Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis
Ashok Agarwal
,
Rossella Cannarella
(1)
,
Ramadan Saleh
(2)
,
Florence Boitrelle
(3, 4)
,
Murat Gül
(5)
,
Tuncay Toprak
(6)
,
Gianmaria Salvio
(7)
,
Mohamed Arafa
(8, 9)
,
Giorgio I Russo
(1)
,
Ahmed M Harraz
(10)
,
Rajender Singh
(11)
,
Nicolas Garrido
(12)
,
Taha Abo-Almagd Abdel-Meguid Hamoda
(13, 14)
,
Amarnath Rambhatla
(15)
,
Parviz Kavoussi
,
Shinnosuke Kuroda
(16)
,
Gökhan Çalik
(17)
,
Pallavi Saini
,
Erman Ceyhan
(18)
,
Fotios Dimitriadis
(19)
,
Ralf Henkel
(20, 21)
,
Andrea Crafa
(1)
,
Ayad Palani
(22)
,
Mesut Berkan Duran
(23)
,
Evangelos Maziotis
(24)
,
Émine Saïs
(3, 4)
,
Marion Bendayan
(3, 4)
,
Mahsa Darbandi
(25)
,
Tan V Le
(26)
,
Sezgin Gunes
,
Petroula Tsioulou
(24)
,
Pallav Sengupta
(27)
,
Berk Hazir
(28)
,
Gökhan Çeker
(29)
,
Sara Darbandi
,
Damayanthi Durairajanayagam
,
Azin Aghamajidi
(30)
,
Noora Alkhalidi
,
Emrullah Sogutdelen
(31)
,
Kristian Leisegang
(21)
,
Abdullah Alarbid
,
Christopher C K Ho
(32)
,
Vineet Malhotra
,
Federica Finocchi
(7)
,
Luís Crisóstomo
(33, 34, 35)
,
Raghavender Kosgi
,
Haitham Elbardisi
(36, 9)
,
Armand Zini
(37)
,
Ponco Birowo
(38)
,
Giovanni Colpi
,
Hyun Jun Park
(39)
,
Ege Can Serefoglu
(40)
,
Quang Nguyen
(41)
,
Edmund Ko
(42)
,
De La Rosette Jean
(43)
,
Germar M Pinggera
(44)
,
Ho Vinh Phuoc Nguyen
(45, 46)
,
Hussein Kandil
(47)
,
Rupin Shah
(48)
1
Unict -
Università degli studi di Catania = University of Catania
2 Sohag University
3 CHI Poissy-Saint-Germain
4 BREED - Biologie de la Reproduction, Environnement, Epigénétique & Développement
5 Selçuk University = Selçuk Üniversitesi
6 İstanbul Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi
7 UNIVPM - Polytechnic University of Marche [Ancona, Italy] / Università Politecnica delle Marche [Ancona, Italia]
8 Hamad Medical Corporation [Doha, Qatar]
9 Weill Cornell Medicine [Qatar]
10 Mansoura University [Egypt]
11 CSIR-CDRI - CSIR-Central Drug Research Institute
12 IVI - Instituo Valenciano de Infertilitad
13 KAU - King Abdul Aziz University
14 Minia University
15 Henry Ford Health System
16 Cleveland Clinic
17 Istanbul Medipol University
18 Başkent University Hospital [Adana, Turkey]
19 Aristotle University of Thessaloniki
20 Imperial College London
21 UWC - University of the Western Cape
22 University of Garmian
23 Pamukkale University
24 NKUA - National and Kapodistrian University of Athens
25 Hope Generation Foundation
26 Pham Ngoc Thach Medical University (Ho Chi Minh city)
27 Gulf Medical University [Ajman, UAE]
28 Skane University Hospital [Lund]
29 BEU - Zonguldak Bülent Ecevit University
30 IUMS - Iran University of Medical Sciences [Tehran, Iran]
31 Abant Izzet Baysal University - Bolu Abant İzzet Baysal Üniversitesi
32 Taylor’s University
33 ICBAS - Instituto de Ciências Biomédicas de Abel Salazar
34 Universidade do Porto = University of Porto
35 University of Turku
36 Hamad medical corporation
37 McGill University = Université McGill [Montréal, Canada]
38 Cipto Mangunkusumo Hospital [Jakarta]
39 PNU - Pusan National University
40 Biruni University
41 VNU - Vietnam National University [Hanoï]
42 Loma Linda University
43 Istanbul University
44 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
45 Children's Hospital No. 2 [Ho Chi Minh City]
46 University of Medicine Pham Ngoc Thach
47 Fakih IVF Fertility Center
48 Lilavati Hospital and Research Centre
2 Sohag University
3 CHI Poissy-Saint-Germain
4 BREED - Biologie de la Reproduction, Environnement, Epigénétique & Développement
5 Selçuk University = Selçuk Üniversitesi
6 İstanbul Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi
7 UNIVPM - Polytechnic University of Marche [Ancona, Italy] / Università Politecnica delle Marche [Ancona, Italia]
8 Hamad Medical Corporation [Doha, Qatar]
9 Weill Cornell Medicine [Qatar]
10 Mansoura University [Egypt]
11 CSIR-CDRI - CSIR-Central Drug Research Institute
12 IVI - Instituo Valenciano de Infertilitad
13 KAU - King Abdul Aziz University
14 Minia University
15 Henry Ford Health System
16 Cleveland Clinic
17 Istanbul Medipol University
18 Başkent University Hospital [Adana, Turkey]
19 Aristotle University of Thessaloniki
20 Imperial College London
21 UWC - University of the Western Cape
22 University of Garmian
23 Pamukkale University
24 NKUA - National and Kapodistrian University of Athens
25 Hope Generation Foundation
26 Pham Ngoc Thach Medical University (Ho Chi Minh city)
27 Gulf Medical University [Ajman, UAE]
28 Skane University Hospital [Lund]
29 BEU - Zonguldak Bülent Ecevit University
30 IUMS - Iran University of Medical Sciences [Tehran, Iran]
31 Abant Izzet Baysal University - Bolu Abant İzzet Baysal Üniversitesi
32 Taylor’s University
33 ICBAS - Instituto de Ciências Biomédicas de Abel Salazar
34 Universidade do Porto = University of Porto
35 University of Turku
36 Hamad medical corporation
37 McGill University = Université McGill [Montréal, Canada]
38 Cipto Mangunkusumo Hospital [Jakarta]
39 PNU - Pusan National University
40 Biruni University
41 VNU - Vietnam National University [Hanoï]
42 Loma Linda University
43 Istanbul University
44 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
45 Children's Hospital No. 2 [Ho Chi Minh City]
46 University of Medicine Pham Ngoc Thach
47 Fakih IVF Fertility Center
48 Lilavati Hospital and Research Centre
Ashok Agarwal
Connectez-vous pour contacter l'auteur
- Fonction : Auteur correspondant
- PersonId : 770805
- ORCID : 0000-0003-0585-1026
- IdRef : 181655853
Connectez-vous pour contacter l'auteur
Rossella Cannarella
- Fonction : Auteur
- PersonId : 813429
- ORCID : 0000-0003-4599-8487
Florence Boitrelle
- Fonction : Auteur
- PersonId : 778478
- IdHAL : florenceboitrelle
- ORCID : 0000-0002-5322-0141
Murat Gül
- Fonction : Auteur
- PersonId : 1183743
- ORCID : 0000-0002-6657-6227
Tuncay Toprak
- Fonction : Auteur
- PersonId : 1183744
- ORCID : 0000-0003-1348-5273
Gianmaria Salvio
- Fonction : Auteur
- PersonId : 808169
- ORCID : 0000-0001-9290-5699
Mohamed Arafa
- Fonction : Auteur
- PersonId : 807966
- ORCID : 0000-0003-0107-8857
Giorgio I Russo
- Fonction : Auteur
- PersonId : 1183745
- ORCID : 0000-0003-4687-7353
Ahmed M Harraz
- Fonction : Auteur
- PersonId : 1183746
- ORCID : 0000-0002-8902-517X
Rajender Singh
- Fonction : Auteur
- PersonId : 1183747
- ORCID : 0000-0002-4592-6566
Nicolas Garrido
- Fonction : Auteur
- PersonId : 1183748
- ORCID : 0000-0001-8271-5218
Taha Abo-Almagd Abdel-Meguid Hamoda
- Fonction : Auteur
- PersonId : 813431
- ORCID : 0000-0002-8070-4088
Amarnath Rambhatla
- Fonction : Auteur
- PersonId : 813410
- ORCID : 0000-0002-1383-6670
Parviz Kavoussi
- Fonction : Auteur
- PersonId : 808487
- ORCID : 0000-0001-7390-5837
Gökhan Çalik
- Fonction : Auteur
- PersonId : 1183749
- ORCID : 0000-0002-9976-9666
Pallavi Saini
- Fonction : Auteur
- PersonId : 1183750
- ORCID : 0000-0003-0072-5573
Erman Ceyhan
- Fonction : Auteur
- PersonId : 1183751
- ORCID : 0000-0001-8223-6399
Fotios Dimitriadis
- Fonction : Auteur
- PersonId : 813421
- ORCID : 0000-0003-1198-9144
Ralf Henkel
- Fonction : Auteur
- PersonId : 807962
- ORCID : 0000-0003-1128-2982
Andrea Crafa
- Fonction : Auteur
- PersonId : 1183752
- ORCID : 0000-0002-8311-9095
Mesut Berkan Duran
- Fonction : Auteur
- PersonId : 813417
- ORCID : 0000-0002-8597-2081
Evangelos Maziotis
- Fonction : Auteur
- PersonId : 1183753
- ORCID : 0000-0002-6717-166X
Émine Saïs
- Fonction : Auteur
- PersonId : 1183754
- ORCID : 0000-0002-4937-8974
Marion Bendayan
- Fonction : Auteur
- PersonId : 1144208
- IdHAL : marion-bendayan
- ORCID : 0000-0003-1633-7735
Mahsa Darbandi
- Fonction : Auteur
- PersonId : 1162687
- ORCID : 0000-0002-2243-9319
Tan V Le
- Fonction : Auteur
- PersonId : 771608
- ORCID : 0000-0003-1766-7453
Sezgin Gunes
- Fonction : Auteur
- PersonId : 1183755
- ORCID : 0000-0002-3103-6482
Petroula Tsioulou
- Fonction : Auteur
- PersonId : 1183756
- ORCID : 0000-0002-3535-8227
Pallav Sengupta
- Fonction : Auteur
- PersonId : 807974
- ORCID : 0000-0002-1928-5048
Berk Hazir
- Fonction : Auteur
- PersonId : 1183757
- ORCID : 0000-0002-8907-8781
Gökhan Çeker
- Fonction : Auteur
- PersonId : 813413
- ORCID : 0000-0002-7891-9450
Sara Darbandi
- Fonction : Auteur
- PersonId : 1162688
- ORCID : 0000-0002-1868-6712
Damayanthi Durairajanayagam
- Fonction : Auteur
- PersonId : 807963
- ORCID : 0000-0001-9049-0215
Azin Aghamajidi
- Fonction : Auteur
- PersonId : 1183758
- ORCID : 0000-0001-5904-5260
Noora Alkhalidi
- Fonction : Auteur
- PersonId : 1183759
- ORCID : 0000-0003-1106-6606
Emrullah Sogutdelen
- Fonction : Auteur
- PersonId : 1183760
- ORCID : 0000-0002-1454-5672
Kristian Leisegang
- Fonction : Auteur
- PersonId : 808496
- ORCID : 0000-0002-3003-8048
Abdullah Alarbid
- Fonction : Auteur
- PersonId : 1183761
- ORCID : 0000-0003-4822-9587
Christopher C K Ho
- Fonction : Auteur
- PersonId : 813415
- ORCID : 0000-0002-8757-6867
Vineet Malhotra
- Fonction : Auteur
- PersonId : 1183762
- ORCID : 0000-0001-6760-0885
Federica Finocchi
- Fonction : Auteur
- PersonId : 1183763
- ORCID : 0000-0003-1551-5990
Luís Crisóstomo
- Fonction : Auteur
- PersonId : 1183764
- ORCID : 0000-0002-9563-6364
Raghavender Kosgi
- Fonction : Auteur
- PersonId : 813428
- ORCID : 0000-0002-2178-0857
Haitham Elbardisi
- Fonction : Auteur
- PersonId : 808126
- ORCID : 0000-0003-3902-7924
Armand Zini
- Fonction : Auteur
- PersonId : 807968
- ORCID : 0000-0002-2194-5578
Ponco Birowo
- Fonction : Auteur
- PersonId : 813412
- ORCID : 0000-0003-2934-6753
Giovanni Colpi
- Fonction : Auteur
- PersonId : 808489
- ORCID : 0000-0003-1431-1777
Hyun Jun Park
- Fonction : Auteur
- PersonId : 808134
- ORCID : 0000-0003-0566-9574
Ege Can Serefoglu
- Fonction : Auteur
- PersonId : 1183765
- ORCID : 0000-0002-2530-7012
Quang Nguyen
- Fonction : Auteur
- PersonId : 1183766
- ORCID : 0000-0002-1670-8885
De La Rosette Jean
- Fonction : Auteur
- PersonId : 761377
- ORCID : 0000-0002-6308-1763
Germar M Pinggera
- Fonction : Auteur
- PersonId : 813422
- ORCID : 0000-0001-6463-2494
Ho Vinh Phuoc Nguyen
- Fonction : Auteur
- PersonId : 1183767
- ORCID : 0000-0002-4348-6034
Hussein Kandil
- Fonction : Auteur
- PersonId : 807967
- ORCID : 0000-0002-5549-3274
Rupin Shah
- Fonction : Auteur
- PersonId : 807976
- ORCID : 0000-0002-7868-5949
Résumé
Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls.
A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies).
A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I²=97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I²=97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I²=98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I²=97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I²=98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI -0.242 to 0.868; I²=89.7%).
This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies' practice recommendations favoring VR to improve conventional semen parameters in infertile men.
Origine | Fichiers produits par l'(les) auteur(s) |
---|