Login to Access Video or Poster Abstract: MP89-04
Sources of Funding: None

Introduction

The treatment options for couples affected by varicocele-associated subfertility include varicocelectomy and assisted reproduction. Our goal was to investigate varicocele grade as a prognostic factor that could be potentially incorporated into shared decision making with affected patients.

Methods

Pubmed, Embase, and MEDLINE databases were searched for studies evaluating the impact of varicocele grade on response to treatment through May 1, 2016. We analyzed all studies of varicocelectomy in infertile men with palpable varicoceles that reported outcomes stratified by varicocele grade. Heterogeneity of semen quality reporting precluded data compilation and meta-analysis. Therefore the impact of varicocele grade on post-treatment semen quality was analyzed by structured data synthesis. The impact of varicocele grade on pregnancy rates was studied by data extraction and meta-analysis using a binary random effects model. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS).

Results

One randomized controlled trial and 11 cohort studies described outcomes of varicocelectomy stratified by varicocele grade in 1,394 infertile men with palpable varicocele. For men with only grade 1 varicocele, only 1 of 5 studies reported improved concentration and just 1 of 6 showed improved motility. In contrast, 5 of 5 studies that evaluated concentration and 4 of 5 studies that evaluated motility after repair of grade 2/3 varicoceles reported positive treatment responses. Four of 6 studies that directly compared concentration response to varicocelectomy in men with grade 1 and grade 2/3 varicoceles reported greater improvements in men with larger varicoceles. Three of 6 studies that directly compared motility response to varicocelectomy in men with grade 1 and grade 2/3 varicoceles reported greater improvements in men with larger varicoceles. Morphology changes were less consistently related to varicocele grade. Meta-analyses of the included studies did not reveal improved pregnancy rates after treatment of either grade 1 or grade 2/3 varicoceles. Quality assessment determined that 4 of the 11 non-randomized studies were of high quality.

Conclusions

Improved semen quality after varicocelectomy has been consistently reported for men with grade 2/3 varicoceles. In contrast, improvement is uncommon for men with grade 1 varicoceles. Incorporation of varicocele grade into patient counseling may improve our ability to select patients for varicocelectomy that are most likely to benefit from surgery.

Funding

None