Varicocele embolisation effects on improving fertility: A meta-analysis

Introduction: Varicocele is characterised by abnormal dilation and enlargement of scrotal venous pampiniform plexus which drains blood from testicles. It is a commonly identified cause of male infertility where twisted and enlarged veins are observed in the spermatic cord. The present meta-analysis aimed at evaluating effects of varicocele embolisation (VE) on improving fertility in infertile or sub-fertile men by analysing sperm parameters. Materials and Methods: A systematic search of existing English literature was conducted to identify studies on changes in sperm concentration, sperm motility, sperm morphology, sperm vitality, total motile sperm count, and FSH (Follicle stimulating hormone) outcomes in patients undergoing VE procedures for the treatment of varicocele. These studies included Randomised Control Trials (RCTs), non-randomised clinical trials, comparative studies, and retrospective and prospective reviews. RevMan (Review Manager v5.4.1) software was used for statistical analysis with a random effects model to determine the standard mean difference. Quality assessment of all studies was performed using risk of bias assessment with RevMan software. Results: A total of 14 relevant studies describing effects of varicocele embolisation on sperm parameters were identified. Statistical analyses for sperm morphology, sperm vitality, and FSH level were insignificant. The effect of VE on sperm concentration, sperm motility, and total motile sperm count was found to be insignificant as per the pooled results of analysis. Conclusion: Present meta-analysis shows effectiveness of VE in improving sperm parameters considered in this study. However, high-quality RCTs with larger sample size are necessary to reach statistically significant and definitive conclusions about varicocele embolisation in improving fertility.