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Meta-Analysis
. 2025 Mar-Apr;19(2):15579883251334561.
doi: 10.1177/15579883251334561. Epub 2025 Apr 28.

Influence of Varicocelectomy on Assisted Reproductive Technology Outcomes of Infertile Patients with Varicocele: A Systematic Review and Meta-Analysis

Wending Teng  1 , Jianfeng Xiao  2 , Qian Xu  3 , Penghao Li  3
Affiliations
Meta-Analysis

Influence of Varicocelectomy on Assisted Reproductive Technology Outcomes of Infertile Patients with Varicocele: A Systematic Review and Meta-Analysis

Wending Teng et al. Am J Mens Health. 2025 Mar-Apr.

Abstract

Varicocele can lead to impaired semen parameters and induce infertility. Varicocelectomy is considered the gold standard for varicocele treatment. However, its impact on improving assisted reproductive technologies (ARTs) outcomes remains contentious. This study seeks to compare reproductive outcomes between infertile men who underwent varicocelectomy and those who did not prior to ARTs. In addition, it evaluates the influence of types of fertilization, couples' ages, and treatment years on clinical pregnancy rates. A comprehensive search was conducted through February 2023 across eight electronic databases using combinations of relevant keywords. Observational and randomized controlled trials (RCTs) were included. Fourteen eligible studies (n = 1,705) were included: 12 retrospective studies (n = 1,467) and 2 prospective studies (n = 238). Pooled results indicated that infertile men who received varicocelectomy had a significantly higher clinical pregnancy rate compared to the control group (OR: 1.38, 95% CI [1.05, 1.83]; I2 = 36%, p = .02). The live birth rate was also significantly higher in the treatment group (OR: 2.18, [1.58, 3.01]; p < .00001; I2 = 0%). However, miscarriage rates did not significantly differ (OR: 1.07; [0.57, 1.98]; I2 = 0%, p = .84). Varicocelectomy significantly improved sperm concentration and normal morphology rate, but did not result in a significant enhancement in sperm motility. Men who underwent varicocelectomy between 2012 and 2019 and subsequently received intracytoplasmic sperm injection exhibited improved outcomes, particularly when their female partners were under 30 years of age. Larger, high-quality RCTs are needed to clarify benefits or avoid unnecessary treatments.

Keywords: ARTs; ICSI; live birth rate; pregnancy rate; varicocelectomy.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flowcharts
Figure 2.
Figure 2.
Meta-Analyses of the Effect of Varicocelectomy on the Reproductive Outcomes of Infertile Patients with Varicocele. (A) Clinical Pregnancy Rate. (B) Live Birth Rate. (C) Miscarriage
Figure 3.
Figure 3.
Forrest Plot for the Effect of Varicocelectomy on the Sperm Parameters. (A) sperm concentration. (B) motility rate of sperm. (C) morphology rate of sperm.
Figure 4.
Figure 4.
Forrest Plot for the Effect of Varicocelectomy on the Clinical Pregnancy Rate in Studies with Different Fertilization Types
Figure 5.
Figure 5.
Forrest Plot for the Effect of Varicocelectomy on the Clinical Pregnancy Rate in Studies with Different Peer Review Mean Ages. (A) Male. (B) Female
Figure 6.
Figure 6.
Forrest Plot for the Effect of Varicocelectomy on the Clinical Pregnancy Rate in Studies with Different Treatment Years
Figure 7.
Figure 7.
Sensitivity Analysis for the Effect of Varicocelectomy on Clinical Pregnancy Rate of Infertile Patients with Varicocele Using Random Effect Model (Odds Ratio)
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