Varicocele repair for severe oligoasthenoteratozoospermia: Scoping review of published guidelines, and systematic review of the literature

Abstract

Background: The outcomes of varicocele repair (VR) for severe oligozooasthenoteratozoospermia (OAT) have not been widely examined. Methods: Assessment of outcomes of VR after severe OAT, employing scoping review of published guidelines, and systematic review of literature. The Newcastle-Ottawa scale appraised the quality of included studies. Findings from both reviews were used to identify knowledge gaps and ways to enhance the evidence base. Results: No published guidelines exist specifically on VR for severe OAT. Of 731 articles retrieved, 15 were included, indicating a scarcity of studies appraising the topic. Most included studies exhibited high risk of bias and low-level evidence. Studies focused on basic sperm parameters; fewer examined hormonal/testicular volume changes, or pregnancy/live births. Studies suggested some post-VR sperm parameters improvements but mostly no changes in hormone levels/testicular volume. We identified four knowledge gaps: methodological issues; narrow scope of research and measurement aspects; lack of genetic considerations; and scarce economic/cost-effectiveness appraisals. We propose some precautions, remedies, and research questions to enhance the thin evidence base. Conclusions: VR for severe OAT has potential to improve sperm parameters. Scarcity of studies, high risk of bias, low-level evidence, and other limitations mitigate against drawing solid conclusions. Future research is required.