Varicocele-Induced Male Infertility: A Bibliometric Perspectives of Mechanistic Insights and Clinical Trends

Abstract

Background

Male infertility (MI) has become a global public health challenge, and varicocele (VC) is considered a common cause of male reproductive disorders. Although scientific research on MI has increased in recent years, there is still a significant lack of systematic integration and analysis of related publications.

Objective

This study employs bibliometric methods to conduct a comprehensive visual analysis of research on MI and VC from 2004 to 2024, aiming to depict the evolutionary trajectory, knowledge framework, and research frontiers in this field.

Methods

Tools such as VOSviewer, CiteSpace, Scimago Graphica, Pajek, R-bibliometrix, and R packages were used for bibliometric analysis and visualization of literature retrieved from the Web of Science database.

Results

From 2004 to 2024, publications on MI and VC have shown exponential growth, with the most pronounced increase occurring in 2020. At the national level, United States and China were the major contributors. Institutionally, the Cleveland Clinic and McGill University emerged as leading research centers. At the author level, Agarwal A. and Esteves S.C. were identified as the most influential contributors. Regarding journals, Andrologia and Fertility and Sterility served as major publication platforms. Keyword analysis delineated the key research domains within MI and VC. High-frequency keywords such as oxidative stress, DNA fragmentation, and spermatogenesis underscored the central research focus on oxidative damage and spermatogenic mechanisms, whereas terms such as varicocelectomy and microsurgery highlighted the sustained clinical interest in surgical interventions. Burst detection suggested a recent shift of research hotspots toward inflammation, lipid peroxidation, obesity, and antioxidant therapies such as vitamin E. Strategic diagram analysis further demonstrated that this field integrates both fundamental and interdisciplinary characteristics. Core topics such as testis and apoptosis were identified, along with well-developed but relatively isolated directions, collectively reflecting a trend of progressive integration from mechanistic exploration to clinical application.

Conclusion

Through bibliometric analysis, this study reveals a significant upward trend in research on MI and VC, reflecting the growing academic attention to multiple directions within the field. Moreover, it systematically maps the intellectual structure and developmental trajectory of the discipline, providing a comprehensive framework for understanding its current status, research foci, and emerging trends.