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Outcome of varicocele repair in men with nonobstructive azoospermia： systematic review and meta-analysis

Asian Journal of Andrology 2016年第2期18卷 246-253,J0005,J0006页

作者： Sandro C Esteves Ricardo Miyaoka Matheus Roque Ashok Agarwal ANDROFERT Center for Male Reproduction Av. Dr. Heitor Penteado 1464 Campinas SP 13075-460 Brazil orlgen Center for Reproductive MedicineRio de Janeiro Aw Rodolfo de Amoedo 140 Rio de Janeiro RJ 22620-330 Brazil American Center for Reproductive Medicine 10681. Carnegie Avenue X-11Cleveland OH 44195 USA.

The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia （NOA）. The surgically obtained sperm retrieval rate （SRR） and pregnancy rates following assisted reproductive technology （ART） with the use of retrieved testicular sperm were the primary outcomes. The secondary outcomes included the presence of viable sperm in postoperative ejaculate to avoid the testicular sperm retrieval and pregnancy rates （both assisted and unassisted） using postoperative ejaculated sperm. An electronic search to collect the data was performed using the MEDLINE and EMBASE databases until April 2015. Eighteen studies were included in this systematic review and accounted for 468 patients who were diagnosed with NOA and varicocele. These patients were subjected to either surgical varicocele repair or percutaneous embolization. Three controlled studies evaluating sperm retrieval outcomes indicated that in patients who underwent varicocelectomy, SRR increased compared to those without varicocele repair （OR： 2,65; 95% Cl. 1.69-4.14; P 〈 0.001）. Although pregnancy rates with the use of testicular sperm favored the varicocelectomy group, results were not statistically significant （clinical pregnancy rate OR： 2.07; 95% CI： 0.92-4.65; P = 0.08; live birth rate OR： 2.19; 95% CI： 0.99-4.83; P = 0.05）. The remaining fifteen studies reported postoperative semen analysis results. In 43.9% of the patients （range： 20.8%-55.0%）, sperm were found in postoperative ejaculates. Pregnancy rates for unassisted and assisted （after IVF/ICSI） were 13.6% and 18.9% in the group of men with sperm in postoperative ejaculates, respectively. Our findings indicate that varicocelectomy in patients with NOA and clinical varicocele is associated with improved SRR. In addition, approximately 44% of the treated men will have enough sperm in the ejaculate to avoid sperm retrieval. Limited data on pregnancy outcomes with both postoperative

关键词： azoospermia male infertility meta-analysis sperm retrieval systematic review varicocele varicocelectomy

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