Surgery or Embolisation for Varicocele in Subfertile Men

The quality of evidence is downgraded by study quality.

A meta-analysis cd000479 assessed the effect of varicocele repair before assisted reproduction in azoospermic and oligospermic men. 7 trials involving a total of 1241 patients were included. Varicocele repair improved live birth rates for the oligospermic (odds ratio [OR] 1.699) and combined oligospermic/azoospermic groups (OR 1.761). Pregnancy rates were higher in the azoospermic group (OR 2.336) and combined oligospermic/azoospermic groups (OR 1.760). Live birth rates were higher for patients undergoing intrauterine insemination after varicocele repair (OR 8.360). Sperm retrieval rates were higher in persistently azoospermic men after repair (OR 2.509).

A Cochrane review [Abstract] 1 included 48 studies with a total of 5384 men. All studies included men from couples with subfertility problems. There were no clear difference between surgical or radiological treatment compared to no treatment in live birth rates (RR 2.27, 95% CI 0.19 to 26.93; 2 RCTs, n=204). Treatment may improve pregnancy rates compared to delayed or no treatment.

References

• Persad E, O'Loughlin CA, Kaur S et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev 2021;(4):CD000479.[PubMed]
• Kirby EW, Wiener LE, Rajanahally S et al. Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis. Fertil Steril 2016;106(6):1338-1343. [PubMed]