Table 7.
Summary of changes in fertility parameters after VR for severe OAT and their levels of evidence*.
| Changes in parameter after VR |
Summary |
||||||||
|---|---|---|---|---|---|---|---|---|---|
| Improved |
Deteriorated/No significant change |
||||||||
| Parameter | Improved | Deteriorated | No significant change | Low LoE | High LoE | Low LoE | High LoE | Suggested Verdict a | |
| Sperm | |||||||||
| Count | Studies (n) | 15b, c | 0 | 0 | 15 | 0 | |||
| LoE | 1 L II, 12 L III, 1 L IV, 1 L V | — | — | 14 | 1 | 0 | 0 | All improved, but mostly low-level evidence, with only one high-level evidence study | |
| Motility | Studies (n) | 12c | 1 | 2 | 12 | 3 | |||
| LoE | 1 L II, 9 L III, 1 L IV, 1 L V | 1 L III | 2 L III | 11 | 1 | 3 | 0 | Mostly improved, with one high-level evidence study; sometimes no significant change, rarely deteriorated, but low-level evidence | |
| Morph | Studies (n) | 6 | 0 | 3 | 6 | 3 | |||
| LoE | 4 L III, 2 L IV | — | 3 L III | 6 | 0 | 3 | 0 | Two thirds improved, one third not improved, but low-level evidence | |
| Hormonal | |||||||||
| FSH | Studies (n) | 1 | 0 | 4 d | 1 | 4 | |||
| LoE | 1 L III | — | 4 L III | 1 | 0 | 4 | 0 | Mostly no significant change, sometimes improved, but low-level evidence | |
| LH | Studies (n) | 0 | 0 | 4d | 0 | 4 | |||
| LoE | — | — | 4 L III | 0 | 0 | 4 | 0 | All no significant change, but low-level evidence | |
| IB | Studies (n) | 1 | 0 | 1 | 1 | 1 | |||
| LoE | 1 L III | — | 1 L III | 1 | 0 | 1 | 0 | Insufficient evidence, low-level evidence suggests equivocal | |
| TT | Studies (n) | 2 | 0 | 5 | 2 | 5 | |||
| LoE | 1 L III, 1 L IV | — | 5 L III | 2 | 0 | 5 | 0 | Mostly no significant change, sometimes improved, but low-level evidence | |
| Testicular | Studies (n) | 0 | 0 | 3e | 0 | 3 | |||
| volume | LoE | — | — | 3 L III | 0 | 0 | 3 | 0 | All no significant changes, but low-level evidence |
| Fertility Outcomes | |||||||||
| PR | Studies (n) | 13 | |||||||
| LoE | 1 L II,10 L III, 1 L IV, 1 L V; All studies that measured this outcome reported either spontaneous or assisted pregnancies | ||||||||
| LBR | Studies (n) | 4 | |||||||
| LoE | 3 L III, 1 L V; All studies that measured this outcome reported live births | ||||||||
*Levels of evidence grading based on Dang et al. (2021) [68] and Clinical Information Access Portal (Undated, c2018) [69], evidence level III or more are considered low, level II and less considered high; —: not applicable; FSH: Follicle stimulating hormone; IB: Inhibin B; L: Level; LBR: Live birth rate; LH: Luteinizing hormone; LoE: level of evidence; Morph: morphology; PR: Pregnancy rate; TT: Testosterone; aSuggested verdict based only on studies that measured the given outcome, verdict could change if all studies had assessed the given outcome; bDespite improvement in majority of sample, 8.9% deteriorated [18]; cDespite improvement across total sample, no significant change among 58.9% (non-responders) [13]; dDespite no significant change in majority of sample, 36.8% (non-responders) deteriorated [37]; eDespite no significant change across majority of sample, 49.7% (artery-preserving varicocelectomy group) showed improvement [40].