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

Ramon, Ryan1; Warli, Syah Mirsya2,3; Siregar, Ginanda Putra2; Prapiska, Fauriski Febrian2; Kadar, Dhirajaya Dharma2; Tala, Mohd Rhiza Z4

1Department of Urology, Faculty of Medicine, Universitas Indonesia – Haji Adam Malik General Hospital, Medan 20136, Indonesia

2Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan 20136, Indonesia

3Department of Urology, Universitas Sumatera Utara Hospital – Universitas Sumatera Utara, Medan 20154, Indonesia

4Department of Obstetric and Gynaecology, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medan 20136, Indonesia

Correspondence: Dr. SM Warli (warli@usu.ac.id)

Originally published: June 14, 2024 Received: October 13, 2023 Accepted: April 11, 2024


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.

Keywords: male infertility; spermatozoa quality; varicocele

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.