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Fertility and Sterility Nov 2016To evaluate how varicocele repair (VR) impacts pregnancy (PRs) and live birth rates in infertile couples undergoing assisted reproduction wherein the male partner has... (Meta-Analysis)
Meta-Analysis Review
Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis.
OBJECTIVE
To evaluate how varicocele repair (VR) impacts pregnancy (PRs) and live birth rates in infertile couples undergoing assisted reproduction wherein the male partner has oligospermia or azoospermia and a history of varicocele.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Azoospermic and oligospermic males with varicoceles and in couples undergoing assisted reproductive technology (ART) with IUI, IVF, or testicular sperm extraction (TESE) with IVF and intracytoplasmic sperm injection (ICSI).
INTERVENTION(S)
Measurement of PRs, live birth, and sperm extraction rates.
MAIN OUTCOME MEASURE(S)
Odds ratios for the impact of VR on PRs, live birth, and sperm extraction rates for couples undergoing ART.
RESULT(S)
Seven articles involving a total of 1,241 patients were included. Meta-analysis showed that VR improved live birth rates for the oligospermic (odds ratio [OR] = 1.699) and combined oligospermic/azoospermic groups (OR = 1.761). Pregnancy rates were higher in the azoospermic group (OR = 2.336) and combined oligospermic/azoospermic groups (OR = 1.760). Live birth rates were higher for patients undergoing IUI after VR (OR = 8.360). Sperm retrieval rates were higher in persistently azoospermic men after VR (OR = 2.509).
CONCLUSION(S)
Oligospermic and azoospermic patients with clinical varicocele who undergo VR experience improved live birth rates and PRs with IVF or IVF/ICSI. For persistently azoospermic men after VR requiring TESE for IVF/ICSI, VR improves sperm retrieval rates. Therefore, VR should be considered to have substantial benefits for couples with a clinical varicocele even if oligospermia or azoospermia persists after repair and ART is required.
Topics: Azoospermia; Female; Fertilization in Vitro; Humans; Live Birth; Male; Odds Ratio; Oligospermia; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Risk Factors; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Treatment Outcome; Urologic Surgical Procedures, Male; Varicocele
PubMed: 27526630
DOI: 10.1016/j.fertnstert.2016.07.1093 -
Frontiers in Bioscience (Landmark... Jan 2009Varicoceles are a treatable cause of male infertility, but very clinically diverse. Both histologic and molecular changes occur in the testes of men with varicocele.... (Review)
Review
Varicoceles are a treatable cause of male infertility, but very clinically diverse. Both histologic and molecular changes occur in the testes of men with varicocele. Physical measurements (scrotal temperature, testicular volume, pressure within the pampiniform plexus, basal lamina thickness) correlate with prognosis, but these correlations have not been accepted as predictors of successful repair because of variation within patient populations. Conventional semen parameters similarly correlate, but these correlations apply only to men with >5 x106 sperm/ejaculate. Levels of toxicants (e.g. norepinephrine, cadmium), reactive oxygen species byproducts, and hormones, their receptors and modulators have been evaluated as predictors in small-scale studies. Medical therapies (antoxidants, anti-inflammatories and hormones) have been applied empirically to small groups of patients with positive results that have not been verified in large-scale trials. Thus, urologists still face a challenge to determine which patients will benefit from varicocelectomies and/or medical interventions. In this review we summarize our current understanding of the pathophysiology of varicoceles, and discuss some of the new findings that may be applicable to specific clinical situations.
Topics: Animals; Disease Models, Animal; Humans; Infertility, Male; Male; Varicocele
PubMed: 19273300
DOI: 10.2741/3478 -
Asian Journal of Andrology 2016The effect of varicocele repair on male fertility remains controversial. It would be helpful to determined which men would benefit most from varicocele repair, and... (Review)
Review
The effect of varicocele repair on male fertility remains controversial. It would be helpful to determined which men would benefit most from varicocele repair, and target repair efforts at those individuals. A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. The greatest improvements in semen parameters were found in men with larger varicoceles. While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man (www.fertilitytreatmentresults.com). Limited data consistently demonstrates the greatest improvements in DNA fragmentation rates in men with higher baseline DNA fragmentation rates. With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. In addition, varicocele repair does seem to reduce the need for more invasive modalities of ART. In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
Topics: Adolescent; Adult; Age Factors; DNA Fragmentation; Humans; Infertility, Male; Male; Prognosis; Treatment Outcome; Varicocele; Young Adult
PubMed: 26732108
DOI: 10.4103/1008-682X.169558 -
Andrology Nov 2021Trace elements perform a vital role in all stages of human physiology, as well as reproduction.
BACKGROUND
Trace elements perform a vital role in all stages of human physiology, as well as reproduction.
OBJECTIVE
This study aimed to assess seminal calcium (Ca) and magnesium (Mg) in infertile men associated with varicocele (Vx).
MATERIALS AND METHODS
Overall, 50 men were divided into two groups: fertile men (n = 20) and infertile men who were scheduled for Vx surgical repair (n = 30). Exclusion criteria were as follows: azoospermia, smoking, leukocytospermia, and consumption of Ca and/or Mg supplements. All cases were subjected to history taking and clinical examination. Semen analysis and assessment of seminal Ca and Mg by the colorimetric method were carried out for all cases at the base point and 3 months postvaricocelectomy.
RESULTS
Generally, the mean seminal Ca and Mg levels demonstrated significant decreases in infertile men with Vx compared with the healthy fertile men linked to higher Vx grade as well as Vx bilaterality. These seminal decreases demonstrated significant increases after Vx surgical repair. Collectively, seminal Ca and Mg levels showed a significant positive correlation (r = 0.665, p= 0.001). Besides, seminal Ca, Mg levels, and Ca/Mg ratio showed significant positive correlation with sperm concentration (r = 0.479, p = 0.001; r = 0.541, p = 0.001; r = 0.282, p = 0.001, respectively), sperm motility percentage (r = 0.493, p = 0.001; r = 0.477, p = 0.001; r = 0.353, P = 0.001, respectively), and sperm normal forms percentage (r = 0.578, p = 0.001; r = 0.520, p = 0.001; r = 0.430, p = 0.001, respectively).
DISCUSSION AND CONCLUSION
Seminal Ca and Mg levels and Ca/Mg ratio are significantly decreased in infertile men associated with Vx compared with fertile men with significant increases after varicocelectomy.
Topics: Adult; Calcium; Case-Control Studies; Humans; Infertility, Male; Magnesium; Male; Postoperative Period; Preoperative Period; Semen; Semen Analysis; Varicocele; Vascular Surgical Procedures
PubMed: 34114754
DOI: 10.1111/andr.13066 -
Fertility and Sterility Feb 2021To explore the exome and transcriptome characteristics potentially underlying the pathogenesis of varicocele (VE).
OBJECTIVE
To explore the exome and transcriptome characteristics potentially underlying the pathogenesis of varicocele (VE).
DESIGN
Experimental study and cohort study.
SETTING
Academic research laboratory and university-affiliated hospital.
PATIENT(S)
Eleven VE patients whose fathers also had VE, plus 151 additional patients and 324 healthy men for variants genotyping; for the rat model, eight Sprague-Dawley male rats.
INTERVENTION(S)
Partial ligation of renal vein was conducted to establish VE rat models for whole-transcriptome RNA sequencing (RNA-seq).
MAIN OUTCOME MEASURE(S)
Genes with differential expression and/or harboring potential pathogenic variants detected via RNA-seq and whole-exome sequencing (WES) then subjected to population-based survey to define candidate genes of VE and analyzed via Gene Ontology and Kyoto Encyclopedia of Genes and Genomes to identify VE-involved pathways.
RESULT(S)
Whole-transcriptome RNA sequencing (RNA-seq) was performed using left spermatic veins of five rat VE models and three controls. We identified 9,688 genes and 18 pathways via RNA-seq, and via WES 160 genes harboring 279 potential deleterious variants and 16 pathways. Nine genes (AAMP, KMT2D, IRS2, SPINT1, IFT122, MKI67, DCHS1, LAMA2, and CBL) had variants in more than one patient who underwent WES, and six of these genes (AAMP, SPINT1, MKI67, IFT122, LAMA2, and DCHS1) showed differential expression. The population-based survey showed that AAMP, SPINT1, and MKI67 were strongly associated with VE risk. Together, two omic 67 data sets revealed four pathways potentially related to VE.
CONCLUSION(S)
For the first time, we have described the exome and transcriptome characteristics of VE. The bi-omics identified novel candidate genes and pathways involving the occurrence and development of VE.
Topics: Animals; Humans; Male; Rats; Rats, Sprague-Dawley; Varicocele; Exome Sequencing
PubMed: 32912637
DOI: 10.1016/j.fertnstert.2020.08.004 -
Proteomic profile of seminal plasma in adolescents and adults with treated and untreated varicocele.Asian Journal of Andrology 2016Varicocele, the most important treatable cause of male infertility, is present in 15% of adult males, 35% of men with primary infertility, and 80% of men with secondary... (Review)
Review
Varicocele, the most important treatable cause of male infertility, is present in 15% of adult males, 35% of men with primary infertility, and 80% of men with secondary infertility. On the other hand, 80% of these men will not present infertility. Therefore, there is a need to differentiate a varicocele that is exerting a deleterious effect that is treatable from a "silent" varicocele. Despite the growing evidence of the cellular effects of varicocele, its underlying molecular mechanisms are still eluding. Proteomics has become a promising area to determine the reproductive biology of semen as well as to improve diagnosis of male infertility. This review aims to discuss the state-of-art in seminal plasma proteomics in patients with varicocele to discuss the challenges in undertaking these studies, as well as the future outlook derived from the growing body of evidence on the seminal proteome.
Topics: Adolescent; Adult; Humans; Infertility, Male; Male; Proteomics; Semen; Varicocele; Young Adult
PubMed: 26643563
DOI: 10.4103/1008-682X.168788 -
Asian Journal of Andrology 2016The objective of this review was to summarize the evidence concerning the benefit of varicocele treatment to improve natural fertility in subfertile males. We also... (Review)
Review
The objective of this review was to summarize the evidence concerning the benefit of varicocele treatment to improve natural fertility in subfertile males. We also analyzed the effect of varicocele treatment on conventional semen parameters and sperm functional tests. An electronic search to collect the data was performed using the PubMed/MEDLINE databases until July 2015. Data pooled from a variety of study designs indicate that varicocelectomy improves semen parameters in the majority of the treated men with clinical varicocele and abnormal semen parameters regardless of the chosen surgical method. Surgical varicocele repair was beneficial not only for alleviating oxidative stress-associated infertility but also to improve sperm nuclear DNA integrity. However, given the low magnitude of the effect size in sperm DNA integrity, further research is needed to elucidate its clinical significance. Conflicting results on the effect of varicocele treatment on natural fertility seem to be due to heterogeneous study designs and, more importantly, patient selection criteria. When these issues are controlled, current evidence indicates that treatment of subclinical varicocele is not warranted, as it does not seem to improve fertility. On the contrary, fair evidence indicates that varicocele treatment should be offered to infertile patients with palpable varicocele and abnormal semen parameters. This evidence supports the current guidelines issued by the American Urological Association and European Association of Urology, which state that varicocele treatment should be offered to male partners of infertile couples presenting for evaluation with clinical varicocele and semen parameters alterations.
Topics: DNA Fragmentation; Humans; Infertility, Male; Male; Meta-Analysis as Topic; Oxidative Stress; Randomized Controlled Trials as Topic; Semen Analysis; Varicocele
PubMed: 26806080
DOI: 10.4103/1008-682X.172639 -
Asian Journal of Andrology 2016The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has... (Review)
Review
The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when. Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy of varicocele repair as well as cost-effectiveness of repair compared to immediate microTESE in azoospermic men and assisted reproductive technology in men with suboptimal semen parameters will be reviewed.
Topics: Cost-Benefit Analysis; Humans; Male; Reproductive Techniques, Assisted; Spermatozoa; Treatment Outcome; Varicocele
PubMed: 26732113
DOI: 10.4103/1008-682X.172644 -
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 -
Acta Medica Portuguesa Jul 1998The treatment of pediatric varicocele has recently been given a special importance due to clinical and experimental evidence of testicular atrophy and histological...
The treatment of pediatric varicocele has recently been given a special importance due to clinical and experimental evidence of testicular atrophy and histological changes in 50% of homolateral and sometimes in contralateral testis. Those changes are progressive and similar to those in infertile adults with varicocele. Between 1st January 1990 and 31st December 1994, 41 boys (five to 15 years old--mean age 11.9 years) were presented for evaluation of primary varicocele at the Pediatric Surgery Department of Dona Estefânia Hospital. The varicocele was left sided in 39 boys, bilateral in one and another on the right, with a predominance of grade II. Forty patients underwent varicocelectomy, 31 (77%) by the Ivanisevìc technique. Varicocele recurred in four cases (10%). The authors discuss the results and make some considerations concerning the management of varicocele in children.
Topics: Adolescent; Child; Child, Preschool; Humans; Male; Recurrence; Varicocele
PubMed: 9859507
DOI: No ID Found