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No clear impact of varicocele treatment on male subfertility

Male subfertility may be related to the presence of varicocele; however, it is not known whether treatment of the varicocele or treatment modality affect subsequent fertility rates. A systematic review has identified 48 studies and compared surgical and radiological treatments with each other and with no treatment. Overall, there is no clear superior treatment modality and it is not certain that treatment has an effect on live birth rate; however, treatment may improve the pregnancy rate. Microscopic subinguinal surgical treatment is possibly more effective and has a lower recurrence rate than other forms of surgical treatment. Robust, larger scale randomised controlled trials (RCTs) are needed to better inform the management of men with varicocele and subfertility.

Cochrane Database Syst Rev 2021;4:CD000479.

Dolutegravir-containing regimens more effective at HIV suppression during pregnancy

Rapid suppression of HIV viral load to undetectable levels is essential during pregnancy to minimise the chance of transmission to the neonate. Historically, studies of new drugs during pregnancy (including antiretroviral therapy) have been minimal due to concerns over adverse effects for neonates. A multicentre RCT conducted in nine countries randomised over 600 women to receive one of two …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.