The Effects of Varicocele Repair on Testicular Sperm Retrieval, Sperm Recovery in the Ejaculate and Clinical Pregnancy Rates in Non-Obstructive Azoospermic Men with Clinical Varicocele: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
PURPOSE: The role of varicocele repair (VR) in infertile men with non-obstructive azoospermia (NOA) and varicocele is controversial in the current guidelines, despite available studies. This study aims to assess the impact of VR on testicular sperm retrieval, sperm recovery from the ejaculate, and clinical pregnancy rates in infertile men with NOA and clinical varicocele through a systematic review and meta-analysis (SRMA) of controlled studies. MATERIALS AND METHODS: A systematic literature search was conducted using the Scopus and PubMed databases up to November 2023. Among the 1,847 articles retrieved, five observational controlled studies comparing reproductive outcomes between infertile men with NOA and clinical varicocele who underwent VR, and a control group that received no treatment, met the inclusion criteria for this SRMA. RESULTS: The selected studies included 269 men with NOA who underwent VR before the testicular sperm extraction (TESE) procedure and 364 men who did not undergo VR. The pooled estimate demonstrated a significantly higher odds ratio (OR) of 2.17 (95% confidence interval [95% CI]: 1.17-4.01, p=0.01) for surgical sperm retrieval in the VR group. VR significantly increased the likelihood of sperm appearance in the ejaculate, with an OR of 7.8 (95% CI: 3.59-16.94, p<0.001). Besides, VR provided a significantly greater clinical pregnancy rate with intracytoplasmic sperm injection (ICSI) compared to non-operated men (OR: 2.18, 95% CI: 1.03-4.60; p=0.04). CONCLUSIONS: This is the first SRMA, consisting of only controlled studies, to demonstrate that VR performed prior to TESE in men with NOA significantly improves sperm production as reflected in the spontaneous appearance of sperm in the semen and higher odds of surgical sperm retrieval and clinical pregnancy compared with non-operated men. Thus, these findings highlight the potentially beneficial impact of VR in men with NOA and clinical varicocele.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.034 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".