Microsurgical varicocelectomy (MVC) is the current gold standard for the treatment of varicocele. Studies have shown that MVC can bring certain clinical benefits to patients with varicocele and male infertility. In today’s era of assisted reproduction, MVC is clinical used usually to improve ART outcomes before treatment with assisted reproductive technology (ART). This article summarizes the efficacy evaluation and cost-effectiveness of MVC combined with ART. Although there is a lack of prospective evidence supporting MVC before ART, many large retrospective studies have shown that operating MVC before using ART may improve ART outcomes. However, large-scale and standardized clinical trials are still needed to further verify the effectiveness and feasibility of MVC before ART.
Objective To employ Mendelian randomization (MR) to assess the potential causal relationship between 15 micronutrients in serum and male infertility, so as to provide a scientific basis for the etiological prevention of male infertility. Methods Male infertility was taken as the outcome variable, and 15 serum micronutrients was regarded as the potential influencing factors. A two-sample MR analysis was conducted using genome-wide association study with the European population. What’s more, multivariable MR analysis was employed to explore the independent effects of potential micronutrients on male infertility. Results A total of 198 single nucleotide polymorphisms across 15 groups were included as instrumental variables to assess the causal association between micronutrients and male infertility. Univariate analysis showed that increased serum iron levels are positively causally associated with a higher risk of male infertility (odds ratio=2.917, P=0.015). Besides, multivariate MR analysis suggested that this positive causal relationship between iron and male infertility remains significant (odds ratio=3.253, P=0.029). Meanwhile, this study found a negative association between elevated vitamin D levels and the risk of male infertility (odds ratio=0.403, P=0.020). Conclusion Elevated serum iron levels and increased vitamin D levels are associated with significant positive and negative causal effects on male infertility, respectively.
