Comparison of sperm parameters and fertility rate in subclinical varicocele patients treated with varicocelectomy versus no varicocelectomy: a systematic review

Abstract

Introduction: Subclinical varicocele is defined as non-palpable varicocele which diagnosed solely through imaging examination, namely ultrasonography. Despite the current high prevalence of subclinical varicocele as one of the most common cause of men infertility, there is still lack of evidence regarding the need to perform varicocelectomy among these patients. This systematic review aims to evaluate and compare the sperm parameters and fertility rate of subclinical varicocele patients treated with varicocelectomy versus no treatment. Methods: A systematic literature search was conducted on the international databases PubMed, Scopus, Cochrane, EMBASE, EBSCOHost, and Google Scholar published in the last ten years up to August 21st, 2022. Risk of bias assessment was performed using the Newcastle-Ottawa Scale tools for cohort study and converted regarding the AHRQ standards. Results: Three cohort studies were conducted in three different countries with 363 patients. The risk of bias assessment revealed that all of the three studies included in this review have good quality and low risk of bias. Varicocelectomy significantly improves sperm parameters in terms of sperm concentration (p<0.05) and sperm motility (p<0.05) while its effects on sperm morphology are not significant (p>0.05). The effects of varicocelectomy on fertility rate are reported by one study by Cantoro et al. as significant (p=0.011). Conclusion: Varicocelectomy correction has been proved to significantly improve sperm parameters in terms of sperm concentration and motility, while its effect on fertility rate remains unclear and no conclusion can be drawn yet. Therefore, this study recommends further randomized controlled studies with larger sample size in the future to prove the effectiveness of varicocelectomy in subclinical varicocele patients before its implementation in clinical settings.