Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis

This systematic review and meta-analysis shows that patients with oligospermia and azoospermia and with clinical varicocele who undergo varicocele repair experience improved live birth and pregnancy rates when using assisted reproductive technology.

Volume 106, Issue 6, Pages 1338-1343


E. Will Kirby, M.D., Laura Elizabeth Wiener, M.S., Saneal Rajanahally, M.D., Karen Crowell, M.L.I.S., Robert M. Coward, M.D.



To evaluate how varicocele repair (VR) impacts pregnancy (PRs) and live birth rates in infertile couples undergoing assisted reproduction wherein the male partner has oligospermia or azoospermia and a history of varicocele.


Systematic review and meta-analysis.


Not applicable.


Azoospermic and oligospermic males with varicoceles and in couples undergoing assisted reproductive technology (ART) with IUI, IVF, or testicular sperm extraction (TESE) with IVF and intracytoplasmic sperm injection (ICSI).


Measurement of PRs, live birth, and sperm extraction rates.

Main Outcome Measure(s)

Odds ratios for the impact of VR on PRs, live birth, and sperm extraction rates for couples undergoing ART.


Seven articles involving a total of 1,241 patients were included. Meta-analysis showed that VR improved live birth rates for the oligospermic (odds ratio [OR] = 1.699) and combined oligospermic/azoospermic groups (OR = 1.761). Pregnancy rates were higher in the azoospermic group (OR = 2.336) and combined oligospermic/azoospermic groups (OR = 1.760). Live birth rates were higher for patients undergoing IUI after VR (OR = 8.360). Sperm retrieval rates were higher in persistently azoospermic men after VR (OR = 2.509).


Oligospermic and azoospermic patients with clinical varicocele who undergo VR experience improved live birth rates and PRs with IVF or IVF/ICSI. For persistently azoospermic men after VR requiring TESE for IVF/ICSI, VR improves sperm retrieval rates. Therefore, VR should be considered to have substantial benefits for couples with a clinical varicocele even if oligospermia or azoospermia persists after repair and ART is required.

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Go to the profile of Mary Samplaski
almost 6 years ago
For most of our Urologic interventions we have limited pregnancy and live birth outcomes. This article addresses this issue for varicocele repair. I would be curious to know if the authors were also able to sub-stratify by initial varicocele grade, and look at any link between this and pregnancy and live birth rates.
Go to the profile of Jason Kovac
almost 6 years ago
Good study and happy that the authors were able to publish this in a journal where reproductive endocrinologists may actually read it. Hopefully this will serve to help promote the idea that sometimes waiting to do IVF can actually lead to better outcomes !
Go to the profile of Edmund Ko
almost 6 years ago
This has been a point of debate between male infertility specialists and REI groups. When the pedal for IVF/ICSI is being pushed hard by the REI groups in these patients, we need to take a step back and consider what is best for our patients. Unless the female partner is older, this meta analysis supports slowing things down and repairing the varicocele to optimize the environment in which sperm is being produced and maybe increase the chance for IVF/ICSI success. Great article! I will definitely pass this along to our REI group.