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Surgery or embolization for varicoceles in subfertile men.

Geraldo de Campos Freire¹

¹Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.

Sao Paulo Medical Journal = Revista Paulista De Medicina

|March 30, 2013

Summary

Varicocele treatment may improve pregnancy rates in subfertile couples. However, evidence quality is low, necessitating further research on live birth outcomes for conclusive results.

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Area of Science:

Reproductive Medicine
Urology
Evidence-Based Medicine

Background:

Varicocele, a common cause of male subfertility, involves dilated scrotal blood vessels.
The precise mechanisms linking varicoceles to infertility and varicocelectomy's restorative effects remain unclear.
The causal relationship between pampiniform plexus distension and fertility impairment is debated.

Discussion:

This meta-analysis evaluated 10 randomized controlled trials (RCTs) involving 894 men with varicoceles and subfertility.
No studies reported live birth rates; pregnancy rates showed a statistically significant improvement with varicocele treatment (OR 1.47, 95% CI 1.05–2.05).
Subgroup analysis of studies focusing on clinical varicoceles and subfertility also favored treatment (OR 2.39, 95% CI 1.56–3.66).

Key Insights:

Varicocele treatment suggests a potential benefit for pregnancy rates in subfertile couples with otherwise unexplained infertility.
The number needed to treat (NNT) for one additional pregnancy was 17 overall, and 7 in the subgroup analysis.
Statistical heterogeneity and the very low quality of evidence limit the conclusiveness of these findings.

Outlook:

Further high-quality RCTs are essential to confirm the impact of varicocele treatment on live birth and pregnancy rates.
Research should prioritize live birth as the primary outcome measure.
Clarifying the underlying pathophysiology of varicocele-induced infertility is crucial.