In men with varicocele, does surgery improve fertility?

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Surgical correction of varicocele in infertile men with either normal or abnormal semen analysis slightly improves pregnancy rates with number needed to treat (NNT) of 17. However, the effects are inconsistent when including only men with abnormal semen analysis (SOR: B, meta-analyses of low-quality RCTs with inconsistent findings). Pregnancy rates as high as 45% at 1 year have been reported after microsurgical varicocelectomy (SOR: C, case series).

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