Impact of Varicocelectomy On Gonadal Hormone Levels and Semen Parameters in Infertile Men with Clinical Varicocele: A Systematic Review and Meta-Analysis

Articles in Press

Document Type : Review Article

Authors

1 Department of Urology, Damietta Faculty of Medicine Al-Azhar University, Damietta, Egypt.

2 Department of Urology, Faculty of Medicine Al-Azhar University, Cairo, Egypt.

Abstract

Introduction: Varicocele is a very common but highly treatable cause of male infertility, with a prevalence of approximately 15% of men. The benefits of varicocele repair in azoospermia and subclinical varicoceles are unclear.
Method: A literature search was performed in PubMed, Scopus, Web of Science, and the Cochrane Library up to September 2024. The quality assessment of studies was made using the Cambridge Checklists, Cochrane ROB 2 tool, Jadad score, and CONSORT guidelines. STATA 17 and R were used for data analysis. Heterogeneity was assessed with Cochran's Q test and I² index, and random effects models were applied. We also conducted further subgroup and meta-regression analyses according to the types of varicocele repair and study design. Additional cumulative meta-analysis, sensitivity analysis, and publication bias via Egger's test were also conducted.

Results: The initial search yielded 1,165 studies. Of these, 595 were duplicates. After title and abstract screening, 496 were excluded, while 56 more were excluded upon full-text review. Finally, 18 studies containing 3,160 patients were ultimately included for final analysis. Meta-analysis of ten studies for Sperm Concentration showed a significant effect (g = 1.242, p = 0.0002; I² = 97.38%.) Analysis for sperm morphology, progressive motility and FSH indicated a moderate effect. Semen volume did not indicate a significant effect. The total sperm count showed a minor, significant effect and pregnancy rates showed a significant positive effect.

Conclusion: Varicocele had significant effects on sperm concentration, total sperm count, and pregnancy rates.

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International Journal of Medical Arts

Articles in Press, Accepted Manuscript
Available Online from 10 March 2025

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