Varicocelectomy for Infertile Men With Clinical Varicocele and Normal

Semen Parameters, in Relation to Pregnancy Rate and Recurrent

Spontaneous Miscarriage Incidence: A Systematic Review

I Komang Bintang Satria Mahaputra, I Made Udiyana Indradiputra, I Dewa Gede Reza Sanjaya
Buleleng General Hospital
Conflict of Interest Disclosure
• No conflict of interest
 Introduction
8-12% of couples1

Up to 50%2

Up to 40%3

Dillema in the management 15-30% of infertile men4

of varicocele
 Objective

• Infertile Couple
• Clinical Varicocele
• Normal Semen
Parameters
Pregnancy rate Miscarriage rate

Semen Parameters
 Material and Methods
Records identified through Eligibility Criteria
Identification

database searching
(n = 55) Inclusion Exclusion
• Adult aged > 18 • Abnormal female
years factor
Records after duplicates removed
(n = 38) • Infertile couple • Subclinical varicocele
• Recurrent
miscarriage
• Normal female • Abnormal semen
Screening

factor parameter
Records screened by title Records excluded
(n = 38) (n = 28) • Clinical • History of previous
varicocele varicocele repair
• Normal semen
parameter
Eligibility

Full-text articles assessed for Full-text articles excluded

eligibility (n = 8)
(n = 10) 8 – The sample have abnormal
semen parameters
Included

Studies included in qualitative

assessment
(n = 2)
 Included Studies
Author Study No. of Study Quality Infertile patient with varicocele and Methode of varicocele repair
and year period centres design Assessment normal semen parameters (n = 221 )
and
country Varicocele Repair Expectant Subinguinal Inguinal
(n = 113) Therapy (n = 108) microsurgical

Fathi et al5, July 2014 – 1, Egypt Non-RCT NOS Score (7) 45 40

2021 January 
2019
Ghanaie et January 1, Iran RCT RoB 2 (Low 68 68
al6, 2012 2004 - risk of bias) 
 Varicocele Grade Profile
Author and Year Varicocele grade
P Varicocele Grade
Varicocele repair Expectant therapy 83
Fathi et al5, 2021
90
Grade 1 - - - 80
Grade 2 15 13 70 47
0.47 60
Grade 3 30 17 28 32
50 21
Ghanaie et al , 2012
6 40
30
Grade 1 17 15 0.08 0
20
Grade 2 41 42 0.24 10
Grade 3 10 11 0.09 0
Fathi et al Ghanaie et al
Grade 1 Grade 2 Grade 3
Varicocele Repair Expectant Therapy

17; 15% 15; 15%

28; 29%
40; 35%

56; 50% 55; 56%

Grade 1 Grade 2 Grade 3 Grade 1 Grade 2 Grade 3

 Improvement in Pregnancy Rate
Pregnancy after 1 year
Author Pregnancy after 1 year follow 86
and year up P < 0.05
P
Varicocele Expectant 90
Repair Therapy 80
58
70 55
Fathi et
al5, 2021 28 9 0.009 60
50
Ghanaie 40 22
et al6, 30 13 < 0.01 30
2012
20
10
0
Varicocele Repair Expectant Therapy Pregnant Not Pregnant

Varicocele Repair Expectant Therapy

22; 20%

55; 49% 58; 51%

86; 80%

Pregnant Not Pregnant Pregnant Not Pregnant

 Improvement in Miscarriage Rate
Author Miscarriage after 1 year follow
and year up Miscarriage rate after 1 year
P
Varicocele Expectant 54
Repair Therapy P = 0.001
60
Fathi et 50
al5, 2021 0 0 -
40
30 13
Ghanaie 9
et al6, 4 9 0.003 20 4
2012 10
0
Live birth Miscarriage
Varicocele Repair Expectant Therapy Varicocele repair Expectant therapy
4; 7%

9; 41%
13; 59%
54; 93%

Misscariage Live Birth Misscariage Live Birth

 Comparison of Semen Analysis
Fathi et al Fathi et al5, 2021 Sperm DNA fragmentation
(SDF)
32.5 33.9 36.1 P
40
26.1 Varicocele Expectant
repair therapy
30
20 Baseline
4.3 5.2 34.93% 35.33% 0.77
10
0 6-months follow
Concentration, million/ml Motility, % Normal morphology, %
up 25.75% 31.26% <0.0001
Baseline 6-months follow up

Ghanaie et al
64.4
70 55.2 56.7 Sperm DNA fragmentation Spontaneous Pregnancy Rate
60 44.8
50 38.4 5; 18%
32.2
40 18; 40%
30
45 28
20
27; 60%
10 23; 82%
0
Concentration, million/ml Motility, % Normal morphology, %
<25% 25%-35%
Baseline 6-months follow up <25% 25%-35%
 Limitation
s

Relatively small numbers of studies identified given specific inclusion criteria

Studies use different methods of varicocele repair

Included studies that non-randomized

 Conclusion

Varicocele repair improves pregnancy rate, miscarriage rate, and semen

analysis

Additional randomized controlled trials must be conducted to provide more evidence of the
benefits of varicocele correction in infertile men with normal semen parameters.
References
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States: national survey data. Fertil Steril 2009; 91: 2466–70.
• Practice Committee of the American, Society for Male Reproduction and Urology. Report on varicocele and
infertility: a committee opinion. Fertil Steril 2014; 102: 1556–60.
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Gynecol Surv. 2014 Feb;69(2):109-15
• Fathi, A., Mohamed, O., Mahmoud, O., Alsagheer, G. a., Reyad, A. M., Abolyosr, A., Abdel-Kader, M. S., &
Saber-Khalaf, M. (2021). The impact of varicocelectomy on sperm DNA fragmentation and pregnancy rate in
subfertile men with normal semen parameters: A pilot study. Arab Journal of Urology, 19(2), 186–190.
• Ghanaie, M. M., Asgari, S. A., Dadrass, N., Allahkhah, A., Iran-Pour, E., & Safarinejad, M. R. (2012). Effects of
varicocele repair on spontaneous first trimester miscarriage: A randomized clinical trial. Urology Journal,
9(2), 505–513.
Thank You