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Asian Journal of Andrology Jun 2024Patients with azoospermia show a prevalence of varicocele of 10.9% and a 14.8% contribution to male infertility. Patients with azoospermia are thought to produce...
Varicocele repair in improving spermatozoa, follicle-stimulating hormone, and luteinizing hormone parameters in infertile males with azoospermia: a systematic review and meta-analysis.
Patients with azoospermia show a prevalence of varicocele of 10.9% and a 14.8% contribution to male infertility. Patients with azoospermia are thought to produce high-quality semen following varicocele treatment. Advising varicocelectomy prior to sperm retrieval in a reproductive program is still debated. This study reviewed the impact of varicocele repair on male infertility using several factors. A literature search was conducted using Scopus, PubMed, Embase, the Wiley Online Library, and Cochrane databases. Sperm concentration, sperm progression, overall sperm motility, sperm morphology, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were also compared. Outcomes were compared between those who received treatment for varicocele and those who did not. The data from the pooled analysis were presented as standardized mean difference (SMD) along with a 95% confidence interval (CI). Heterogeneity was evaluated using I2. Additionally, we conducted analyses for publication bias, sensitivity, and subgroup analysis as appropriate. Nine studies were included after screening relevant literature. Statistical analysis revealed a significant improvement in sperm concentration (SMD: 1.81, 95% CI: 0.84-2.77, P < 0.001), progressive sperm motility (SMD: 4.28, 95% CI: 2.34-6.22, P < 0.001), and sperm morphology (SMD: 3.59, 95% CI: 2.27-4.92, P < 0.001). Total sperm motility showed no significant difference following varicocele repair (SMD: 0.81, 95% CI: -0.61-2.22, P = 0.26). No significant differences were seen in serum FSH (SMD: 0.01, 95% CI: -0.16-0.19, P = 0.87) and LH (SMD: 0.19, 95% CI: -0.01-0.40, P = 0.07) levels as well. This study supports varicocele repair in infertile men with clinical varicocele, as reflected by the improvement in sperm parameters after varicocelectomy compared with no treatment. There were no significant improvements in serum FSH and LH levels.
PubMed: 38877692
DOI: 10.4103/aja202426 -
Andrology Jan 2024Obesity negatively impact on the metabolism of sex hormones, leading to reduced testosterone serum levels. However, how the obesity could negatively impact on the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Obesity negatively impact on the metabolism of sex hormones, leading to reduced testosterone serum levels. However, how the obesity could negatively impact on the overall gonadal function, particularly on male fertility, remained unclear so far.
OBJECTIVE
To systematically review evidences regarding the influence of body weight excess on the sperm production.
METHODS
A meta-analysis was conducted, searching all prospective and retrospective observational studies reporting male subjects older than 18 years old, with body weight excess from overweight to severe obesity were considered. Only studies using the V edition of the World Health Organization (WHO) manual for semen analysis interpretation were considered. No specific interventions were considered. Search was focused on studies comparing overweight/obese to normal weight subjects.
RESULTS
Twenty-eight studies were considered. Total sperm count and sperm progressive motility were significantly lower in overweight compared to normal weight subjects. Meta-regression analyses demonstrated that patients' age impacted on sperm parameters. Similarly, obese men showed lower sperm concentration, total sperm number, progressive and total motilities, and normal morphology lower than normal weight subjects. Reduced sperm concentration in obese men was influenced by age, smoking habit, varicocele, and total testosterone serum levels at meta-regression analyses.
CONCLUSIONS
The male potential fertility is reduced in subjects with increased body weight, compared to normal weight men. The higher was the increased body weight, the worst was the sperm quantity/quality. This result comprehensively included obesity among non-communicable risk factor for male infertility, shedding new lights on the negative impact of increased body weight on overall gonadal function.
Topics: Male; Humans; Adolescent; Overweight; Retrospective Studies; Prospective Studies; Semen; Body Mass Index; Semen Analysis; Sperm Count; Infertility, Male; Obesity; Spermatozoa; Sperm Motility; Weight Gain; Fertility; Testosterone; World Health Organization
PubMed: 37226894
DOI: 10.1111/andr.13460 -
Andrology Feb 2024Clinical palpable varicocoeles in conjunction with isolated teratozoospermia are rarely observed. Therefore, the effects of varicocoelectomy on sperm morphology are not... (Review)
Review
BACKGROUND
Clinical palpable varicocoeles in conjunction with isolated teratozoospermia are rarely observed. Therefore, the effects of varicocoelectomy on sperm morphology are not clear. The aim of this meta-analysis is to compile studies that assess the effectiveness of varicocoelectomy in isolated teratozoospermia to reach a more consistent and reliable conclusion.
MATERIAL-METHODS
The present meta-analysis was registered to PROSPERO (CRD42023467933). We utilized the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline to report the outcomes. Articles published before 1 October 2023 were included in the study. The search terms used were teratozoospermia, isolated teratozoospermia, varicocoelectomy for isolated teratozoospermia, and semen analysis after varicocoelectomy in isolated teratozoospermia.
RESULTS
We identified 1,013 studies in full publications or abstracts using the methodology and the search terms. Five studies were included for systematic review, while four were included for meta-analysis. The five studies (10-14) included 348 patients aged 18-44 years. The pooled analysis revealed a significant improvement in sperm morphology in isolated teratozoospermia patients undergoing varicocoelectomy (Q = 199.42, p < 0.0001; I = 98.49%). The pooled analysis revealed no significant improvement in sperm concentration in isolated teratozoospermia patients undergoing varicocoelectomy (Q = 5.69, p = 0.058; I = 64.85%). Three of the examined studies provided information regarding pregnancy rate and it was high in all studies. According to the Newcastle-Ottowa scale (NOS) assessment, the total quality score of all studies was 7. The funnel plot test demonstrated a visible asymmetry, and Begg and Mazumdar's rank correlation test confirmed the publication bias (p = 0.04).
DISCUSSION
Varicocoelectomy can be an effective and reliable treatment option in patients with isolated morphology abnormalities and clinically palpable varicocoele.
CONCLUSION
This meta-analysis reported that varicocoelectomy may increase pregnancy rates by improving semen parameters in infertile men with isolated teratozoospermia, although this conclusion requires further evidence.
PubMed: 38345602
DOI: 10.1111/andr.13602 -
International Urology and Nephrology May 2024Varicocelectomy was considered to be beneficial to patients with varicocele-related infertility. However, there are only a few researchers who have explored the...
BACKGROUND
Varicocelectomy was considered to be beneficial to patients with varicocele-related infertility. However, there are only a few researchers who have explored the relationship between better timing and postoperative semen improvement in patients.
METHODS
We conducted this meta-analysis by enrolling published prospective studies to find out the best waiting time after varicocelectomy to wait for better improvement of semen quality. An extensive search was conducted in PubMed, Web of Science, and Cochrane Library to identify eligible studies. The included studies were then analyzed comprehensively using STATA software and standardized mean differences (SMDs) and their corresponding 95% confidence intervals were calculated.
RESULTS
Our comprehensive analysis showed that after varicocelectomy, follow-up results within 3 months or longer showed a significant improvement in semen parameters compared to the preoperative period. Notably, no further improvement in semen parameters was observed when the follow-up period reached six months or longer (semen volume: WMD: - 0.07 (- 0.29, 0.16); sperm concentration: WMD: - 1.33 (- 2.33, - 4.99); sperm motility: WMD: 2.31 (- 0.55, 5.18); sperm morphology: WMD: 1.29 (- 0.66, 3.24); sperm total motile count: WMD: 3.95 (- 6.28, 14.19)).
CONCLUSIONS
Three months after varicocelectomy may be the optimal time for semen parameters compared to six months or even longer, which means it is also the preferable time for conception. However, more well-designed prospective studies are needed in the future to validate our conclusion.
PubMed: 38761331
DOI: 10.1007/s11255-024-04080-y