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Role of varicocele treatment in assisted reproductive technologies

Mehmet G Sönmez¹, Ahmet H Haliloğlu²

¹Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey.

Arab Journal of Urology

|May 2, 2018

Abstract

Objective:

In this review, we investigate the advantage of varicocele repair prior to assisted reproductive technologies (ART) for infertile couples and provide cost analysis information.

Materials And Methods:

We searched the following electronic databases: PubMed, Medline, Excerpta Medica Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL). The following search strategy was modified for the various databases and search engines: 'varicocele', 'varicocelectomy', 'varicocele repair', 'ART', 'in vitro fertilisation (IVF)', 'intracytoplasmic sperm injection (ICSI)'.

Results:

A total of 49 articles, including six meta-analyses, 32 systematic reviews, and 11 original articles, were included in the analysis. Bypassing potentially reversible male subfertility factors using ART is currently common practice. However, varicocele may be present in 35% of men with primary infertility and 80% of men with secondary infertility. Varicocele repair has been shown to be an effective treatment for infertile men with clinical varicocele, thus should play an important role in the treatment of such patients due to the foetal/genetic risks and high costs that are associated with increased ART use.

Conclusion:

Varicocele repair is a cost-effective treatment method that can improve semen parameters, pregnancy rates, and live-birth rates in most infertile men with clinical varicocele. By improving semen parameters and sperm structure, varicocele repair can decrease or even eliminate ART requirement.

Keywords:

ART, assisted reproductive technologies Assisted reproductive technology CINAHL, Cumulative Index to Nursing and Allied Health Literature Embase, Excerpta Medica Database ICSI, intracytoplasmic sperm injection IUI, intrauterine insemination IVF, in vitro fertilisation In vitro fertilisation Intracytoplasmic sperm injection NOA, non-obstructive azoospermia ROS, reactive oxygen species SDF, sperm DNA fragmentation TESE, testicular sperm extraction TMSC, total motile sperm count Varicocele Varicocelectomy

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