Effects of varicocele repair on sperm dna fragmentation and seminal malondialdehyde levels in infertile men with clinical varicocele a systematic review and meta-analysis
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2024Author
Cannarella, RossellaShah, Rupin
Saleh, Ramadan
Boitrelle, Florence
Hamoda, Taha Abo-Almagd Abdel-Meguid
Singh, Rajender
Salvio, Gianmaria
Toprak, Tuncay
Falcone, Marco
Gül, Murat
Dimitriadis, Fotios
Rambhatla, Amarnath
Russo, Giorgio I.
Ko, Edmund
Zini, Armand
Kavoussi, Parviz
Phuoc, Nguyen Ho Vinh
Kandil, Hussein
Ghayda, Ramy Abou
Birowo, Ponco
Gherabi, Nazim
Ceyhan, Erman
Dong, Jie
Malhotra, Vineet
Durairajanayagam, Damayanthi
Kolbaşı, Bircan
Bahar, Fahmi
Çalık, Gökhan
Çayan, Selahittin
Pinggera, Germar Michael
Calogero, Aldo E.
Rajmil, Osvaldo
Mostafa, Taymour
Atmoko, Widi
Harraz, Ahmed M.
Le, Tan V.
de la Rosette, Jean J. M. C. H.
Hakim, Lukman
Pescatori, Edoardo
Sergeyev, Oleg
Rashed, Ayman
Saini, Pallavi
Agarwal, Ashok
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Cannarella, R., Shah, R., Saleh, R., Boitrelle, F., Hamoda, T. A. A. A. M., Singh, R. ... Agarwal, A. (2024). Effects of varicocele repair on sperm dna fragmentation and seminal malondialdehyde levels in infertile men with clinical varicocele a systematic review and meta-analysis. World Journal of Men's Health, 42(2), 321-337. http://dx.doi.org/10.5534/wjmh.230235Abstract
Purpose: Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA). Materials and Methods: A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD). Results: Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I2=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I2=93.7%). Conclusions: Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.