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Cited by 47Sperm and Testicular FunctionMale Reproductive Health StudiesReproductive Health and Technologies

Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

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Cannarella, Rossella, Shah, Rupin, Hamoda, Taha Abo-Almagd Abdel-Meguid, Boitrelle, Florence, Saleh, Ramadan, Gul, Murat, Rambhatla, Amarnath, Kavoussi, Parviz +137 more·2024·The World Journal of Men's Health
DOI 10.5534/wjmh.230034PMC PMC10782123
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Abstract

PURPOSE: The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles. MATERIALS AND METHODS: The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies). RESULTS: Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129-0.278; p<0.001; I²=83.62%, Egger's p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474-1.706; p<0.001; I²=97.86%, Egger's p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526-2.121; p<0.001; I²=97.88%, Egger's p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318-1.968; p<0.001; I²=98.65%, Egger's p=0.0003; progressive sperm motility: SMD 1.845, 95% CI: 1.537%-2.153%; p<0.001; I²=98.97%, Egger's p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%-1.759%; p<0.001; l2=97.98%, Egger's p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%-1.211%; p<0.001; I²=97.87%, Egger's p=0.1864. CONCLUSIONS: The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele.

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  • Varicocele results in an increased rate of abnormal sperm morphology.

    “Varicocele, which is an important cause of male infertility, also results in an increased rate of abnormal sperm morphology (67).”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [67]

    The Results section (7. Sperm morphology; page not available in our copy) reports significantly improved sperm morphology after varicocele repair, supporting a link between varicocele and poorer morphology. This before-and-after finding does not directly establish that varicocele causes an increased rate of abnormal sperm morphology compared with men without varicocele. (LLM, conf=0.82)

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Authors
Cannarella, R., Shah, R., Hamoda, T. A.-A. A.-M., Boitrelle, F., Saleh, R., Gul, M., Rambhatla, A., Kavoussi, P., Toprak, T., Harraz, A. M., Ko, E., Çeker, G., Durairajanayagam, D., Alkahidi, N., Kuroda, S., Crafa, A., Henkel, R., Salvio, G., Hazir, B., Darbandi, M., Bendayan, M., Darbandi, S., Falcone, M., Garrido, N., Kosgi, R., Sawaid Kaiyal, R., Karna, K., Phuoc, N. H. V., Birowo, P., Colpi, G. M., de la Rosette, J., Pinggera, G.-M., Nguyen, Q., Zini, A., Zohdy, W., Singh, R., Saini, P., Glina, S., Lin, H., Mostafa, T., Rojas-Cruz, C., Arafa, M., Calogero, A. E., Dimitriadis, F., Kothari, P., Karthikeyan, V. S., Okada, K., Chiba, K., Kadıoglu, A., Altay, B., Turunc, T., Zilaitiene, B., Gokalp, F., Adamyan, A., Katz, D., Chung, E., Mierzwa, T. C., Zylbersztejn, D. S., Paul, G. M., Sofikitis, N., Sokolakis, I., Malhotra, V., Brodjonegoro, S. R., Adriansjah, R., Tsujimura, A., Amano, T., Balercia, G., Ziouziou, I., Deswanto, I. A., Martinez, M., Park, H. J., Bakırcıoglu, M. E., Ceyhan, E., Aydos, K., Ramsay, J., Minhas, S., Al Hashimi, M., Ghayda, R. A., Tadros, N., Sindhwani, P., Ho, C. C. K., Rachman, R. I., Rodriguez Pena, M., Motawi, A., Ponnusamy, A. K., Dipankar, S., Amir, A., Binsaleh, S., Serefoglu, E. C., Banthia, R., Khalafalla, K., Basukarno, A., Bac, N. H., Singla, K., Ambar, R. F., Makarounis, K., Priyadarshi, S., Duarsa, G. W. K., Atmoko, W., Jindal, S., Arianto, E., Akhavizadegan, H., El Bardisi, H., Shoshany, O., Busetto, G. M., Moussa, M., Jamali, M., Al-Marhoon, M. S., Ruzaev, M., Farsi, H. M. A., Mutambirwa, S., Lee, D. S., Kulaksiz, D., Cheng, Y.-S., Bouzouita, A., Sarikaya, S., Kandil, H., Tsampoukas, G., Farkouh, A., Bowa, K., Savira, M., Mogharabian, N., Le, T. V., Harjanggi, M., Anh, D. T., Long, T. Q. T., Soebadi, M. A., Hakim, L., Tanic, M., Ari, U. C., Parikh, F. R., Calik, G., KV, V., Dorji, G., Rezano, A., Rajmil, O., Tien, D. M. B., Yuan, Y., Lizarraga-Salas, J. F., Eze, B., Ngoo, K. S., Lee, J., Arslan, U., Agarwal, A., & Forum, G. A.
Affiliations
  • Cleveland Clinic (US)
  • Lilavati Hospital & Research Centre (IN)
  • King Abdulaziz University (SA)
  • Université de Versailles Saint-Quentin-en-Yvelines (FR)
  • Sohag University (EG)
  • Department of Urology, Selcuk University School of Medicine, Konya, Turkey.
  • Henry Ford Health (US)
  • Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.
  • Sağlık Bilimleri Üniversitesi (TR)
  • Mansoura University (EG)
  • Loma Linda University (US)
  • İstanbul Başakşehir Çam ve Sakura Şehir Hastanesi (TR)
  • Universiti Teknologi MARA System (MY)
  • Department of Internal Medicine, Trinity Health/Mercy Health, Muskegon, MI, USA.
  • University of Catania (IT)
  • Imperial College London (GB)
  • Marche Polytechnic University (IT)
  • Reproductive Medicine, Clinical Research Centre, Lund University, Malmö, Sweden.
  • Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran.
  • Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
  • IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
  • Department of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India.
  • Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
  • University of Massachusetts Chan Medical School (US)
  • Pham Ngoc Thach University of Medicine (VN)
  • University of Indonesia (ID)
  • Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland.
  • Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey.
  • Innsbruck Medical University (AT)
  • Vietnam National University, Hanoi (VN)
  • McGill University (CA)
  • Cairo University (EG)
  • Central Drug Research Institute, Male Reproductive Health Research Laboratory, Lucknow, Uttar Pradesh, India.
  • Central Drug Research Institute (IN)
  • Faculdade de Medicina do ABC (BR)
  • Peking University (CN)
  • Department of Urology, University Hospital of Rostock, Rostock, Germany.
  • Aristotle University of Thessaloniki (GR)
  • Topiwala National Medical College & BYL Nair Charitable Hospital (IN)
  • Apollo Hospitals (IN)
  • Kobe University (JP)
  • Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
  • Department of Urology, Ege University, Izmir, Turkey.
  • Urocentre Urology Clinic, Adana, Turkey.
  • Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania, Turkey.
  • Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey.
  • Department of Urology, Astghik Medical Center, Yerevan, Armenia.
  • The University of Melbourne (AU)
  • The University of Queensland (AU)
  • Division of Urology, Centro Universitario FMABC, Santo André, Brazil.
  • Hospital Israelita Albert Einstein (BR)
  • Universidade Federal do Paraná (BR)
  • University of Ioannina (GR)
  • SCM Clinic and Hospital, New Delhi, India.
  • Universitas Gadjah Mada (ID)
  • Dr. Hasan Sadikin General Hospital (ID)
  • Juntendo University Urayasu Hospital (JP)
  • Nagano Red Cross Hospital (JP)
  • Université Ibn Zohr (MA)
  • Elang Medika Corpora Hospital, Tangerang, Indonesia.
  • University of Santo Tomas Hospital (PH)
  • Pusan National University Hospital (KR)
  • SENSART Clinic, Istanbul, Turkey.
  • Başkent University (TR)
  • Ankara University (TR)
  • Hammersmith Hospital (GB)
  • Charing Cross Hospital (GB)
  • Department of Urology, Burjeel Hospital, Abu Dhabi, UAE.
  • University Hospitals of Cleveland (US)
  • SIU Medicine (US)
  • University of Toledo (US)
  • Taylor's University (MY)
  • Instituto de Ginecología y Fertilidad (IFER) y Universidad Barcelo, Buenos Aires, Argentina.
  • AndroOne Men’s Health Clinic, Salem, India.
  • All India Institute of Medical Sciences, Mangalagiri (IN)
  • Rumah Sakit Umum Pusat Dr. Wahidin Sudirohusodo (ID)
  • King Saud University (SA)
  • Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.
  • Western General Hospital (GB)
  • The University of Texas MD Anderson Cancer Center (US)
  • Department of Urology, Dr. Dradjat Hospital, Serang, Indonesia.
  • Department of Andrology and Sexual Medicine, Hanoi Medical University’s Hospital, Hanoi, Vietnam.
  • Clarity Health, Chandigarh, India.
  • Department of Urology and Andrology, Locus Medicus, Athens, Greece.
  • SMS Medical College (IN)
  • Udayana University (ID)
  • Department of Andrology & Reproductive Medicine, Jindal Hospital & Fertility Center, Meerut, India.
  • RSUP Prof. Dr. R. D. Kandou (ID)
  • University of Tehran (IR)
  • Department of Urology, Hamad Medical Corporation, Doha, Qatar.
  • University of Illinois Chicago (US)
  • University of Foggia (IT)
  • Lebanese University (LB)
  • Department of Urology, Military Teaching Hospital, Rabat, Morocco.
  • Department of Surgery, Urology Division, Sultan Qaboos University, Muscat, Oman.
  • Urology Clinic, Moscow, Russia.
  • Sefako Makgatho Health Sciences University (ZA)
  • The Catholic University of Korea Seoul St. Mary's Hospital (KR)
  • Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey.
  • National Cheng Kung University Hospital (TW)
  • Faculté de médecine de Tunis (TN)
  • Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
  • Fakih IVF Fertility Center, Abu Dhabi, UAE.
  • University of Oxford (GB)
  • Global Andrology Forum, Moreland Hills, OH, USA.
  • University of Lusaka (ZM)
  • Shahroud University of Medical Sciences (IR)
  • IVF Jakarta - YPK Mandiri, Jakarta, Indonesia.
  • Tam Anh IVF Center, Tam Anh General Hospital, Hanoi, Vietnam.
  • Bệnh viện Phụ Sản Hà Nội (VN)
  • Universitas Airlangga (ID)
  • Department of Urology, General Hospital, Cuprija, Serbia.
  • Department of Reproduction and Artificial Insemination, Faculty of Veterinary Medicine, Kafkas University, Kars, Turkey.
  • Jaslok Hospital (IN)
  • Cure & SK Hospital, Trivandrum, India.
  • Khesar Gyalpo University of Medical Sciences of Bhutan (BT)
  • Puigvert Foundation (ES)
  • Bệnh viện Bình Dân (VN)
  • Instituto de Ciencias en Reproducción Humana Vida, León, Mexico.
  • Enugu State University of Science and Technology (NG)
  • Urology Unit, Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia.
  • National University Hospital (SG)
Corresponding author
Agarwal, Ashok
ORCID
Venue
The World Journal of Men's Health
Publisher
XMLink
Published
2024
Volume
42
Issue
1
Pages
92
ISSN
  • 2287-4208 (ISSN-L)
  • 2287-4690
DOI
10.5534/wjmh.230034
PMC
PMC10782123
OpenAlex
W4382465100
Cited by
47
References
6
Citations by year
2026: 16 · 2025: 18 · 2024: 12 · 2023: 1
FWCI
10.50
Type
journal article
Language
en
Open access
Licence
Locations
  • The World Journal of Men s Health (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, cc-by-nc)
  • Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion, cc-by-nc)
  • Digital Commons-TMC (Texas Medical Center) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
  • Lithuanian University of Health Sciences (submittedVersion, cc-by-nc)
  • Lund University Publications (Lund University) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
  • Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
Keywords
varicocelectomy, male infertility, semen parameters, semen volume, sperm concentration, total sperm count, motile sperm count, sperm progressive motility, sperm viability, varicocele, pre-post test comparison, varicocele recurrence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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