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Effect of varicocele surgical repair on antisperm antibody positivity rate in patients with clinical varicocele: a systematic review and meta-analysis
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DOI：10.3389/fendo.2026.1925219.png)
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Abstract
En 中文
BackgroundVaricocele is a common correctable cause of male infertility; and antisperm antibodies (ASA) have been detected at varying rates in affected men. However; the effect of varicocele repair on ASA positivity remains controversial; and no meta-analysis has specifically quantified this outcome in men with clinical varicocele.MethodsWe systematically searched PubMed; Web of Science; Embase; Cochrane Library; CNKI; VIP; Wanfang; and SinoMed up to April 30; 2026. Before-after studies reporting ASA positivity rates or ASA levels in men with clinical varicocele were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were performed by surgical technique. Sensitivity analyses and publication bias assessment were conducted.ResultsTen studies (13 comparisons; 722 patients) were included in the RR analysis. Varicocele repair was associated with a lower ASA positivity rate compared with preoperative levels (RR = 0.42; 95% CI: 0.35-0.52; P < 0.00001). Subgroup analysis according to surgical technique showed lower postoperative ASA positivity rates in the microsurgical; laparoscopic; and high ligation groups; with the lowest pooled RR observed in the microsurgical subgroup (RR = 0.32). A significant subgroup difference was observed (P = 0.01). Sensitivity analyses excluding studies with back-calculated data or a 6-month follow-up gave pooled RRs of 0.43 and 0.40; respectively; consistent with the primary analysis. Three studies reporting continuous ASA levels were not pooled because of extreme heterogeneity (I2 = 98%) and were described narratively.ConclusionVaricocele repair was associated with reduced ASA positivity among men with clinical varicocele; with the lowest pooled RR observed in the microsurgical subgroup. The results are robust across sensitivity analyses. These findings suggest that varicocele repair may influence immune-related alterations reflected by ASA positivity; however; the clinical utility of ASA testing for surgical decision-making remains uncertain.
Keywords:
meta-analysis
male infertility
varicocele
antisperm antibody
varicocele repair
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