{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:40:38Z","timestamp":1791916838153,"version":"4.3.4"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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\n                    <jats:italic toggle=\"yes\">I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    . 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\u20132.77,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001), progressive sperm motility (SMD: 4.28, 95% CI: 2.34\u20136.22,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001), and sperm morphology (SMD: 3.59, 95% CI: 2.27\u20134.92,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001). Total sperm motility showed no significant difference following varicocele repair (SMD: 0.81, 95% CI: \u22120.61\u20132.22,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.26). No significant differences were seen in serum FSH (SMD: 0.01, 95% CI: \u22120.16\u20130.19,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.87) and LH (SMD: 0.19, 95% CI: \u22120.01\u20130.40,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 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.\n                  <\/jats:p>","DOI":"10.4103\/aja202426","type":"journal-article","created":{"date-parts":[[2024,6,15]],"date-time":"2024-06-15T02:00:07Z","timestamp":1718416807000},"page":"628-634","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Varicocele repair in improving spermatozoa, follicle-stimulating hormone, and luteinizing hormone parameters in infertile males with azoospermia: a systematic review and meta-analysis"],"prefix":"10.4103","volume":"26","author":[{"given":"Ryan","family":"Ramon","sequence":"first","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Universitas Indonesia \u2013 Haji Adam Malik General Hospital, Medan 20136, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syah Mirsya","family":"Warli","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara \u2013 Haji Adam Malik General Hospital, Medan 20136, Indonesia"},{"name":"Department of Urology, Universitas Sumatera Utara Hospital \u2013 Universitas Sumatera Utara, Medan 20154, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ginanda Putra","family":"Siregar","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara \u2013 Haji Adam Malik General Hospital, Medan 20136, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fauriski Febrian","family":"Prapiska","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara \u2013 Haji Adam Malik General Hospital, Medan 20136, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhirajaya Dharma","family":"Kadar","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara \u2013 Haji Adam Malik General Hospital, Medan 20136, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Rhiza Z","family":"Tala","sequence":"additional","affiliation":[{"name":"Department of Obstetric and Gynaecology, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medan 20136, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"R1-20241031","doi-asserted-by":"crossref","first-page":"E1152","DOI":"10.1001\/amajethics.2018.1152","article-title":"Infertility, inequality, and how lack of insurance coverage compromises reproductive autonomy","volume":"20","author":"Insogna","year":"2018","journal-title":"AMA J Ethics"},{"key":"R2-20241031","doi-asserted-by":"crossref","first-page":"627","DOI":"10.5534\/wjmh.210210","article-title":"Role of cytocentrifugation combined with nuclear fast picroindigocarmine staining in detecting cryptozoospermia in men diagnosed with azoospermia","volume":"40","author":"Sharma","year":"2022","journal-title":"World J Mens Health"},{"key":"R3-20241031","doi-asserted-by":"crossref","first-page":"4","DOI":"10.5534\/wjmh.170010","article-title":"Varicocele and testicular pain:a review","volume":"37","author":"Paick","year":"2019","journal-title":"World J Mens Health"},{"key":"R4-20241031","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.eururo.2021.08.014","article-title":"European Association of Urology guidelines on male sexual and reproductive health:2021 update on male infertility","volume":"80","author":"Minhas","year":"2021","journal-title":"Eur Urol"},{"key":"R5-20241031","doi-asserted-by":"crossref","first-page":"152","DOI":"10.23736\/S0031-0808.18.03528-0","article-title":"Indications and outcomes of varicocele repair","volume":"61","author":"Cho","year":"2019","journal-title":"Panminerva Med"},{"key":"R6-20241031","doi-asserted-by":"crossref","first-page":"246","DOI":"10.4103\/1008-682X.169562","article-title":"Outcome of varicocele repair in men with nonobstructive azoospermia:systematic review and meta-analysis","volume":"18","author":"Esteves","year":"2016","journal-title":"Asian J Androl"},{"key":"R7-20241031","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1159\/000112609","article-title":"Results of varicocelectomy in patients with isolated teratozoospermia","volume":"80","author":"\u00c7akan","year":"2008","journal-title":"Urol Int"},{"key":"R8-20241031","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/j.fertnstert.2008.12.118","article-title":"The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele","volume":"93","author":"Seo","year":"2010","journal-title":"Fertil Steril"},{"key":"R9-20241031","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.eururo.2010.12.008","article-title":"Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial","volume":"59","author":"Abdel-Meguid","year":"2011","journal-title":"Eur Urol"},{"key":"R10-20241031","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1038\/aja.2011.48","article-title":"The role of varicocele sclerotherapy in men with severe oligo-astheno-teratozoospermia","volume":"13","author":"Ghanem","year":"2011","journal-title":"Asian J Androl"},{"key":"R11-20241031","first-page":"505","article-title":"Effects of varicocele repair on spontaneous first trimester miscarriage:a randomized clinical trial","volume":"9","author":"Ghanaie","year":"2012","journal-title":"Urol J"},{"key":"R12-20241031","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s11255-013-0394-2","article-title":"Effect of performing varicocelectomy before intracytoplasmic sperm injection on clinical outcomes in non-azoospermic males","volume":"45","author":"Gokce","year":"2013","journal-title":"Int Urol Nephrol"},{"key":"R13-20241031","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.urology.2014.10.031","article-title":"Is varicocelectomy beneficial in men previously deemed subfertile but with normal semen parameters based on the new guidelines? A retrospective study","volume":"85","author":"McGarry","year":"2015","journal-title":"Urology"},{"key":"R14-20241031","first-page":"e65451","article-title":"The effects of acupuncture treatment in infertile patients with clinical varicocele","volume":"10","author":"Ketabchi","year":"2018","journal-title":"Nephrourol Mon"},{"key":"R15-20241031","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.4103\/njcp.njcp_173_20","article-title":"The effect of varicocelectomy on the pregnancy rate in patients with severe oligospermia","volume":"23","author":"Turgut","year":"2020","journal-title":"Niger J Clin Pract"},{"key":"R16-20241031","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2:a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"R17-20241031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11292-008-9066-0","article-title":"Drawing conclusions about causes from systematic reviews of risk factors:the Cambridge quality checklists","volume":"5","author":"Murray","year":"2009","journal-title":"J Exp Criminol"},{"key":"R18-20241031","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/S0094-0143(02)00075-7","article-title":"Varicocele:current concepts in pathophysiology, diagnosis, and treatment","volume":"29","author":"Fretz","year":"2002","journal-title":"Urol Clin North Am"},{"key":"R19-20241031","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1093\/humupd\/7.5.473","article-title":"Varicocele and male infertility:part II:pathophysiology of varicoceles in male infertility","volume":"7","author":"Naughton","year":"2001","journal-title":"Hum Reprod Update"},{"issue":"Suppl 1","key":"R20-20241031","doi-asserted-by":"crossref","first-page":"89","DOI":"10.6061\/clinics\/2013(Sup01)10","article-title":"The role of varicocele treatment in the management of non-obstructive azoospermia","volume":"68","author":"Inci","year":"2013","journal-title":"Clinics (Sao Paulo)"},{"key":"R21-20241031","first-page":"149","article-title":"Biochemical changes in testicular varicocele","volume":"22","author":"Fujisawa","year":"1989","journal-title":"Syst Biol Reprod Med"},{"key":"R22-20241031","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/j.1439-0272.2007.00794.x","article-title":"Influence of genital heat stress on semen quality in humans","volume":"39","author":"Jung","year":"2007","journal-title":"Andrologia"},{"key":"R23-20241031","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1111\/j.1464-410X.2010.09959.x","article-title":"Review of current varicocelectomy techniques and their outcomes","volume":"108","author":"Diegidio","year":"2011","journal-title":"BJU Int"},{"key":"R24-20241031","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1136\/bmj.2.4935.356","article-title":"Varicocele in subfertility results of treatment","volume":"2","author":"Tulloch","year":"1955","journal-title":"Br Med J"},{"key":"R25-20241031","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/00005392-199909010-00031","article-title":"Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure","volume":"162","author":"Kim","year":"1999","journal-title":"J Urol"},{"key":"R26-20241031","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/S0015-0282(98)00108-3","article-title":"Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia","volume":"70","author":"Matthews","year":"1998","journal-title":"Fertil Steril"},{"key":"R27-20241031","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1590\/S1677-55382005000600005","article-title":"Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology","volume":"31","author":"Esteves","year":"2005","journal-title":"Int Braz J Urol"},{"key":"R28-20241031","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1080\/01485010490425250","article-title":"Induction of spermatogenesis by inguinal varicocele repair in azoospermic men","volume":"50","author":"\u00c7akan","year":"2004","journal-title":"Arch Androl"},{"key":"R29-20241031","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1016\/j.fertnstert.2003.10.036","article-title":"Role of varicocelectomy in men with nonobstructive azoospermia","volume":"81","author":"Schlegel","year":"2004","journal-title":"Fertil Steril"},{"key":"R30-20241031","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1093\/humrep\/12.6.1222","article-title":"Extended sperm preparation:an alternative to testicular sperm extraction in non-obstructive azoospermia","volume":"12","author":"Ron-El","year":"1997","journal-title":"Hum Reprod"},{"key":"R31-20241031","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.1016\/j.juro.2010.02.012","article-title":"Varicocele repair in patients with nonobstructive azoospermia:a meta-analysis","volume":"183","author":"Weedin","year":"2010","journal-title":"J Urol"},{"key":"R32-20241031","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1080\/2090598X.2021.1956838","article-title":"Varicocele treatment in non-obstructive azoospermia:a systematic review","volume":"19","author":"Jensen","year":"2021","journal-title":"Arab J Urol"},{"key":"R33-20241031","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s12262-016-1571-1","article-title":"Effect of varicocelectomy on serum FSH and LH levels for patients with varicocele:a systematic review and meta-analysis","volume":"80","author":"Tian","year":"2018","journal-title":"Indian J Sur"}],"container-title":["Asian Journal of Andrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aja202426","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:41:37Z","timestamp":1787067697000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aja202426"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,14]]},"references-count":33,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/aja202426","relation":{},"ISSN":["1745-7262","1008-682X"],"issn-type":[{"value":"1745-7262","type":"print"},{"value":"1008-682X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,14]]},"assertion":[{"value":"2023-10-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}