P-644: Re-assessing the value of varicocelectomy as a treatment for male subfertility: A new meta-analytical approach

Abstract

Although, varicoceles are recognized as a leading cause of male infertility, however, the the value of a varicocelectomy in improving semen parameters or pregnancy outcomes is a topic of continuous debate. In this report, we present a meta-analysis with a new perspective to determine the efficacy of a varicocelectomy. We analyzed relevant articles on the topic, and included studies on infertile men with palpable varicoceles (i.e. clinical) and at least one abnormal semen parameter. We utilized a new scoring system that quantified bias, and relied on the scores for inclusion of both prospective randomized trials and observational studies. The meta-analysis evaluated only those studies that had pre and post-operative semen data on the same patient and spontaneous or natural pregnancy rates following a surgical varicocelectomy. Meta-analysis. We performed a comprehensive literature review using the Medline (from 1985 to 2005), EMBASE, BIOSIS and Cochrane databases (1985-2005) with the following key search words: varicocele, varicocelectomy, sperm count, motility and morphology, spermatic vein ligation, microsurgery, male infertility, pregnancy etc. Only studies meeting specific selection criteria were selected for the meta-analysis. The data were then entered in the RevMan software (version 4.2.8) developed by the Cochrane collaborative for the purpose of meta-analysis (www.cochrane.org). Sperm concentration increased by 9.71 X 106/mL (95% CI: [7.34, 12.08], P < 0.00001) and motility increased by 9.92% (95% CI: [4.90, 14.95], P = 0.0001) following microsurgery. Similarly, sperm concentration increased by 12.03 X 106/mL (95% CI: [5.71, 18.35], P = 0.0002) and motility increased by 11.72% (95% CI: [4.33, 19.12], P = 0.002) after high ligation. The change in sperm morphology was statistically significant or 3.16% (95% CI: [0.72, 5.60]; P = 0.01)(Table 1). The odds of spontaneous pregnancy after surgical varicocelectomy, as compared to no/medical treatment for clinical varicocele, was significantly different at 2.87 (95% CI: [1.33, 6.20], P = 0.007) using a random effects model or 2.63 (95% CI: [1.60, 4.33], P = 0.0001) with fixed effects model (Figure 1).Tabled 1View Large Image Figure ViewerDownload (PPT) A surgical varicocelectomy significantly improves semen parameters (count, motility and morphology) in infertile males with palpable lesions and the spontaneous pregnancy outcomes in their female partners. Contrary to previous meta-analyses, our study suggests that varicocelectomy does indeed have beneficial effects on fertility status.