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Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

Cannarella R 1 , Shah R 2 , Hamoda TAA 3 , Boitrelle F 4 , Saleh R 5 , Gul M 6 Show all authors , Rambhatla A 7 , Kavoussi P 8 , Toprak T 9 , Harraz AM 10 , Ko E 11 , Çeker G 12 , Durairajanayagam D 13 , Alkahidi N 14 , Kuroda S 15 , Crafa A 1 , Henkel R 16 , Salvio G 17 , Hazir B 18 , Darbandi M 19 , Bendayan M 4 , Darbandi S 19 , Falcone M 20 , Garrido N 21 , Kosgi R 22 , Sawaid Kaiyal R 15 , Karna K 23 , Phuoc NHV 24 , Birowo P 25 , Colpi GM 26 , de la Rosette J 27 , Pinggera GM 28 , Nguyen Q 29 , Zini A 30 , Zohdy W 31 , Singh R 32 , Saini P 33 , Glina S 34 , Lin H 35 , Mostafa T 31 , Rojas-Cruz C 36 , Arafa M 31 , Calogero AE 1 , Dimitriadis F 37 , Kothari P 38 , Karthikeyan VS 39 , Okada K 40 , Chiba K 40 , Kadıoglu A 41 , Altay B 42 , Turunc T 43 , Zilaitiene B 44 , Gokalp F 45 , Adamyan A 46 , Katz D 47 , Chung E 48 , Mierzwa TC 34 , Zylbersztejn DS 49 , Paul GM 50 , Sofikitis N 51 , Sokolakis I 52 , Malhotra V 53 , Brodjonegoro SR 54 , Adriansjah R 55 , Tsujimura A 56 , Amano T 57 , Balercia G 17 , Ziouziou I 58 , Deswanto IA 59 , Martinez M 60 , Park HJ 61 , Bakırcıoglu ME 62 , Ceyhan E 63 , Aydos K 64 , Ramsay J 65 , Minhas S 66 , Al Hashimi M 67 , Ghayda RA 68 , Tadros N 69 , Sindhwani P 70 , Ho CCK 71 , Rachman RI 25 , Rodriguez Pena M 72 , Motawi A 31 , Ponnusamy AK 73 , Dipankar S 74 , Amir A 75 , Binsaleh S 76 , Serefoglu EC 77 , Banthia R 78 , Khalafalla K 79 , Basukarno A 80 , Bac NH 81 , Singla K 82 , Ambar RF 34 , Makarounis K 83 , Priyadarshi S 84 , Duarsa GWK 85 , Atmoko W 25 , Jindal S 86 , Arianto E 87 , Akhavizadegan H 88 , El Bardisi H 79 , Shoshany O 89 , Busetto GM 90 , Moussa M 91 , Jamali M 92 , Al-Marhoon MS 93 , Ruzaev M 94 , Farsi HMA 3 , Mutambirwa S 95 , Lee DS 96 , Kulaksiz D 97 , Cheng YS 98 , Bouzouita A 99 , Sarikaya S 100 , Kandil H 101 , Tsampoukas G 102 , Farkouh A 103 , Bowa K 104 , Savira M 25 , Mogharabian N 105 , Le TV 24 , Harjanggi M 106 , Anh DT 107 , Long TQT 108 , Soebadi MA 109 , Hakim L 110 , Tanic M 111 , Ari UC 112 , Parikh FR 113 , Calik G 27 , Kv V 114 , Dorji G 115 , Rezano A 116 , Rajmil O 117 , Tien DMB 24 , Yuan Y 35 , Lizarraga-Salas JF 118 , Eze B 119 , Ngoo KS 120 , Lee J 121 , Arslan U 9 , Agarwal A 104 , Global Andrology Forum

Affiliations 

  • 1 Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
  • 2 Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
  • 3 Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
  • 4 Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
  • 5 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
  • 6 Department of Urology, Selcuk University School of Medicine, Konya, Turkey
  • 7 Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
  • 8 Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
  • 9 Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
  • 10 Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
  • 11 Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
  • 12 Department of Urology, Başakşehir Cam and Sakura City Hospital, Istanbul, Turkey
  • 13 Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
  • 14 Department of Internal Medicine, Trinity Health/Mercy Health, Muskegon, MI, USA
  • 15 Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
  • 16 Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
  • 17 Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
  • 18 Reproductive Medicine, Clinical Research Centre, Lund University, Malmö, Sweden
  • 19 Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
  • 20 Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
  • 21 IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
  • 22 Department of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India
  • 23 Department of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA
  • 24 Department of Andrology, Binh Dan Hospital, Ho Chi Minh, Vietnam
  • 25 Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • 26 Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
  • 27 Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
  • 28 Department of Urology, Innsbruck Medical University, Innsbruck, Austria
  • 29 Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
  • 30 Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
  • 31 Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
  • 32 Central Drug Research Institute, Male Reproductive Health Research Laboratory, Lucknow, Uttar Pradesh, India
  • 33 Division of Endocrinology, Central Drug Research Institute, Lucknow, India
  • 34 Division of Urology, Centro Universitario FMABC, Santo André, Brazil
  • 35 Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
  • 36 Department of Urology, University Hospital of Rostock, Rostock, Germany
  • 37 Department of Urology, Aristotle University School of Medicine, Thessaloniki, Greece
  • 38 Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India
  • 39 Andrology Unit, Department of Urology, Apollo Hospitals, Greams Road, Chennai, India
  • 40 Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
  • 41 Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  • 42 Department of Urology, Ege University, Izmir, Turkey
  • 43 Urocentre Urology Clinic, Adana, Turkey
  • 44 Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania, Turkey
  • 45 Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
  • 46 Department of Urology, Astghik Medical Center, Yerevan, Armenia
  • 47 Men's Health Melbourne, Victoria, Australia
  • 48 Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
  • 49 Fleury Group and Hospital Israelita Albert Einstein, São Paulo, Brazil
  • 50 Department of Clinical Surgery, Health Sciences Sector of the Federal University of Parana (UFPR), Curitiba, Paraná, Brazil
  • 51 Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
  • 52 2nd Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • 53 SCM Clinic and Hospital, New Delhi, India
  • 54 Division of Urology, Department of Surgery, Prof. Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  • 55 Department of Urology, Hasan Sadikin Hospital, Medical Faculty of Padjadjaran University, Bandung, Indonesia
  • 56 Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
  • 57 Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
  • 58 Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
  • 59 Elang Medika Corpora Hospital, Tangerang, Indonesia
  • 60 Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
  • 61 Department of Urology, Pusan National University School of Medicine, Busan, Korea
  • 62 SENSART Clinic, Istanbul, Turkey
  • 63 Department of Urology, Baskent University Faculty of Medicine, Ankara, Turkey
  • 64 Department of Urology, Ankara University School of Medicine, Ankara, Turkey
  • 65 Department of Andrology, Hammersmith Hospital, Imperial, London, UK
  • 66 Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
  • 67 Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
  • 68 Institute of Urology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
  • 69 Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
  • 70 Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
  • 71 Department of Surgery, School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia
  • 72 Instituto de Ginecología y Fertilidad (IFER) y Universidad Barcelo, Buenos Aires, Argentina
  • 73 AndroOne Men's Health Clinic, Salem, India
  • 74 Department of Physiology, All India Institute of Medical Sciences Mangalagiri, Mangalagiri, India
  • 75 Department of Urology, Dr Wahidin Sudirohusodo Hospital, Makassar, Indonesia
  • 76 Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 77 Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
  • 78 Department of Urology, Western General Hospital, Edinburgh, UK
  • 79 Department of Urology, Hamad Medical Corporation, Doha, Qatar
  • 80 Department of Urology, Dr. Dradjat Hospital, Serang, Indonesia
  • 81 Department of Andrology and Sexual Medicine, Hanoi Medical University's Hospital, Hanoi, Vietnam
  • 82 Clarity Health, Chandigarh, India
  • 83 Department of Urology and Andrology, Locus Medicus, Athens, Greece
  • 84 Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
  • 85 Department of Urology, Prof. Dr. I.G.N.G Ngoerah General Hospital, Faculty of Medicine, Universitas Udayana, Bali, Indonesia
  • 86 Department of Andrology & Reproductive Medicine, Jindal Hospital & Fertility Center, Meerut, India
  • 87 Department of Urology, Prof R.D. Kandou Hospital, Manado, Indonesia
  • 88 Urology Department, Tehran University of Medical Scienes, Tehran, Iran
  • 89 Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
  • 90 Department of Urology and Renal Transplantation, Univeristy of Foggia, Foggia, Italy
  • 91 Department of Urology, Lebanese University, Beirut, Lebanon
  • 92 Department of Urology, Military Teaching Hospital, Rabat, Morocco
  • 93 Department of Surgery, Urology Division, Sultan Qaboos University, Muscat, Oman
  • 94 Urology Clinic, Moscow, Russia
  • 95 Department of Urology, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Science University, Medunsa, Ga-Rankuwa, South Africa
  • 96 Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
  • 97 Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey
  • 98 Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 99 Department of Anatomy, Faculty of Medicine, Faculty Tunis Manar, Tunis, Tunisia
  • 100 Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
  • 101 Fakih IVF Fertility Center, Abu Dhabi, UAE
  • 102 Department of Urology, Oxford University Hospital, Oxford, UK
  • 103 Global Andrology Forum, Moreland Hills, OH, USA
  • 104 Department of Urology, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
  • 105 Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
  • 106 IVF Jakarta - YPK Mandiri, Jakarta, Indonesia
  • 107 Tam Anh IVF Center, Tam Anh General Hospital, Hanoi, Vietnam
  • 108 Department of Obstetrics and Gynecology, Hanoi Obstetric and Gynecology Hospital, Hanoi, Vietnam
  • 109 Department of Urology, Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  • 110 Department of Urology, Universitas Airlangga Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  • 111 Department of Urology, General Hospital, Cuprija, Serbia
  • 112 Department of Reproduction and Artificial Insemination, Faculty of Veterinary Medicine, Kafkas University, Kars, Turkey
  • 113 FertilTree-Jaslok International Fertility Centre, Jaslok Hospital, Mumbai, Maharashtra, India
  • 114 Cure & SK Hospital, Trivandrum, India
  • 115 Department of Anatomy, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
  • 116 Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
  • 117 Department of Andrology, Fundacio Puigvert, Barcelona, Spain
  • 118 Instituto de Ciencias en Reproducción Humana Vida, León, Mexico
  • 119 Department of Surgery, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
  • 120 Urology Unit, Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
  • 121 Department of Urology, National University Hospital, Singapore
World J Mens Health, 2024 Jan;42(1):92-132.
PMID: 37382284 DOI: 10.5534/wjmh.230034

Abstract

PURPOSE: The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles.

MATERIALS AND METHODS: The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies).

RESULTS: Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129-0.278; p<0.001; I²=83.62%, Egger's p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474-1.706; p<0.001; I²=97.86%, Egger's p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526-2.121; p<0.001; I²=97.88%, Egger's p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318-1.968; p<0.001; I²=98.65%, Egger's p=0.0003; progressive sperm motility: SMD 1.845, 95% CI: 1.537%-2.153%; p<0.001; I²=98.97%, Egger's p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%-1.759%; p<0.001; l2=97.98%, Egger's p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%-1.211%; p<0.001; I²=97.87%, Egger's p=0.1864.

CONCLUSIONS: The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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