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More research needed into the safest and most effective treatment for varicoceles in men affected by subfertility
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More research needed into the safest and most effective treatment for varicoceles in men affected by subfertility
Clinical question Are surgical and radiological treatments for varicoceles in men with subfertility safe and effective?
Any treatment (surgical or radiological) may be more effective in increasing pregnancy rates than delayed or no treatment. Although both surgical and radiological treatments each improved pregnancy rates in participants with abnormal semen parameters and clinical varicocele, it is not yet clear if this translates into increased live birth rates.
When comparing surgical with radiological treatment, no valid conclusions could be drawn on which treatment modality was superior. The evidence on varicocele recurrence and adverse events (hydrocele formation, pain, epididymitis, haematoma and suture granuloma) was also inconclusive. Evidence on quality of life was lacking for this comparison.
When comparing surgical treatments with each other, microscopic subinguinal surgical treatment showed higher pregnancy rates and lower varicocele recurrence rates than other surgical treatments.
The clinical and statistical heterogeneity of the studies and the small numbers of participants should be taken into account. The overall certainty of the evidence was rated mostly as low or very low for all outcomes.
Varicoceles are associated with male subfertility; however, the mechanisms by which varicoceles affect fertility have yet to be satisfactorily explained. Several treatment options exist for varicoceles, including surgical or radiological treatment; however, the safest and most efficient treatment remains unclear.
Cochrane Systematic Review Persad E, O’Loughlin CA, Kaur S, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev 2021;4:CD000479. This review contains 48 trials with a total of 5384 participants.