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Asian Journal of Andrology 2016In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain.... (Review)
Review
In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain. The surgical treatment of varicocele for hypogonadism is controversial and debated. Recently, multiple reports in the literature have suggested that varicocele is associated with hypogonadism and varicocele repair can increase testosterone levels. Men with hypogonadal symptoms should have at least two serum testosterone levels. Microsurgical varicocelectomy may be beneficial for men with clinically palpable varicoceles with documented hypogonadism. In this review, we summarize the most recent literature linking varicocele to hypogonadism and sexual dysfunction and the impact of repair on serum testosterone levels. We performed a search of the published English literature. The key words used were "varicocele and hypogonadism" and "varicocele surgery and testosterone." We included published studies after 1998. We, also, evaluated the effect of surgery on the changes in the serum testosterone level regardless of the indication for the varicocele repair.
Topics: Erectile Dysfunction; Humans; Hypogonadism; Male; Testosterone; Varicocele
PubMed: 26696437
DOI: 10.4103/1008-682X.169560 -
Turkish Journal of Medical Sciences Jun 2023Mechanisms to explain inflammation in male infertility of unknown cause are still being investigated. The inflammasome is a key regulator of innate immunity in the...
BACKGROUND
Mechanisms to explain inflammation in male infertility of unknown cause are still being investigated. The inflammasome is a key regulator of innate immunity in the inflammatory response to infections. Our study aims to investigate the effects of varicocele on infertility, its relationship with antioxidant and inflammasome mechanisms, and how it could be guided in azoospermic or nonazoospermic patients.
METHODS
A cross-sectional cohort study was conducted at the department of urology in our university hospital. Eightyeight randomly selected men aged 20-45 admitted to our hospital because of infertility between September 2019 and July 2020 were included in the study. Patients were divided into four equal groups according to their clinical status, those with/without azoospermia and with/without varicocele. Blood and semen samples were taken from the patients. NOD-like receptor pyrin domain-containing 3 (NLRP3) and interleukin-1 beta (IL1β) and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were measured in serum and semen, and the groups were compared statistically.
RESULTS
Serum and semen NLRP3, IL1β, TAS, TOS, and OSI values of the patients with varicocele or azoospermia were significantlyhigher than those without either varicocele or azoospermia (p < 0.05). The oxidative stress markers TAS, TOS, and OSI values were significantly higher in the other groups than those without azoospermia and varicocele (p < 0.05).
DISCUSSION
Inflammasome mechanisms, such as NLRP3 and IL1-β molecules, may provide additional benefit in evaluating the need and benefit of surgical or medical treatment in infertility with and without vascular pathology and with and without azoospermia.
Topics: Humans; Male; Antioxidants; Azoospermia; Inflammasomes; Varicocele; Cross-Sectional Studies; NLR Family, Pyrin Domain-Containing 3 Protein; Infertility, Male; Oxidative Stress; Oxidants
PubMed: 37476898
DOI: 10.55730/1300-0144.5631 -
Fertility and Sterility Jun 2016Ultrasound imaging and angiography play a crucial role in the diagnosis and treatment of men with subfertility. The most commonly used imaging modality is ultrasound... (Review)
Review
Ultrasound imaging and angiography play a crucial role in the diagnosis and treatment of men with subfertility. The most commonly used imaging modality is ultrasound (US), which can be used for diagnostic purposes or to aid in treatment. Scrotal US can be used to document varicoceles in subfertile men in the context of difficult examination or for confirmation before treatment. Spectral Doppler, sonoelastography, and power Doppler have aided in the evaluation and treatment of azoospermia and oligospermia. They have proven useful in the detection of spermatogenesis and sperm retrieval. In the population with congenital Wolffian duct abnormalities, renal US can evaluate renal anomalies. In subfertile men with low ejaculate volume and oligospermia or azoospermia transrectal US can be used to evaluate and assist in treatment of ejaculatory duct obstruction. Non-US-based modalities are also commonly used in evaluating and treating men with subfertility. Magnetic resonance imaging (MRI) can be used for evaluation of pituitary adenomas in hypogonadism. More invasive imaging modalities used during treatment of subfertile men include vasography for vasal obstruction, venography and angioembolization for varicocele, and US-guided needle placement for testis-sparing surgery. Male subfertility is a complex problem and the use of imaging techniques is often essential in providing accurate diagnosis and appropriate treatment.
Topics: Angiography; Azoospermia; Ejaculatory Ducts; Humans; Infertility, Male; Magnetic Resonance Imaging; Male; Testis; Ultrasonography, Doppler
PubMed: 27125229
DOI: 10.1016/j.fertnstert.2016.04.009 -
Oxidative Medicine and Cellular... 2020Since autophagy was suspected to occur in the pathological situation of varicocele (VCL), we have attempted to confirm it here using a surgical model of...
Since autophagy was suspected to occur in the pathological situation of varicocele (VCL), we have attempted to confirm it here using a surgical model of varicocele-induced rats. Thirty Wistar rats were divided into three groups (varicocele/sham/control) and analyzed two months after the induction of varicocele. Testicular tissue sections and epididymal mature sperm were then monitored for classic features of varicocele, including disturbance of spermatogenesis, impaired testicular carbohydrate and lipid homeostasis, decreased sperm count, increased sperm nuclear immaturity and DNA damage, oxidative stress, and lipid peroxidation. At the same time, we evaluated the Atg7 protein content and LC3-II/LC3-1 protein ratio in testis and mature sperm cells, two typical markers of early and late cellular autophagy, respectively. We report here that testis and mature sperm show higher signs of autophagy in the varicocele group than in the control and sham groups, probably to try to mitigate the consequences of VCL on the testis and germ cells.
Topics: Animals; Autophagy; Disease Models, Animal; Male; Rats; Rats, Wistar; Reactive Oxygen Species; Spermatozoa; Testis; Varicocele
PubMed: 32351674
DOI: 10.1155/2020/5140383 -
Asian Journal of Andrology 2016A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. If a semen analysis is not... (Review)
Review
A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. If a semen analysis is not obtained from the adolescent male, in the absence of other symptoms, the main clinical indication used by many urologists to recommend repair is testicular atrophy. The varicocele may result in testicular damage in some males causing testicular atrophy with impaired sperm production and decreased Leydig cell function, while in other males the varicocele may seemingly cause no ill effects. In adult men, varicoceles are frequently present and surgically correctable, yet the measurable benefits of surgical repair are slight according to a Cochrane review. While occurring more commonly in infertile men than fertile men, only 20% of men with a documented varicocele will suffer from fertility problems. Most varicoceles found in adolescents are detected during a routine medical examination, and it is difficult to predict which adolescent presenting with a varicocele will ultimately show diminished testicular function in adolescence or adulthood. As in adults, the mainstay of treatment for varicocele in adolescents is surgical correction. However, unlike an adult varicocelectomy (the microsurgical approach is the most common), treatment for an adolescent varicocele is more often laparoscopic. Nevertheless, the goals of treatment are the same in the adolescent and adult patients. Controversy remains as to which patients to treat, when to initiate the treatment, and what type of treatment is the best. This review will present the current understanding of the etiology, diagnosis and treatment of the adolescent varicocele.
Topics: Adolescent; Adult; Age Factors; Humans; Male; Testis; Varicocele; Young Adult
PubMed: 26698233
DOI: 10.4103/1008-682X.167724 -
International Journal of Molecular... Dec 2022Varicocele is one of the main causes of infertility in men, thus representing an important clinical problem worldwide. Inflammation contributes mainly to its... (Review)
Review
Varicocele is one of the main causes of infertility in men, thus representing an important clinical problem worldwide. Inflammation contributes mainly to its pathogenesis, even if the exact pathophysiological mechanisms that correlate varicocele and infertility are still unknown. In addition, oxidative stress, apoptosis, hypoxia, and scrotal hyperthermia seem to play important roles. So far, the treatment of varicocele and the care of the fertility-associated problems still represent an area of interest for researchers, although many advances have occurred over the past few years. Recent experimental animal studies, as well as the current epidemiological evidence in humans, demonstrated that many functional foods of natural origin and nutraceuticals that are particularly abundant in the Mediterranean diet showed anti-inflammatory effects in varicocele. The aim of the present narrative review is to mainly evaluate recent experimental animal studies regarding the molecular mechanisms of varicocele and the state of the art about possible therapeutic approaches. As the current literature demonstrates convincing associations between diet, food components and fertility, the rational intake of nutraceuticals, which are particularly abundant in foods typical of plant-based eating patterns, may be a reliable therapeutic supportive care against varicocele and, consequently, could be very useful in the cure of fertility-associated problems in patients.
Topics: Male; Animals; Humans; Varicocele; Infertility, Male; Functional Food; Models, Animal; Dietary Supplements
PubMed: 36555779
DOI: 10.3390/ijms232416118 -
Seminars in Interventional Radiology Jun 2021Varicocele refers to an abnormally dilated and tortuous pampiniform venous plexus within the spermatic cord. The prevalence of varicocele is reported to be approximately... (Review)
Review
Varicocele refers to an abnormally dilated and tortuous pampiniform venous plexus within the spermatic cord. The prevalence of varicocele is reported to be approximately 15% in the general male population. Its incidence increases with age and has a higher incidence in infertile men. Varicocele treatment (surgical or interventional) is considered one of the most common therapies of reversible infertility in men. Percutaneous embolization offers nonsurgical, minimally invasive option for the treatment of varicoceles, requiring only minimal sedation. In this article, the authors review the clinical and technical details of percutaneous varicocele embolization with a summary of currently available evidence.
PubMed: 34108803
DOI: 10.1055/s-0041-1727105 -
Andrologia Nov 2019Although varicoceles are a widely accepted identifiable male factor in infertile couples, the benefit of varicocele repair in improving pregnancy and live birth rates...
Although varicoceles are a widely accepted identifiable male factor in infertile couples, the benefit of varicocele repair in improving pregnancy and live birth rates remains uncertain. The Study for Future Families obtained semen and reproductive hormone samples from US men whose partners were currently pregnant. In our analysis cohort of 709 men, a varicocele was detected by clinical examination in 56 (8%) of men. Men with varicocele had smaller left testis, and lower total and total motile sperm counts than men without varicocele. Gonadotropin levels were higher as well in men with varicocele. Interestingly, testosterone levels were also slightly higher in men with varicocele. Despite these differences, there was no difference between the groups in the time to achieve the study pregnancy or percentage of men with a previous pregnancy. We conclude that even in fertile men, varicoceles are associated with some degree of testicular hypofunction. This would support current recommendations to consider varicocele repair in male partners in infertile couples who demonstrate both a varicocele and abnormal semen parameters and after evaluation for treatable female factors.
Topics: Adult; Cohort Studies; Female; Fertility; Gonadotropins; Humans; Male; Pregnancy; Prospective Studies; Semen; Semen Analysis; Testis; Testosterone; Varicocele
PubMed: 31448444
DOI: 10.1111/and.13407 -
Reproductive Sciences (Thousand Oaks,... Jan 2021The evaluation of the seminal plasma plays a relevant role in the definition of male infertility and in assisted reproduction outcomes; for this reason, it would be... (Comparative Study)
Comparative Study
The evaluation of the seminal plasma plays a relevant role in the definition of male infertility and in assisted reproduction outcomes; for this reason, it would be recommended to find biochemical markers able to characterize sperm pathology. In this study, 53 infertile patients (grouped by the presence leukocytospermia, idiopathic infertility, or varicocele) and 10 fertile men were selected. Spermiogram was performed by light microscopy, and sperm ultrastructure was evaluated by transmission electron microscopy (TEM) mathematically elaborated. Testosterone (TESTO), estradiol (E2), ferritin (FERR), iron (Fe), transferrin (TRSF), triglycerides (TRG), cholesterol (CHOL), and isoprostanes (F-IsoPs) were detected in seminal plasma. Sperm characteristics and biochemical components were correlated by Spearman's rank correlation coefficient in the whole population and in each group. The levels of TESTO and E2 were positively correlated with sperm quality in particular, and E2 was correlated with fertility index expressing the number of sperm free of ultrastructural defects evaluated by TEM. On the contrary, the indices of iron metabolism (FERR, Fe, and TRSF) were positively associated with low sperm quality and sperm necrosis, particularly in leukocytospermia and varicocele groups, pathologies in which an inflammatory status and oxidative stress condition are present. The study of the seminal plasma composition deserves attention because the levels of the various components seem to be associated with specific reproductive pathologies.
Topics: Adult; Biomarkers; Case-Control Studies; Diagnosis, Differential; Estradiol; F2-Isoprostanes; Ferritins; Fertility; Humans; Infertility, Male; Iron; Lipids; Male; Microscopy, Electron, Transmission; Necrosis; Predictive Value of Tests; Semen; Sperm Count; Sperm Motility; Spermatogenesis; Spermatozoa; Testosterone; Transferrin; Varicocele
PubMed: 32696238
DOI: 10.1007/s43032-020-00260-0 -
Asian Journal of Andrology 2016Varicocele is a common medical condition entangled with many controversies. Though it is highly prevalent in men with infertility, still it marks its presence in males... (Review)
Review
Varicocele is a common medical condition entangled with many controversies. Though it is highly prevalent in men with infertility, still it marks its presence in males who do have normal fertility. Determining which patients are negatively affected by varicocele would enable clinicians to better select those men who benefitted the most from surgery. Since conventional semen analysis has been limited in its ability to evaluate the negative effects of varicocele on fertility, a multitude of specialized laboratory tests have emerged. In this review, we examine the role and significance of specialized sperm function tests with regards to varicocele. Among the various tests, analysis of sperm DNA fragmentation and measurements of oxidative stress markers provide an independent measure of fertility in men with varicocele. These diagnostic modalities have both diagnostic and prognostic information complementary to, but distinct from conventional sperm parameters. Test results can guide management and aid in monitoring intervention outcomes. Proteomics, metabolomics, and genomics are areas; though still developing, holding promise to revolutionize our understanding of reproductive physiology, including varicocele.
Topics: Acrylic Resins; Andrology; Humans; Infertility, Male; Male; Prognosis; Spermatozoa; Varicocele
PubMed: 26780873
DOI: 10.4103/1008-682X.172642