Varicocele repair in improving spermatozoa, follicle-stimulating hormone, and luteinizing hormone parameters in infertile males with azoospermia: a systematic review and meta-analysis

Abstract

Patients with azoospermia show a prevalence of varicocele of 10.9% and a 14.8% contribution to male infertility. Patients with azoospermia are thought to produce high-quality semen following varicocele treatment. Advising varicocelectomy prior to sperm retrieval in a reproductive program is still debated. This study reviewed the impact of varicocele repair on male infertility using several factors. A literature search was conducted using Scopus, PubMed, Embase, the Wiley Online Library, and Cochrane databases. Sperm concentration, sperm progression, overall sperm motility, sperm morphology, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were also compared. Outcomes were compared between those who received treatment for varicocele and those who did not. The data from the pooled analysis were presented as standardized mean difference (SMD) along with a 95% confidence interval (CI). Heterogeneity was evaluated using I2 . Additionally, we conducted analyses for publication bias, sensitivity, and subgroup analysis as appropriate. Nine studies were included after screening relevant literature. Statistical analysis revealed a significant improvement in sperm concentration (SMD: 1.81, 95% CI: 0.84-2.77, P < 0.001), progressive sperm motility (SMD: 4.28, 95% CI: 2.34-6.22, P < 0.001), and sperm morphology (SMD: 3.59, 95% CI: 2.27-4.92, P < 0.001). Total sperm motility showed no significant difference following varicocele repair (SMD: 0.81, 95% CI: -0.61-2.22, P = 0.26). No significant differences were seen in serum FSH (SMD: 0.01, 95% CI: -0.16-0.19, P = 0.87) and LH (SMD: 0.19, 95% CI: -0.01-0.40, P = 0.07) levels as well. This study supports varicocele repair in infertile men with clinical varicocele, as reflected by the improvement in sperm parameters after varicocelectomy compared with no treatment. There were no significant improvements in serum FSH and LH levels.

Figure 1

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for literature search.

Figure 2

Forest plot and funnel plot of the spermatozoa parameters analysis in infertile participants with varicocele who underwent varicocelectomy compared to control (no treatment). (a) Spermatozoa concentration analysis. (b) Spermatozoa progression analysis. (c) Spermatozoa motility analysis. (d) Spermatozoa morphology analysis. s.d.: standard deviation; CI: confidence interval; IV: inverse variance; SMD: standardized mean difference; s.e.: standard error.

Figure 3

Forest plot and funnel plot of FSH serum levels in participants receiving varicocelectomy compared to control. FSH: follicle-stimulating hormone; s.d.: standard deviation; CI: confidence interval; IV: inverse variance; SMD: standardized mean difference; s.e.: standard error.

Figure 4

Forest plot and funnel plot of LH serum levels in participants receiving varicocelectomy compared to control. LH: luteinizing hormone; s.d.: standard deviation; CI: confidence interval; IV: inverse variance; SMD: standardized mean difference; s.e.: standard error.