It is crucial to identify the subfertile men with varicocele who will benefit the most from varicocelectomy, and the factors which help in predicting the response to varicocelectomy. We aimed to evaluate the impact of varicocelectomy on total motile sperm count (TMSC) and spontaneous pregnancy (SP) rates. A comprehensive literature search was performed using Medline/PubMed and Google Scholar up to December 26, 2018, with no restriction on language and year of publication. Published articles reporting different degrees of TMSC before and after varicocelectomy in infertile men with varicocele (palpable and/or clinical) were extracted. In addition, SP rates as a function of TMSC after varicocelectomy were reviewed. Potential biases were analyzed to rule out skewing factors. Mean TMSC was graded as: <2 million – profound, 2–5 million – severe, 5–10 million – moderate, and >10 million – mild. Data were analyzed using Stata11. Among the total 96 articles identified through electronic and manual searches of references, nine articles fulfilling the inclusion criteria were included. All degrees of TMSC resulted in a significant postoperative improvement, with only small differences, among the profound [10.20 million (95% confidence interval [CI]: 9.11–11.30, p < 0.0001)], severe [15.77 million (95% CI: 10.65–20.89, p < 0.0001)], and moderate groups [19.18 million (95% CI: 10.40–27.96, p < 0.0001)]. However, the mild group demonstrated a highly significant improvement [49.68 million (95% CI: 38.74–60.62, p < 0.0001)]. After varicocelectomy, the SP rate was highest in the TMSC >20 million group (55.4%), followed by TMSC 5–20 million group (45.4%), and TMSC <5 million group (26.3%). In comparison, the TMSC <1.5 million group demonstrated the lowest SP rate (16.0%). Moderate evidence suggests that varicocelectomy results in a significantly improved TMSC. The improvement in TMSC and SP rates is higher in patients who present a mild or moderate decreased TMSC.

Abbreviations: TMSC: total motile sperm count; SP: spontaneous pregnancy; ART: assisted reproductive technology; IVF: in-vitro fertilization; IUI: intrauterine insemination; WMD: weighted mean difference; CI: confidence interval

至关重要的是，要从精索静脉曲张切除术中受益最大的精巢下静脉曲张男性，以及有助于预测对精索静脉曲张切除术的反应的因素。我们旨在评估精索静脉曲张切除术对总运动精子计数（TMSC）和自发妊娠（SP）率的影响。截至2018年12月26日，使用Medline / PubMed和Google Scholar进行了全面的文献搜索，对语言和出版年份没有限制。摘录了报道不育精索静脉曲张（可触及和/或临床）的精索静脉曲张切除术之前和之后不同程度TMSC的已发表文章。此外，回顾了精索静脉曲张切除术后SP率与TMSC的关系。分析了潜在的偏见以排除偏斜因素。平均TMSC的评分为：<200万–严重，2–5百万–严重，5–10百万-中等，> 1,000万–轻度。使用Stata11分析数据。在通过电子和手工检索参考文献鉴定的总共96篇文章中，包括了9篇符合纳入标准的文章。TMSC的所有程度均导致术后显着改善，只有极小差异[1020万（95％置信区间[CI]：9.11-11.3。，p <0.0001）]，严重[1577万（95％CI：95％CI： 10.65–20.89，p <0.0001）]和中度人群[1918万（95％CI：10.40–27.96，p <0.0001）]。但是，轻度组表现出非常显着的改善[4968万（95％CI：38.74-60.62，p <0.0001）]。经精索静脉曲张切除术后，TMSC> 2000万组（55.4％）的SP率最高，其次是TMSC 5-20000000组（45.4％），且TMSC < 500万组（26.3％）。相比之下，TMSC <150万的小组显示出最低的SP率（16.0％）。中度证据表明精索静脉曲张切除术可显着改善TMSC。TMSC轻度或中度下降的患者中TMSC和SP率的改善更高。

缩写： TMSC：活动精子总数；SP：自然怀孕；ART：辅助生殖技术；试管婴儿：体外受精；IUI：宫内授精；WMD：加权均数差；CI：置信区间