Impact of Varicocelectomy On Gonadal Hormone Levels and Semen Parameters in Infertile Men with Clinical Varicocele: A Systematic Review and Meta-Analysis | ||
| International Journal of Medical Arts | ||
| Article 4, Volume 7, Issue 5, May 2025, Pages 5667-5681 PDF (2.26 M) | ||
| Document Type: Review Article | ||
| DOI: 10.21608/ijma.2025.356058.2117 | ||
| Authors | ||
| Abdelrahman Mahmoud Mansour Elsa Saleh* 1; Ahmed Yousef Aboelsaad1; Saed Khater1; Mourad Mahmoud Mourad2 | ||
| 1Department of Urology, Damietta Faculty of Medicine Al-Azhar University, Damietta, Egypt. | ||
| 2Department of Urology, Faculty of Medicine Al-Azhar University, Cairo, Egypt. | ||
| Abstract | ||
| Introduction: Varicocele, affecting ~15% of men, is a common but treatable cause of infertility, especially in primary infertility. The efficacy of repair depends on varicocele grade and patient factors, though its benefits in azoospermia and subclinical cases remain uncertain. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library up to September 2024. Study quality was assessed using the Cambridge Checklists, Cochrane ROB 2 tool, Jadad score, and CONSORT guidelines. Data analysis was performed in STATA 17 and R, using Hedges' g for effect size and log risk ratio for categorical data. Heterogeneity was evaluated with Cochran's Q test and the I² index, applying random effects models. Subgroup and meta-regression analyses were conducted based on varicocele repair type and study design, along with cumulative meta-analysis, sensitivity analysis, and publication bias assessment via Egger's test. Results: The initial search identified 1,165 studies, with 595 duplicates removed. After screening, 496 studies were excluded by title and abstract, and 56 after full-text review, leaving 18 studies with 3,160 patients for analysis. A meta-analysis of 10 studies found a significant effect on sperm concentration [Hedges’ g = 1.242, p = 0.0002; I² = 97.38%]. Sperm morphology analysis [12 studies] showed a moderate effect [Hedges’ g = 0.809, p = 0.0337; I² = 97.71%]. No significant effects were found for semen volume [Hedges’ g = -0.272, p = 0.5; I² = 95.35%], progressive motility, or FSH levels. Total sperm count showed a minor but significant effect [Hedges’ g = 0.877, p = 0.0428]. Pregnancy rates significantly improved [log risk ratio = 0.56, p = 0.00] with low heterogeneity [I² = 26.32%]. Most analyses showed substantial heterogeneity. Conclusion: Varicocele repair significantly improves sperm concentration, total count, morphology, motility, and pregnancy rates, though effects on semen volume, progressive motility, and hormones were not significant. These findings support varicocelectomy for male infertility, highlighting the need for further research to refine patient selection and standardize outcomes. | ||
| Keywords | ||
| Male Infertility; Pregnancy Rate; Semen Analysis; Spermatogenesis; Varicocelectomy | ||
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