Predictors of microsurgical varicocelectomy efficacy in male infertility treatment: critical assessment and systematization

Abstract

In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment. Regarding the outcomes of varicocele repair, we considered semen improvement and pregnancy and analyzed them separately. Based on the 2011 Oxford CEBM Levels of Evidence, we assigned a score to each trial that studied the role of the predictor. We systematized the studied predictors based on the total points, which were, in turn, calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant, into three levels of significance: predictors of high, moderate, and low clinical significance. Preoperative total motile sperm count (TMSC) coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy. In addition, for semen improvement alone, scrotal Doppler ultrasound (DUS) parameters, sperm DNA fragmentation index (DFI), and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.

Varicocelectomy in Male Subfertility Treatment: ‘‘Updated’’ Indications for Surgery

“…For semen improvement alone, scrotal DUS parameters, sperm DFI and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy success. They also concluded that despite microsurgical varicocelectomy is the preferred option for varicocele surgical repair, there is still insufficient evidence on predictors of this technique efficacy in terms of pregnancy and live birth rates [15]. So, how should we select which of the patients is recommended to be operated for varicocele and who is not according to semen quality?…”

Mailuoshutong pill for varicocele-associated male infertility—Phytochemical characterisation and multitarget mechanism

“…Although the pathophysiological mechanisms of male infertility caused by VC have not been elucidated, current studies have focused on elevated local testicular temperature, oxidative stress, metabolite accumulation, and hormonal disorders (Razi et al, 2021). Varicocelectomy, the primary treatment for varicoceleassociated male infertility, can mitigate delayed testicular development and impaired semen quality, but studies have shown that some patients still do not return to baseline semen quality after surgery (Arab et al, 2021;Shomarufov et al, 2022). There is an urgent need to find effective complementary alternative therapies.…”