Influence of Varicocelectomy on Assisted Reproductive Technology Outcomes of Infertile Patients with Varicocele: A Systematic Review and Meta-Analysis

Varicocele can lead to impaired semen parameters and induce infertility. Varicocelectomy is considered the gold standard for varicocele treatment. However, its impact on improving assisted reproductive technologies (ARTs) outcomes remains contentious. This study seeks to compare reproductive outcomes between infertile men who underwent varicocelectomy and those who did not prior to ARTs. In addition, it evaluates the influence of types of fertilization, couples' ages, and treatment years on clinical pregnancy rates. A comprehensive search was conducted through February 2023 across eight electronic databases using combinations of relevant keywords. Observational and randomized controlled trials (RCTs) were included. Fourteen eligible studies (n = 1,705) were included: 12 retrospective studies (n = 1,467) and 2 prospective studies (n = 238). Pooled results indicated that infertile men who received varicocelectomy had a significantly higher clinical pregnancy rate compared to the control group (OR: 1.38, 95% CI [1.05, 1.83]; I-2 = 36%, p = .02). The live birth rate was also significantly higher in the treatment group (OR: 2.18, [1.58, 3.01]; p < .00001; I-2 = 0%). However, miscarriage rates did not significantly differ (OR: 1.07; [0.57, 1.98]; I-2 = 0%, p = .84). Varicocelectomy significantly improved sperm concentration and normal morphology rate, but did not result in a significant enhancement in sperm motility. Men who underwent varicocelectomy between 2012 and 2019 and subsequently received intracytoplasmic sperm injection exhibited improved outcomes, particularly when their female partners were under 30 years of age. Larger, high-quality RCTs are needed to clarify benefits or avoid unnecessary treatments.