Purpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls. Materials and Methods: A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies). Results: A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I2=97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I2=97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I2=98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I2=97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I2=98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI -0.242 to 0.868; I2=89.7%). Conclusions This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies’ practice recommendations favoring VR to improve conventional semen parameters in infertile men.

Introduction: Toxoplasma gondii is a protozoan parasite which causes a zoonotic disease called toxoplasmosis. The main purpose of this study was to investigate the seropositivity rate of specific antibodies “anti-T. gondii IgG and IgM antibodies using enzyme-linked immunosorbant assay” in hemodialysis patients attending the Teaching Hospital, Baquba City, Diyala Province, Iraq and to determine the potentially preventable risk factors. Methods: Eighty five hemodialysis patients with kidney failure and 85 healthy volunteers were selected for this study. Results: The percentage of seropositivity for IgG antibodies in patients with hemodialysis was 54.1% while it was 38.2% among the healthy control subjects and the difference was significant between the two groups [Odds Ratio (OR)= 1.8586; 95% Confidence Interval (CI)= 1.0097-3.4212; P= 0.0465]. In contrast, IgM antibodies were not detected in any of the patients or the healthy subjects. Many risk factors were identified, including contact with cats (OR, 2.62; P= 0.0398); eating undercooked meat (OR, 2.6, P= 0.0439); drinking unfiltered water (OR, 2.86, P= 0.0433); and eating outside the home (OR, 5.6, P= 0.0024) as risk factors for toxoplasmosis. However, smoking was not found to be as a risk factor for toxoplasmosis (OR, 2.1, P= 0.1204). Conclusion: The results of the present study revealed a high prevalence of toxoplasma infection in hemodialysis patients and therefore, we recommend monitoring these patients for T. gondii infection to minimize the spreading of toxoplasmosis via treating the seropositive patients with the available commercial drugs.
Hemodialysis