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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Background Varicocele 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. Methods We 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. Results Ten 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 (I 2 = 98%) and were described narratively. Conclusion Varicocele 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.

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