Effects of Varicocele Repair on Testicular Endocrine Function: A Systematic Review and Meta-Analysis

Area of Science:

• Reproductive endocrinology and male infertility research.
• Clinical outcomes of surgical interventions for varicocele.

Background:

• Varicocele, a common cause of male infertility, is associated with hormonal imbalances.
• Understanding the impact of varicocele repair (VR) on key reproductive hormones is crucial for patient management.

Purpose of the Study:

• To assess the effect of varicocele repair (VR) on serum levels of total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B.
• To compare hormonal levels post-VR with pre-treatment values, unrepaired varicoceles, and healthy controls.

Main Methods:

• Systematic review and meta-analysis adhering to MOOSE and PRISMA-P guidelines.
• Studies selected based on the PICOS model, comparing outcomes before and after VR.
• Sub-analysis of total testosterone based on baseline levels, fertility status, follow-up time, and VR technique.

Main Results:

• VR significantly increased total testosterone levels compared to pre-treatment and unrepaired varicocele groups, normalizing levels compared to healthy controls.
• A trend towards decreased LH levels was observed post-VR compared to pre-treatment, with significantly lower levels compared to unrepaired varicoceles.
• FSH levels decreased significantly after VR compared to pre-treatment and unrepaired varicoceles, but remained higher than in healthy controls; inhibin B levels showed no significant change.

Conclusions:

• Varicocele repair effectively increases and normalizes serum total testosterone and LH levels.
• The findings support considering VR for patients with low or declining testosterone levels.
• This meta-analysis provides the largest assessment of VR's impact on Leydig and Sertoli cell function.