📃 Paper Title: Assessment of efficacy of varicocele repair for male subfertility: a systematic review
🧍 Author: Evers
🕒 Year: 2003
📚 Journal: The Lancet
🌎 Country: The Netherlands
ㅤContext to the study:
Can you discuss a systematic review that found no significant evidence to support the use of varicocoele repair for male subfertility?
ㅤ✅ Take-home message of study:
This systematic review of seven randomised controlled trials found no significant evidence to support the use of varicocoele repair as an effective treatment for male or unexplained subfertility. However, the review might have had insufficient power to detect small effects due to the small number of patients in some subgroups.
ㅤ Systematic review
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Study participants:
The review included studies involving subfertile couples with male partners who had varicocoeles.
Inclusion Criteria:
Treatment of varicocoele in subfertile couples
Random allocation to treatment and control groups
Pregnancy or live birth rates as an outcome measure
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Key study outcomes:
The review included seven eligible studies published between 1979 and 2002.
There were 61 pregnancies among 281 treated couples and 50 pregnancies among 259 controls.
The overall relative benefit of treatment was 1.01 (95% CI 0.73-1.40) by the fixed effects model and 1.04 (0.62-1.75) by the random effects model.
The overall risk difference was 0.2% (-7 to 7) and 3% (-7 to 14), respectively.
Varicocoele treatment was not effective in trials restricted to male subfertility with clinical varicocoele, or in those that included men with subclinical varicocoele or normal semen analysis.
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Study Limitations:
This systematic review might have had insufficient power to detect small effects due to the small number of patients in some subgroups.
None of the seven eligible studies described a strategy for concealment of the allocation sequence, which may have introduced bias.
In 5 studies, patients assigned to the treatment group were treated with surgical ligation and the other 2 studies received either surgical ligation or embolization or sclerosization.
Since all studies were surgical or procedural, none of the patients were blinded.
None of the studies offered intention to treat analysis.
5 women allocated to the repair arm conceived before the partners had agreed to an operation.
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