Fertility and Sterility
Volume 88, Issue 3 , Pages 639-648, September 2007

Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis

  • Joel L. Marmar, M.D.

      Affiliations

    • Division of Urology, Robert Wood Johnson Medical School at Camden, Camden, New Jersey
    • ,
  • Ashok Agarwal, Ph.D.

      Affiliations

    • Reproductive Research Center, Glickman Urological Institute and Department of Obstetrics-Gynecology, Cleveland Clinic, Cleveland, Ohio
    • Corresponding Author InformationReprint requests: Ashok Agarwal, Ph.D., Professor, Lerner College of Medicine, Case Western Reserve University, and Director, Reproductive Research Center, Glickman Urological Institute and Department of Obstetrics-Gynecology, Cleveland Clinic, 9500 Euclid Ave., Desk A19.1, Cleveland, OH 44195 (FAX: 216-445-6049).
    • ,
  • Sushil Prabakaran, M.D.

      Affiliations

    • Reproductive Research Center, Glickman Urological Institute and Department of Obstetrics-Gynecology, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Rishi Agarwal

      Affiliations

    • Reproductive Research Center, Glickman Urological Institute and Department of Obstetrics-Gynecology, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Robert A. Short, Ph.D.

      Affiliations

    • Health Research and Education Center, Washington State University, Spokane, Washington
    • ,
  • Susan Benoff, Ph.D.

      Affiliations

    • North Shore–LIJ Research Institute, Manhasset, New York
    • ,
  • Anthony J. Thomas Jr., M.D.

      Affiliations

    • Reproductive Research Center, Glickman Urological Institute and Department of Obstetrics-Gynecology, Cleveland Clinic, Cleveland, Ohio

Received 11 January 2006; received in revised form 1 December 2006; accepted 5 December 2006. published online 16 April 2007.

Objective

To determine the efficacy of varicocelectomy as a treatment for male factor infertility by improving the chance of spontaneous pregnancy.

Design

Meta-analysis.

Setting

Cleveland Clinic's Glickman Urological Institute.

Patient(s)

Infertile men with abnormal results on semen analyses and a palpable varicocele.

Intervention(s)

Surgical varicocelectomy.

Main Outcome Measure(s)

Spontaneous pregnancy outcome.

Result(s)

The odds of spontaneous pregnancy after surgical varicocelectomy, compared with no or medical treatment for palpable varicocele, were 2.87 (95% confidence interval [CI], 1.33–6.20) with use of a random-effects model or 2.63 (95% CI, 1.60–4.33) with use of a fixed-effects model. The number needed to treat was 5.7 (95% CI, 4.4–9.5).

Conclusion(s)

Surgical varicocelectomy in infertile men with palpable lesions and at least one abnormal semen parameter improves the odds of spontaneous pregnancy in their female partners. Five studies were included (two randomized, three observational). All were scored for bias. Our study suggests that varicocelectomy in selected patients does indeed have beneficial effects on fertility status.

Key Words: Varicocelectomy, pregnancy, meta-analysis, random effect

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 Supported by funds from the Reproductive Research Center and the Glickman Urological Institute, Cleveland Clinic, and by grant number ES10496 to S. B. from the National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland.

PII: S0015-0282(07)00025-8

doi:10.1016/j.fertnstert.2006.12.008

Fertility and Sterility
Volume 88, Issue 3 , Pages 639-648, September 2007

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