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Fertility and Sterility Oct 2020
Topics: DNA Methylation; Egg Yolk; Humans; Male; Spermatozoa; Varicocele
PubMed: 32861441
DOI: 10.1016/j.fertnstert.2020.07.047 -
Reproductive Sciences (Thousand Oaks,... Oct 2022Hypoxia has been suggested as an important pathophysiological feature in varicocele disease. On the other hand, the expression of hypoxia-inducible factor 1-alpha... (Review)
Review
Hypoxia has been suggested as an important pathophysiological feature in varicocele disease. On the other hand, the expression of hypoxia-inducible factor 1-alpha (HIF1-α) is associated with the incidence of hypoxia. In this study, we investigated the expression of HIF1-α in varicocele disease through a comprehensive systematic review. We searched PubMed, Scopus, Web of Science, and Embase databases to identify the related studies published up to February 2021. Human studies have demonstrated an increase in the HIF-1α protein expression in the internal spermatic vein (ISV) of the varicocele testicle. HIF-1α mRNA expression in the seminal plasma was significantly higher in infertile varicocele patient compared with fertile ones. Similarly, most animal studies demonstrated a significant increase in HIF-1α gene and protein expression in varicocele testicular tissue compared with control groups. The studies illustrated that hypoxia followed by increased expression of hypoxia-inducible factor 1-alpha (HIF1-α) mRNA and protein occurs in varicocele disease. Expression of HIF-1α regulates the expression of many genes, including VEGF, p53, GLUT, Bax, and Caspase-3, that could be involved in many of the varicocele pathophysiological effects such as DNA fragmentation and apoptosis of sperm cells. Further studies with a large number of patients are necessary and can provide more definitive evidence.
Topics: Animals; Caspase 3; Humans; Hypoxia; Hypoxia-Inducible Factor 1; Hypoxia-Inducible Factor 1, alpha Subunit; Male; RNA, Messenger; Semen; Tumor Suppressor Protein p53; Varicocele; Vascular Endothelial Growth Factor A; bcl-2-Associated X Protein
PubMed: 34313997
DOI: 10.1007/s43032-021-00696-y -
Urologiia (Moscow, Russia : 1999) Jun 2021Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm.
UNLABELLED
Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm.
THE STUDY OBJECTIVE
to evaluate the quantitative correlation between varicocele and reproductive function with a large sample.
DESIGN
a cross-sectional and case control study.
MATERIALS AND METHODS
3632 patients from infertile couples and 276 fertile males. The ejaculate was tested following WHO recommendations (2010), DNA fragmentation was evaluated with chromatin dispersion in agarose gel.
RESULTS
we found weak correlation between varicocele degree (VD) and the spermogram parameters: -0.11 for concentration (<0.001), -0.08 for progressively motile sperm count (PMSC) in the ejaculate (<0.001), 0.11 for DNA fragmentation (<0.01), correlation with other parameters was insignificant (p>0.05). The clinical varicocele (V) prevalence in the fertile (F) and the infertile (I) males was the same: 27.2% (75/276) in the F, 31.4% (101/322) in the I1 with oligoasthenotertozoospermia (OAT) syndrome, 34.4% (43/125) in the I2 with OAT (p>0.05). In the general sample of the males from infertile couples V was found insignificantly more frequently in the I2 than in the I1 31.6% (426/1348) and 28.1% (641/2284), respectively (OR=1.13; p<0.05), because of degree 1 varicocele: 23.5% 20.2%, respectively (OR=1.16; p<0.05). Compared to the males without varicocele, median concentration is 8 mln/ml less in degree I,17mln/ml in degree II and 24 mln/ml in degree III (p<0.001); we found parallel increase in oligozoospermia rate: from 14% without varicocele to 27 and 26% in degree II and III (p<0.05-0.01). The PMSC in degree I varicocele is 10 mln less (-16% of the group without varicocele),in degree II 27 mln less (-44%), in degree III 23 mln less (-38%) (<0.001); the difference between the groups with degrees II and III is insignificant (p>0.05). The DNA fragmentation was significantly lower only in degree III (p<0.05). We found no difference in the sperm motility and morphology among the groups (p>0.05).
CONCLUSION
In varicocele, the sperm count decreases but in of cases, concentration is within reference values; there is no difference between degree II and III. The sperm motility and morphology do not depend upon varicocele. The DNA fragmentation is increased in degree III varicocele. The relative risk of infertility in varicocele is low (OR is less or equal 1.13).
Topics: Case-Control Studies; Cross-Sectional Studies; DNA Fragmentation; Humans; Infertility, Male; Male; Sperm Count; Sperm Motility; Spermatozoa; Varicocele
PubMed: 34251112
DOI: No ID Found -
International Journal of Molecular... May 2022Varicocele (VC) is the most common abnormality identified in men evaluated for hypofertility. Increased levels of reactive oxygen species (ROS) and reduced antioxidants... (Review)
Review
Varicocele (VC) is the most common abnormality identified in men evaluated for hypofertility. Increased levels of reactive oxygen species (ROS) and reduced antioxidants concentrations are key contributors in varicocele-mediated hypofertility. Moreover, inflammation and alterations in testicular immunity negatively impact male fertility. In particular, NLRP3 inflammasome activation was hypothesized to lead to seminal inflammation, in which the levels of specific cytokines, such as IL-1β and IL-18, are overexpressed. In this review, we described the role played by oxidative stress (OS), inflammation, and NLRP3 inflammasome activation in VC disease. The consequences of ROS overproduction in testis, including inflammation, lipid peroxidation, mitochondrial dysfunction, chromatin damage, and sperm DNA fragmentation, leading to abnormal testicular function and failed spermatogenesis, were highlighted. Finally, we described some therapeutic antioxidant strategies, with recognized beneficial effects in counteracting OS and inflammation in testes, as possible therapeutic drugs against varicocele-mediated hypofertility.
Topics: Antioxidants; Humans; Inflammasomes; Inflammation; Male; NLR Family, Pyrin Domain-Containing 3 Protein; Oxidative Stress; Reactive Oxygen Species; Varicocele
PubMed: 35563625
DOI: 10.3390/ijms23095233 -
Andrologia Feb 2021The effects of reactive oxygen species on male fertility are governed by the oxidative paradox, defined by a delicate balance between oxidative stress and antioxidant... (Review)
Review
The effects of reactive oxygen species on male fertility are governed by the oxidative paradox, defined by a delicate balance between oxidative stress and antioxidant capacity. When regulated appropriately, reactive oxygen species ensure effective function; however, when uninhibited, they represent key players in male factor infertility. Mechanisms responsible for this include oxidative destruction of sperm lipid membranes, damage to gamete DNA both by gene mutation and by direct breakdown of the DNA backbone, mitochondrial dysfunction and apoptotic cell death. Utilizing various male pathologies as case studies, we see ways in which oxidative stress has the potential to impact fertility in a negative way. Varicocele, erectile dysfunction, testicular cancer and even idiopathic male infertility highlight common mechanistic pathways, as well as subtle variations in the ways reactive oxygen species can operate. Oxidative biomarkers have emerged to better study male infertility, predict reproductive success and modify assisted reproductive technologies to minimize oxidative stress.
Topics: Antioxidants; Humans; Infertility, Male; Male; Oxidative Stress; Reactive Oxygen Species; Spermatozoa; Testicular Neoplasms; Varicocele
PubMed: 32323352
DOI: 10.1111/and.13581 -
Current Opinion in Urology Jan 2023A male factor is either the primary cause or is contributory in at least half of all couples with infertility. Currently, many male factor problems may be disregarded,... (Review)
Review
PURPOSE OF REVIEW
A male factor is either the primary cause or is contributory in at least half of all couples with infertility. Currently, many male factor problems may be disregarded, as reproductive technology has advanced so much that in-vitro fertilization (IVF)/Intracytoplasmic sperm injection (ICSI) allows the use of even a single sperm to achieve pregnancy.
RECENT FINDINGS
Varicocele is the most commonly diagnosed correctable cause. Microsurgical repair is considered the gold standard for repair. Research has shown that varicocele repair can impact the outcome of reproductive management and upgrade male infertility from adoption or donor sperm only to IVF/ICSI and microTESE, or IVF/ICSI with ejaculated sperm, or from IVF/ICSI to intrauterine insemination (IUI) or often naturally conceived.
SUMMARY
Varicocele diagnosis and repair is an essential part of infertility evaluation. Not only does it potentially impact antiretroviral therapy choices, but it can also increase testosterone levels benefiting long-term male health.
Topics: Female; Pregnancy; Male; Humans; Varicocele; Semen; Fertilization in Vitro; Infertility, Male; Fertilization
PubMed: 36444648
DOI: 10.1097/MOU.0000000000001053 -
Andrologia Dec 2020The aim of the study was to investigate whether or not there is a significant relationship between varicocele and SFJ insufficiency. This study included 200 men with...
The aim of the study was to investigate whether or not there is a significant relationship between varicocele and SFJ insufficiency. This study included 200 men with (study group) and 200 men without (control group) primary varicocele which was initially diagnosed by observation during the Valsalva manoeuver. Subsequently, scrotal and lower extremity venous Doppler ultrasonography (USG) was performed by a senior radiologist, and participants with testicular veins >3.0 mm in diameter and reverse blood flow were determined to have varicocele. SFJ insufficiency was defined as retrograde flow in the SFJ of longer than 0.5 s. Retrograde venous flow in the pampiniform plexus was determined 3.5% (study) versus 0.0% (control) and 77.0% (study) versus 0.0% (control) in the right testis and left testis, respectively, and bilaterally at 11.5% (study) versus 0.0% (control). The presence of SFJ insufficiency was also found to be higher in the study group than in the control group (unilaterally: 26.0% versus 15.0%; bilaterally: 14.0% versus 5.0%). The current study demonstrates a statistically significant relationship between varicocele and SFJ insufficiency and supports the argument that varicocele is not a local disease and may be attributable to a systemic vascular insufficiency. Additional studies with larger series are needed to further elucidate this topic.
Topics: Femoral Vein; Humans; Male; Spermatic Cord; Testis; Ultrasonography, Doppler, Color; Varicocele; Varicose Veins; Venous Insufficiency
PubMed: 32902914
DOI: 10.1111/and.13820 -
Reproductive Biology and Endocrinology... Jan 2021Published studies have shown contradictory results regarding the relationship between somatometric parameters and varicoceles. We performed a systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Published studies have shown contradictory results regarding the relationship between somatometric parameters and varicoceles. We performed a systematic review and meta-analysis to investigate the possible effects of age, height, weight, and body mass index (BMI) on the presence and severity of varicoceles.
METHODS
Databases including EMBASE, MEDLINE, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Web of Science, and Google Scholar were systematically searched to identify relevant articles published up to March 2020. Two researchers independently identified eligible articles and extracted data. Cochran's Q statistic and I statistics were used to assess heterogeneity. Meta-analysis was performed using StataSE 12.0 software (StataCorp LP, USA). Random-effects models were used to obtain the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Publication bias was assessed using Begg's funnel plot and Egger's regression test.
RESULTS
The search strategy produced 272 articles, of which 18 articles were eligible according to the inclusion/exclusion criteria. A total of 56,325 patients with varicocele and 1,334,694 patients without varicocele were included in the meta-analysis to evaluate the effect of somatometric parameters on the presence and severity of varicocele. The overall results demonstrated that the presence of varicoceles was significantly associated with height (WMD = 1.41, 95% CI = 1.07 to 1.74, P < 0.001) and inversely correlated with BMI (WMD = - 1.35, 95% CI = -1.67 to - 1.03, P < 0.001) but not with age (WMD = -0.93, 95% CI = -2.19 to 0.33, P = 0.149) or weight (WMD = 0.24, 95% CI = -2.24 to 2.72, P = 0.850). The severity of varicocele was inversely correlated with increased BMI but not with age.
CONCLUSION
The presence of varicoceles was significantly associated with height and inversely correlated with BMI.
Topics: Age Factors; Body Mass Index; Body Weight; Body Weights and Measures; China; Humans; Male; Prevalence; Risk Factors; Severity of Illness Index; Somatotypes; Varicocele
PubMed: 33472653
DOI: 10.1186/s12958-021-00695-3 -
Progres En Urologie : Journal de... Dec 2021Although the progress in diagnosis methods revealed a high incidence of infra-clinical varicocele, the clinical signification of this pathology is controversial. We...
BACKGROUND
Although the progress in diagnosis methods revealed a high incidence of infra-clinical varicocele, the clinical signification of this pathology is controversial. We compared left unilateral varicocelectomy to bilateral surgery in patients with left clinical varicocele associated to an infra-clinical right one.
PATIENTS AND METHODS
It is a retrospective study conducted between January 2007 and December 2015 concerning men followed for a varicocele related infertility (one-year or more primary infertility) with two altered sperm analysis (oligospermia and/or asthenospermia) and had a left clinical varicocele associated to right infra-clinical one detected at Doppler Ultrasound. Surgical techniques used were open surgery (sub-inguinal way), antegrade sclerotherapy and coelioscopy. All patients were reviewed with a 6 month post operatively spermogram and minimum follow up of 1 year.
RESULTS
Our study included 95 men. Thirty-five patients have had a unilateral left surgery (Group I) and 60 patients have had a bilateral surgical treatment (Group II). The pre-operative spermatic parameters (concentration and progressive mobility) were comparable for the 2 groups. After the surgical treatment, an improvement of these parameters was noted in all the patients without significant difference between the two groups regarding sperm concentration (24.07±9.36×10/mL Vs 23.29±3.88×10/mL) and their progressive mobility (30.47±9.04% Vs 32.39±9.54%). The spontaneous pregnancy rate was 22.8% for patients in group I and 26.6% for those in group II without any statistically difference (p=0.68).
CONCLUSION
Treatment of a right s infra-clinical varicocele, when combined with a left clinical varicocele, gave better results in terms of sperm parameters and spontaneous pregnancy than unilateral varicocelectomy but without statistically significant results.
LEVEL OF EVIDENCE
3.
Topics: Female; Humans; Infertility, Male; Male; Pregnancy; Retrospective Studies; Semen Analysis; Sperm Count; Varicocele
PubMed: 34272180
DOI: 10.1016/j.purol.2021.03.002 -
The Journal of Urology Oct 2021We assessed the role of standing vs supine scrotal ultrasound (SUS) for varicocele assessment by evaluating differences in clinical outcomes.
PURPOSE
We assessed the role of standing vs supine scrotal ultrasound (SUS) for varicocele assessment by evaluating differences in clinical outcomes.
MATERIALS AND METHODS
We retrospectively reviewed men from 2008-2020 diagnosed with varicocele who had documented SUS with both supine and standing assessments with and without Valsalva. Clinical outcomes (semen parameters, TUNEL and serum testosterone [T]) after microsurgical varicocelectomy were compared among men who had varicoceles diagnosed by standing SUS (vein size >2.5 mm, vein size >3.0 mm or reversal of flow) to those who would have been missed on supine SUS only.
RESULTS
A total of 349 men underwent varicocelectomy (right: 5 [1.4%]; left: 118 [33.8%]; bilateral: 226 [64.8%]). Disagreement between those with abnormal standing vs normal supine for vein size >2.5 mm was: 56 men (16.1%) on the right and 31 men (8.9%) on the left, for vein size >3.0 mm was: 64 men (18.3%) on the right, and 56 men (16.1%) on the left, and for flow reversal was: 36 (14.0%) on the right and 40 (15.4%) on the left. For those >2.5 mm, only T had significant improvements on the left (p=0.05). For those >3.0 mm significant differences were seen for sperm motility on the right (p=0.04), and TUNEL (p=0.04) and T (p <0.01) on the left. For flow reversal, significant differences were seen for sperm concentration (p <0.01), morphology (p=0.03) and volume (p=0.05) on the right and TUNEL on the left (p=0.02).
CONCLUSIONS
Standing SUS identifies a greater number of men who would have been missed using supine SUS only.
Topics: Adult; Humans; Male; Microsurgery; Missed Diagnosis; Retrospective Studies; Scrotum; Standing Position; Supine Position; Ultrasonography; Urologic Surgical Procedures, Male; Valsalva Maneuver; Varicocele; Veins
PubMed: 34032502
DOI: 10.1097/JU.0000000000001877