This review identified and analysed RCTs evaluating the effects of varicocele repair on partner pregnancy outcomes, using standard methods. Attempts were made to minimise bias in the selection and appraisal of relevant published literature, and the results were combined using broadly appropriate statistical techniques.
The authors main conclusions were based on a subgroup of three RCTs with only 312 participants with clinical varicocele and impaired semen quality. These three trials appear to have used different surgical techniques, but no further information was available on the participants, outcomes other than pregnancy rates, and length of follow-up. These trials also appear to have been at risk of bias.
Given these limitations, the authors' recommendation for a large properly conducted RCT appears to be justified. The reliability of their conclusion on the effectiveness of varicocelectomy is less certain.