrate that VR performed prior to TESE in men with NOA significantly improves sperm production as reflected in the spontaneous appearance of sperm in the semen and higher odds of surgical sperm retrieval and clinical pregnancy compared with non-operated men. Thus, these findings highlight the potentially beneficial impact of VR in men with NOA and clinical varicocele.
Medical Subject Headings
Azoospermia; Infertility; male; Pregnancy; Sperm retrieval; Spermatozoa; Varicocele
PubMed ID
40676886
ePublication
ePub ahead of print
