Impact of varicocelectomy prior ICSI on clinical and neonatal outcomes: A multilevel analysis

Little is known about the effectiveness and safety of varicocele repair in patients with male factor infertility undergoing ICSI treatment. Data concerning neonatal outcomes is lacking. We aimed to investigate the effect of varicocele repair prior ICSI.
We analyzed retrospective data from June 2016 to January 2024 using propensity score regression analyses. We compared embryological, clinical and neonatal outcomes. We also evaluated the effect of cofounders on the rate of live birth using multivariate analysis.
Data from 582 ICSI cycles showed no association between livebirth and varicocele repair for male-factor patients undergoing ICSI (aOR 0.81[95% CI0.52, 1.25]; p = 0.3) in the adjusted multilevel logistic analysis. Four hundred and four ICSI cycles were included in the propensity score regression analysis, which confirmed the same non-significant increase of livebirth and other embryological and clinical outcomes. Data about neonatal outcomes were similar between the two groups, except for the rate of very preterm birth were higher in the varicocelectomy group compared to the untreated varicocele group.
In male-factor infertility associated with varicocele and undergoing ICSI treatment, varicocelectomy does not significantly increase the odds of live birth compared with untreated varicocele. The increased number of very preterm birth in the varicocelectomy group may be related to the high number of multiple gestations exists in the varicocelectomy group and may not correlate to the procedures itself. Further well-powered prospective trails remain warranted.
Varicocele repair prior ICSI does not improve the overall success.

目前对于接受卵胞浆内单精子显微注射（Intracytoplasmic Sperm Injection，ICSI）治疗的男性因素不育症患者，精索静脉曲张修复术的有效性与安全性尚不明确，且相关新生儿结局的数据亦存在缺失。本研究旨在探讨ICSI术前实施精索静脉曲张修复术的临床效应。
本研究回顾性分析了2016年6月至2024年1月的临床数据，采用倾向得分回归法进行分析，对比了胚胎学、临床及新生儿结局；同时通过多变量分析，评估了混杂因素对活产率的影响。
对582个ICSI周期的数据进行调整后多水平logistic回归分析显示，在接受ICSI治疗的男性因素不育患者中，活产率与精索静脉曲张修复术无显著关联（调整后比值比aOR=0.81，95%置信区间CI：0.52~1.25；P=0.3）。倾向得分回归分析纳入了404个ICSI周期，结果同样证实，精索静脉曲张修复术并未使活产率及其他胚胎学、临床结局出现具有统计学意义的升高。两组新生儿结局整体无显著差异，仅精索静脉结扎术组的极早早产率高于未接受手术的精索静脉曲张患者组。
对于合并精索静脉曲张且接受ICSI治疗的男性因素不育症患者，与未接受手术治疗者相比，精索静脉结扎术并未显著提高活产的发生几率。精索静脉结扎术组极早早产率升高，可能与该组多胎妊娠比例较高相关，而非手术操作本身所致。未来仍需开展样本量充足的前瞻性研究以进一步验证上述结论。
ICSI术前实施精索静脉曲张修复术，并未提升整体治疗成功率。