Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis.

OBJECTIVE To determine the efficacy of varicocelectomy as a treatment for male factor infertility by improving the chance of spontaneous pregnancy. DESIGN Meta-analysis. SETTING Cleveland Clinic's Glickman Urological Institute. PATIENT(S) Infertile men with abnormal results on semen analyses and a palpable varicocele. INTERVENTION(S) Surgical varicocelectomy. MAIN OUTCOME MEASURE(S) Spontaneous pregnancy outcome. RESULT(S) The odds of spontaneous pregnancy after surgical varicocelectomy, compared with no or medical treatment for palpable varicocele, were 2.87 (95% confidence interval [CI], 1.33-6.20) with use of a random-effects model or 2.63 (95% CI, 1.60-4.33) with use of a fixed-effects model. The number needed to treat was 5.7 (95% CI, 4.4-9.5). CONCLUSION(S) Surgical varicocelectomy in infertile men with palpable lesions and at least one abnormal semen parameter improves the odds of spontaneous pregnancy in their female partners. Five studies were included (two randomized, three observational). All were scored for bias. Our study suggests that varicocelectomy in selected patients does indeed have beneficial effects on fertility status.