Advance in microsurgical varicocelectomy in the era of assisted reproduction_West China Medical Journal

Authors：

YANG Jiahao ,  LIU Liangren , CHEN Bo , LI Jin , CHEN Zeyu , HUANG Yin , CAO Dehong , WANG Puze , RAN Biao

Department of Urology / Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Liangren, Email: liuliangren@scu.edu.cn

Keywords：

Microsurgical varicocelectomy; assisted reproductive technology; varicocele; male infertility

DOI：

10.7507/1002-0179.202403229

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Microsurgical varicocelectomy (microsurgical varicocelectomy, MVC) is the current gold standard for the treatment of varicocele. Studies have shown that MVC can bring certain clinical benefits to patients with varicocele and male infertility. In today’s era of assisted reproduction, MVC is clinical used usually to improve ART outcomes before treatment with assisted reproductive technology (assisted reproductive technology, ART). This article summarizes the efficacy evaluation and cost-effectiveness of MVC combined with ART. Although there is a lack of prospective evidence supporting MVC before ART, many large retrospective studies have shown that operating MVC before using ART may improve ART outcomes. However, large-scale and standardized clinical trials are still needed to further verify the effectiveness and feasibility of MVC before ART.

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2.	Ombelet W. WHO fact sheet on infertility gives hope to millions of infertile couples worldwide. Facts Views Vis Obgyn, 2020, 12(4): 249-251.
3.	Sharma A, Shrivastava D. Psychological problems related to infertility. Cureus, 2022, 14(10): e30320.
4.	Tao P, Coates R, Maycock B. Investigating marital relationship in infertility: a systematic review of quantitative studies. J Reprod Infertil, 2012, 13(2): 71-80.
5.	Eisenberg ML, Esteves SC, Lamb DJ, et al. Male infertility. Nat Rev Dis Primer, 2023, 9(1): 49.
6.	Alsaikhan B, Alrabeeah K, Delouya G, et al. Epidemiology of varicocele. Asian J Androl, 2016, 18(2): 179-181.
7.	Agarwal A, Majzoub A, Parekh N, et al. A schematic overview of the current status of male infertility practice. World J Mens Health, 2020, 38(3): 308-322.
8.	Kamel RM. Assisted reproductive technology after the birth of louise brown. J Reprod Infertil, 2013, 14(3): 96-109.
9.	Birenbaum-Carmeli D, Inhorn MC. Assisting reproduction, testing genes: global encounters with the new biotechnologies. Berghahn Books, 2009.
10.	D’Angelo A, Amso N, Hassan R. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. The Cochrane database of systematic reviews, 2017(5): CD002811.
11.	Qin J, Liu X, Sheng X, et al. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril, 2016, 105(1): 73-85. e1-6.
12.	Practice Committee of American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril, 2012, 97(4): 825-834.
13.	Hansen M, Kurinczuk JJ, Milne E, et al. Assisted reproductive technology and birth defects: a systematic review and meta-analysis. Hum Reprod Update, 2013, 19(4): 330-353.
14.	Pandey S, Shetty A, Hamilton M, et al. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update, 2012, 18(5): 485-503.
15.	Qin J, Sheng X, Wang H, et al. Assisted reproductive technology and risk of congenital malformations: a meta-analysis based on cohort studies. Arch Gynecol Obstet, 2015, 292(4): 777-798.
16.	Pastuszak AW, Wang R. Varicocele and testicular function. Asian J Androl, 2015, 17(4): 659-667.
17.	Elbardisi H, Finelli R, Agarwal A, et al. Predictive value of oxidative stress testing in semen for sperm DNA fragmentation assessed by sperm chromatin dispersion test. Andrology, 2020, 8(3): 610-617.
18.	Shridharani A, Owen RC, Elkelany OO, et al. The significance of clinical practice guidelines on adult varicocele detection and management. Asian J Androl, 2016, 18(2): 269-275.
19.	Chan P. Management options of varicoceles. Indian J Urol, 2011, 27(1): 65-73.
20.	Mirilas P, Mentessidou A. Microsurgical subinguinal varicocelectomy in children, adolescents, and adults: surgical anatomy and anatomically justified technique. 2012, 33(3): 338-349.
21.	Schauer I, Madersbacher S, Jost R, et al. The impact of varicocelectomy on sperm parameters: a meta-analysis. J Urol, 2012, 187(5): 1540-1547.
22.	Birowo P, Rahendra Wijaya J, Atmoko W, et al. The effects of varicocelectomy on the DNA fragmentation index and other sperm parameters: a meta-analysis. Basic Clin Androl, 2020, 30: 15.
23.	Kadihasanoglu M, Ozbek E. Varicocele is associated with hypogonadism and impaired erectile function: a prospective comparative study. Andrologia, 2017, 49(9): e12785.
24.	Sathya Srini V, Belur Veerachari S. Does varicocelectomy improve gonadal function in men with hypogonadism and infertility? Analysis of a prospective study. Int J Endocrinol, 2011, 2011: 916380.
25.	Zohdy W, Ghazi S, Arafa M. Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility. J Sex Med, 2011, 8(3): 885-893.
26.	Tharakan T, Corona G, Foran D, et al. Does hormonal therapy improve sperm retrieval rates in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update, 2022, 28(5): 609-628.
27.	Esteves SC, Miyaoka R, Roque M, et al. Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl, 2016, 18(2): 246-253.
28.	Ashkenazi J, Dicker D, Feldberg D, et al. The impact of spermatic vein ligation on the male factor in in vitro fertilization-embryo transfer and its relation to testosterone levels before and after operation. Fertil Steril, 1989, 51(3): 471-474.
29.	Esteves SC, Oliveira FV, Bertolla RP. Clinical outcomes of intracytoplasmic sperm injection in infertile men with treated and untreated clinical varicocele. J Urol, 2010, 184(4): 1442-1446.
30.	Esteves SC, Roque M, Agarwal A. Outcome of assisted reproductive technology in men with treated and untreated varicocele: systematic review and meta-analysis. Asian J Androl, 2016, 18(2): 254-258.
31.	Kim ED, Leibman BB, Grinblat DM, et al. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol, 1999, 162(3 Pt 1): 737-740.
32.	Aboulghar MA, Mansour RT, Serour GI, et al. Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm. Fertil Steril, 1997, 68(1): 108-111.
33.	Haydardedeoglu B, Turunc T, Kilicdag EB, et al. The effect of prior varicocelectomy in patients with nonobstructive azoospermia on intracytoplasmic sperm injection outcomes: a retrospective pilot study. Urology, 2010, 75(1): 83-86.
34.	Lee R, Li PS, Goldstein M, et al. A decision analysis of treatments for nonobstructive azoospermia associated with varicocele. Fertil Steril, 2009, 92(1): 188-196.
35.	Weedin JW, Khera M, Lipshultz LI. Varicocele repair in patients with nonobstructive azoospermia: a meta-analysis. J Urol, 2010, 183(6): 2309-2315.
36.	Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost-effectiveness analysis. Urology, 1997, 49(1): 83-90.
37.	Fenwick E, Eze A, D’Hooghe T, et al. The value of treatment for infertility: a systematic literature review of willingness-to-pay thresholds and approaches for determining the cost-effectiveness of fertility therapies. Best Pract Res Clin Obstet Gynaecol, 2023, 89: 102340.
38.	Aydos K, Aydos OS. Sperm selection procedures for optimizing the outcome of ICSI in patients with NOA. J Clin Med, 2021, 10(12): 2687.
39.	Vahidi S, Horoki AZ, Talkhooncheh MH, et al. Success rate and ART outcome of microsurgical sperm extraction in non obstructive azoospermia: a retrospective study. Int J Reprod Biomed, 2021, 19(9): 781-788.

1. Leslie SW, Soon-Sutton TL, Khan MAB. Male Infertility. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2024.
2. Ombelet W. WHO fact sheet on infertility gives hope to millions of infertile couples worldwide. Facts Views Vis Obgyn, 2020, 12(4): 249-251.
3. Sharma A, Shrivastava D. Psychological problems related to infertility. Cureus, 2022, 14(10): e30320.
4. Tao P, Coates R, Maycock B. Investigating marital relationship in infertility: a systematic review of quantitative studies. J Reprod Infertil, 2012, 13(2): 71-80.
5. Eisenberg ML, Esteves SC, Lamb DJ, et al. Male infertility. Nat Rev Dis Primer, 2023, 9(1): 49.
6. Alsaikhan B, Alrabeeah K, Delouya G, et al. Epidemiology of varicocele. Asian J Androl, 2016, 18(2): 179-181.
7. Agarwal A, Majzoub A, Parekh N, et al. A schematic overview of the current status of male infertility practice. World J Mens Health, 2020, 38(3): 308-322.
8. Kamel RM. Assisted reproductive technology after the birth of louise brown. J Reprod Infertil, 2013, 14(3): 96-109.
9. Birenbaum-Carmeli D, Inhorn MC. Assisting reproduction, testing genes: global encounters with the new biotechnologies. Berghahn Books, 2009.
10. D’Angelo A, Amso N, Hassan R. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. The Cochrane database of systematic reviews, 2017(5): CD002811.
11. Qin J, Liu X, Sheng X, et al. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril, 2016, 105(1): 73-85. e1-6.
12. Practice Committee of American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril, 2012, 97(4): 825-834.
13. Hansen M, Kurinczuk JJ, Milne E, et al. Assisted reproductive technology and birth defects: a systematic review and meta-analysis. Hum Reprod Update, 2013, 19(4): 330-353.
14. Pandey S, Shetty A, Hamilton M, et al. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update, 2012, 18(5): 485-503.
15. Qin J, Sheng X, Wang H, et al. Assisted reproductive technology and risk of congenital malformations: a meta-analysis based on cohort studies. Arch Gynecol Obstet, 2015, 292(4): 777-798.
16. Pastuszak AW, Wang R. Varicocele and testicular function. Asian J Androl, 2015, 17(4): 659-667.
17. Elbardisi H, Finelli R, Agarwal A, et al. Predictive value of oxidative stress testing in semen for sperm DNA fragmentation assessed by sperm chromatin dispersion test. Andrology, 2020, 8(3): 610-617.
18. Shridharani A, Owen RC, Elkelany OO, et al. The significance of clinical practice guidelines on adult varicocele detection and management. Asian J Androl, 2016, 18(2): 269-275.
19. Chan P. Management options of varicoceles. Indian J Urol, 2011, 27(1): 65-73.
20. Mirilas P, Mentessidou A. Microsurgical subinguinal varicocelectomy in children, adolescents, and adults: surgical anatomy and anatomically justified technique. 2012, 33(3): 338-349.
21. Schauer I, Madersbacher S, Jost R, et al. The impact of varicocelectomy on sperm parameters: a meta-analysis. J Urol, 2012, 187(5): 1540-1547.
22. Birowo P, Rahendra Wijaya J, Atmoko W, et al. The effects of varicocelectomy on the DNA fragmentation index and other sperm parameters: a meta-analysis. Basic Clin Androl, 2020, 30: 15.
23. Kadihasanoglu M, Ozbek E. Varicocele is associated with hypogonadism and impaired erectile function: a prospective comparative study. Andrologia, 2017, 49(9): e12785.
24. Sathya Srini V, Belur Veerachari S. Does varicocelectomy improve gonadal function in men with hypogonadism and infertility? Analysis of a prospective study. Int J Endocrinol, 2011, 2011: 916380.
25. Zohdy W, Ghazi S, Arafa M. Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility. J Sex Med, 2011, 8(3): 885-893.
26. Tharakan T, Corona G, Foran D, et al. Does hormonal therapy improve sperm retrieval rates in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update, 2022, 28(5): 609-628.
27. Esteves SC, Miyaoka R, Roque M, et al. Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl, 2016, 18(2): 246-253.
28. Ashkenazi J, Dicker D, Feldberg D, et al. The impact of spermatic vein ligation on the male factor in in vitro fertilization-embryo transfer and its relation to testosterone levels before and after operation. Fertil Steril, 1989, 51(3): 471-474.
29. Esteves SC, Oliveira FV, Bertolla RP. Clinical outcomes of intracytoplasmic sperm injection in infertile men with treated and untreated clinical varicocele. J Urol, 2010, 184(4): 1442-1446.
30. Esteves SC, Roque M, Agarwal A. Outcome of assisted reproductive technology in men with treated and untreated varicocele: systematic review and meta-analysis. Asian J Androl, 2016, 18(2): 254-258.
31. Kim ED, Leibman BB, Grinblat DM, et al. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol, 1999, 162(3 Pt 1): 737-740.
32. Aboulghar MA, Mansour RT, Serour GI, et al. Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm. Fertil Steril, 1997, 68(1): 108-111.
33. Haydardedeoglu B, Turunc T, Kilicdag EB, et al. The effect of prior varicocelectomy in patients with nonobstructive azoospermia on intracytoplasmic sperm injection outcomes: a retrospective pilot study. Urology, 2010, 75(1): 83-86.
34. Lee R, Li PS, Goldstein M, et al. A decision analysis of treatments for nonobstructive azoospermia associated with varicocele. Fertil Steril, 2009, 92(1): 188-196.
35. Weedin JW, Khera M, Lipshultz LI. Varicocele repair in patients with nonobstructive azoospermia: a meta-analysis. J Urol, 2010, 183(6): 2309-2315.
36. Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost-effectiveness analysis. Urology, 1997, 49(1): 83-90.
37. Fenwick E, Eze A, D’Hooghe T, et al. The value of treatment for infertility: a systematic literature review of willingness-to-pay thresholds and approaches for determining the cost-effectiveness of fertility therapies. Best Pract Res Clin Obstet Gynaecol, 2023, 89: 102340.
38. Aydos K, Aydos OS. Sperm selection procedures for optimizing the outcome of ICSI in patients with NOA. J Clin Med, 2021, 10(12): 2687.
39. Vahidi S, Horoki AZ, Talkhooncheh MH, et al. Success rate and ART outcome of microsurgical sperm extraction in non obstructive azoospermia: a retrospective study. Int J Reprod Biomed, 2021, 19(9): 781-788.

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