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 ,Revised 1 December 2006 ,Accepted 5 December 2006.

References 

  1. Madgar I, Weissenberg R, Lunenfeld B, Karasik A, Goldwasser B. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril. 1995;63:120–124
  2. Schlesinger MH, Wilets IF, Nagler HM. Treatment outcome after varicocelectomy. A critical analysis. Urol Clin North Am. 1994;21:517–529
  3. Marmar JL, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol. 1994;152:1127–1132
  4. Onozawa M, Endo F, Suetomi T, Takeshima H, Akaza H. Clinical study of varicocele: statistical analysis and the results of long-term follow-up. Int J Urol. 2002;9:455–461
  5. Okuyama A, Fujisue H, Matsui T, Doi Y, Takeyama M, Nakamura N, et al. Surgical repair of varicocele: effective treatment for subfertile men in a controlled study. Eur Urol. 1988;14:298–300
  6. Cayan S, Kadioglu TC, Tefekli A, Kadioglu A, Tellaloglu S. Comparison of results and complications of high ligation surgery and microsurgical high inguinal varicocelectomy in the treatment of varicocele. Urology. 2000;55:750–754
  7. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 1992;148:1808–1811
  8. Sayfan J, Soffer Y, Orda R. Varicocele treatment: prospective randomized trial of 3 methods. J Urol. 1992;148:1447–1449
  9. Segenreich E, Israilov SR, Shmueli J, Niv E, Servadio C. Correlation between semen parameters and retrograde flow into the pampiniform plexus before and after varicocelectomy. Eur Urol. 1997;32:310–314
  10. Kamischke A, Nieschlag E. Varicocele treatment in the light of evidence-based andrology. Hum Reprod Update. 2001;7:65–69
  11. Clinical guidelines: Fertility: assessment and treatment for people with fertility problems. National Collaborating Centre for Women's and Children's Health 2004;54–5.
  12. Evers JL, Collins JA. Surgery or embolisation for varicocele in subfertile men. Cochrane Database Syst Rev. 2004;CD000479
  13. Nilsson S, Edvinsson A, Nilsson B. Improvement of semen and pregnancy rate after ligation and division of the internal spermatic vein: fact or fiction?. Br J Urol. 1979;51:591–596
  14. Grasso M, Lania C, Castelli M, Galli L, Franzoso F, Rigatti P. Low-grade left varicocele in patients over 30 years old: the effect of spermatic vein ligation on fertility. BJU Int. 2000;85:305–307
  15. Breznik R, Vlaisavljevic V, Borko E. Treatment of varicocele and male fertility. Arch Androl. 1993;30:157–160
  16. Rageth JC, Unger C, DaRugna D, Steffen R, Stucki D, Barone C, et al. Long-term results of varicocelectomy. Urol Int. 1992;48:327–331
  17. Krause W, Muller HH, Schafer H, Weidner W. Does treatment of varicocele improve male fertility? Results of the “Deutsche Varikozelenstudie,” a multicentre study of 14 collaborating centres. Andrologia. 2002;34:164–171
  18. Jarow JP, Sharlip ID, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al. Best practice policies for male infertility. J Urol. 2002;167:2138–2144
  19. Sharlip ID, Jarow JP, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al. Best practice policies for male infertility. Fertil Steril. 2002;77:873–882
  20. Dohle GR, Colpi GM, Hargreave TB, Papp GK, Jungwirth A, Weidner W. EAU Guidelines on Male Infertility. Eur Urol. 2005;48:703–711
  21. Williams JK. Understanding evidence-based medicine: a primer. Am J Obstet Gynecol. 2001;185:275–278
  22. Templeton A. Varicocele and infertility. Lancet. 2003;361:1838–1839
  23. Marmar J, Benoff S. New scientific information related to varicoceles. J Urol. 2003;170:2371–2373
  24. Ficarra V, Cerruto MA, Ligouri G, Mazzano G, Minucci S, Tracia A, et al. Treatment of varicocele in subfertile men: The Cochrane review—a contrary opinion. Eur Urol. 2006;49:258–263
  25. Yavetz H, Levy R, Papo J, Yogev L, Paz G, Jaffa AJ, et al. Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improved sperm quality. Int J Androl. 1992;15:338–344
  26. Shlansky-Goldberg RD, VanArsdalen KN, Rutter CM, Soulen MC, Haskal ZJ, Baum RA, et al. Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes. J Vasc Interv Radiol. 1997;8:759–767
  27. Peipert JF, Phipps MG. Observational studies. Clin Obstet Gynecol. 1998;41:235–244
  28. Norris SL, Atkins D. Challenges in using nonrandomized studies in systemic reviews of treatment interventions. Ann Intern Med. 2005;142:1112–1119
  29. Cook DJ, Sackett DL, Spitzer WO. Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam Consultation on Meta-Analysis. J Clin Epidemiol. 1995;48:167–171
  30. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions 4.2.5. In: The Cochrane Library, 2005. Chichester: Wiley.
  31. Bender R. Calculating confidence intervals for the number needed to treat. Controlled Clin Trials. 2001;22:102–110
  32. Nieschlag E, Hertle L, Fischedick A, Abshagen K, Behre HM. Update on treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Hum Reprod. 1998;13:2147–2150
  33. Thacker SB, Stroup DF, Peterson HB. Meta-analysis for the practicing obstetrician gynecologist. Clin Obstet Gynecol. 1998;41:275–281
  34. Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC. Meta-analyses of randomized controlled trials. N Engl J Med. 1987;316:450–455
  35. Egger M, Smith GD. Bias in location and selection of studies. BMJ. 1998;316:61–66
  36. Berlin JA. Does blinding of readers affect the results of meta-analyses? University of Pennsylvania Meta-analysis Blinding Study Group. Lancet. 1997;350:185–186
  37. Beck CT. The effects of postpartum depression on maternal-infant interaction: a meta-analysis. Nurs Res. 1995;44:298–304
  38. Dennis LK, Snetselaar LG, Nothwehr FK, Stewart RE. Developing a scoring method for evaluating dietary methodology in reviews of epidemiologic studies. J Am Diet Assoc. 2003;103:483–487
  39. Juni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282:1054–1060
  40. Comhaire F. Clinical andrology: from evidence-base to ethics. The “E” quintet in clinical andrology. Hum Reprod. 2000;15:2067–2071
  41. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–2012
  42. Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet. 2003;361:1849–1852
  43. Ombelet W, Bosmans E, Janssen M, Cox A, Vlasselaer J, Gyselaers W, et al. Semen parameters in a fertile versus subfertile population: a need for change in the interpretation of semen testing. Hum Reprod. 1997;12:987–993
  44. Bonde JP, Ernst E, Jensen TK, Hjollund NH, Kolstad H, Henriksen TB, et al. Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners. Lancet. 1998;352:1172–1177
  45. Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med. 2001;345:1388–1393
  46. Benoff S, Gilbert BR. Varicocele and male infertility: part I. Preface. Hum Reprod Update. 2001;7:47–54
  47. Marmar J. Varicocele and male infertility: part II. Hum Reprod Update. 2001;7:461–742
  48. Saleh RA, Agarwal A, Sharma RK, Said TM, Sikka SC, Thomas AJ. Evaluation of nuclear DNA damage in spermatozoa from infertile men with varicocele. Fertil Steril. 2003;80:1431–1436
  49. Zini A, Blumenfeld A, Libman J, Willis J. Beneficial effect of microsurgical varicocelectomy on human sperm DNA integrity. Hum Reprod. 2005;20:1018–1021
  50. Cayan S, Lee D, Black LD, Reijo Pera RA, Turek PJ. Response to varicocelectomy in oligospermic men with and without defined genetic infertility. Urology. 2001;57:530–535
  51. Marmar JL, Benoff S. The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome. Hum Reprod. 2005;20:2279–2288

 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

Article Tools

* Image Usage & Resolution