Open, Laparoscopic, and Microsurgical Varicocelectomy for Male Infertility: a Systematic Review and Meta-analysis

The objective of the present systematic review and meta-analysis was to assess the effect of open, microsurgical, and laparoscopic varicocelectomy on the number of patients with improved sperm parameters (sperm concentration, motility) 6-12 months after surgery, spontaneous pregnancy rates >= 12 months after surgery, and postoperative sperm parameters in infertile males with a varicocele. We searched the Cochrane Library, PubMed, MEDLINE, and EMBASE databases from inception to December 2018 for randomized controlled trials (RCTs) comparing open, microsurgical, and laparoscopic varicocelectomy for male infertility. The meta-analysis demonstrated a significantly higher number of patients with improved sperm parameters 6-12 months after microsurgical varicocelectomy compared to laparoscopic varicocelectomy (OR = 1.63, 95% CI 1.03-2.56; p = 0.04) or open varicocelectomy (OR = 2.06, 95% CI 1.57-2.70; p < 0.0001), a significantly higher spontaneous pregnancy rate at >= 12 months after microsurgical varicocelectomy compared to open varicocelectomy (OR = 1.47, 95% CI 1.10-1.98; p = 0.01), a significant increase in postoperative sperm motility and concentration in patients that had undergone microsurgical varicocelectomy compared to laproscopic varicocelectomy or open varicocelectomy. These data suggest that, compared to laproscopic or open varicocelectomy, microsurgical varicocelectomy provides the greatest benefit to the most patients, results in a higher spontaneous pregnancy rate, and causes greater improvements in postoperative sperm parameters in males with a history of infertility. More high-quality large studies are needed to better illustrate the effects of the various surgical methods used to treat varicocele.