📃 Paper Title: Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach
🧍 Author: Agarwal
🕒 Year: 2007
📚 Journal: Urology
🌎 Country: USA
ㅤContext to the study:
What is the evidence to treat a varicocele associated with male infertility?
ㅤ✅ Take-home message of study:
Surgical varicocelectomy confers a significant improvement in semen parameters for infertile men with a combination of palpable varicocele and abnormal semen parameters.
ㅤ Meta-analysis
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Study participants:
Meta-analysis of 17 studies (randomized controlled trials and observational) using a new scoring system developed to adjust and quantify for various potential sources of bias.
Inclusion criteria: Infertile men with clinically palpable varicocele(s) who had undergone surgical varicocelectomy (high ligation or inguinal microsurgery), having one or more abnormal semen parameters. Men enrolled in these studies had at least three semen analyses (sperm count, motility, and morphology), before and after surgical varicocelectomy. Exclusion criteria: studies of subjects with subclinical varicoceles were excluded. Did not include studies evaluating the role of varicocelectomy in improving semen parameters in adolescents.
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Key study outcomes:
Analysis of patients who underwent varicocelectomy with microsurgical technique showed that sperm concentration increased by 9.71 x 106 /mL (95% CI 7.34 to 12.08, P <0.00001) and motility increased by 9.92% (95% CI 4.90 to 14.95, p = 0.0001). Similar analysis after high ligation varicocelectomy demonstrated that the sperm concentration increased by 12.03 x 106 /mL (95% CI 5.71 to 18.35, P = 0.0002) while motility increased by 11.72% (95% CI 4.33 to 19.12, p = 0.002). Sperm morphology improved by 3.16% (95% CI 0.72 to 5.60, p = 0.01) after both microsurgery and high ligation varicocelectomy.
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Study Limitations:
Because only a few RCTs met inclusion criteria, combining data from observational studies and RCTs meant there was a reduction in internal validity.
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