Correctable Cause Of Male Infertility Research Articles

Machine learning-based classification of varicocoele grading: A promising approach for diagnosis and treatment optimization.

Varicocoele is a correctable cause of male infertility. Although physical examination is still being used in diagnosis and grading, it gives conflicting results when compared to ultrasonography-based varicocoele grading. We aimed to develop a multi-class machine learning model for the grading of varicocoeles based on ultrasonographic measurements. Between January and May 2024, we enrolled unilateral varicocoele patients at an infertility clinic, assessing their varicocoele stages using the Dubin and Amelar system. We measured vascular diameter and reflux time at the testicular apex and the subinguinal region ultrasonography in both the supine and standing positions. Using these measurements, we developed four multi-class machine learning models, evaluating their performance metrics and determining which patient position and projection were most influential in varicocoele grading. We included 248 patients with unilateral varicocoele in the study, their average age was 26.61±4.95 years old. Of these, 212 had left-sided and 36 had right-sided varicocoeles. According to the Dubin and Amelar system, there were 66 grade I, 96 grade II, and 86 grade III varicocoeles. Among the models we created, the random forest (RF) model performed best, with an overall accuracy of 0.81±0.06, an F1 score of 0.79±0.02, a sensitivity of 0.69±0.02, and a specificity of 0.8±0.03. Vascular diameter measurement at the testicular apex in the supine position had the most impact on grading across all models. In support vector machine and multi-layer perceptron models, reflux time measurements from the subinguinal projection in the standing position contributed the most, while in RF and k-nearest neighbors models, measurements from the subinguinal projection in the supine position were the most influential. Machine learning methods have demonstrated superior accuracy in predicting disease compared to traditional statistical regressions and nomograms. These advancements hold promise for clinically automated prediction of varicocoele grades in patients. Tailored varicocoele grading for individuals has the potential to enhance treatment effectiveness and overall quality of life.

The Andrological Landscape in the Twenty-First Century: Making Sense of the Advances in Male Infertility Management for the Busy Clinicians.

Male infertility represents a significant global problem due to its essential health, social, and economic implications. It is unsurprising that scientific research is very active in this area and that advances in the diagnostic and therapeutic fields are notable. This review presents the main diagnostic advances in male infertility, starting from the changes made in the latest WHO Manual of semen analysis and discussing the more molecular aspects inherent to "omics". Furthermore, the usefulness of artificial intelligence in male infertility diagnostics and the latest advances in varicocele diagnosis will be discussed. In particular, the diagnostic path of male infertility is increasingly moving towards a personalized approach to the search for the specific biomarkers of infertility and the prediction of treatment response. The treatment of male infertility remains empirical in many regards, but despite that, advances have been made to help formulate evidence-based recommendations. Varicocele, the most common correctable cause of male infertility, has been explored for expanded indications for repair. The following expanded indications were discussed: elevated sperm DNA fragmentation, hypogonadism, orchalgia, and the role of varicocele repair in non-obstructive azoospermia. Moving forward with the available data, we discussed the stepwise approach to surgical sperm retrieval techniques and the current measures that have been investigated for optimizing such patients before testicular sperm extraction. Finally, the key points and expert recommendations regarding the best practice for diagnosing and treating men with infertility were summarized to conclude this review.

P-061 Effect of Varicocelectomy on fertility potential and pregnancy outcome: results of a large cohort from a tertiary medical center

Abstract Study question Does varicocelectomy improve semen parameters, hormones & pregnancy outcomes in infertile men with clinical varicocele? Summary answer In infertile men with clinical varicocele, sperm count, motility, and DNA fragmentation improved significantly after varicocelectomy. Pregnancy outcomes improved for both spontaneous and assisted reproduction. What is known already Infertility is estimated to impact 15% of couples attempting to conceive worldwide. Varicocele has been identified as the most common surgically correctable cause of male infertility. Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters & pregnancy outcomes remains controversial. Few systematic reviews and meta-analyses (SRMAs) evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach with fewer studies reporting on pregnancy outcomes. Study design, size, duration This was a retrospective study of 2171 patients presenting with infertility & clinical varicocele between 2014 and 2024. Participants/materials, setting, methods Exclusion criteria were prior medications, medical illnesses causing infertility, or endocrine disorders. All participants underwent sub-inguinal microsurgical varicocelectomy. Data regarding patient demographics, clinical findings, semen analysis, serum hormone levels & pregnancy outcomes were collected pre and post-operatively. Variables were examined before & after varicocelectomy. X2 test and Kruskal-Wallis test were used to analyze categorical and numerical values, respectively. A p value < 0.05 was considered statically significant. Main results and the role of chance A 2171 participants were included. The mean age ± SD of the study population was 33.65 ± 8.54 years. Their mean right testicular size, left testicular size, right vein size, and left vein size were 14.38 ± 4.56,13.46 ± 3.49, 2.47±0.79 & 3.99 ±1.33 respectively. When subdividing them by grade of varicocele, on the right side, grades 1, 2, and 3 were detected in 692 (31.9%), 491 (22.6%), and 63 (2.9%), respectively. While on the left side, grades 1, 2, and 3 varicoceles were detected in 303 (13.9%), 999 (46%) & 867 (39.9%), respectively. Indication for surgery was pain (37%, primary infertility (42.9%), secondary infertility (18.3%), and others (3.6%). The majority performed unilateral varicocelectomy (1776 {81.8%}), while 396 (18.2%) underwent bilateral varicocelectomy. Varicocelectomy significantly improved sperm count, total & progressive motility & DNA fragmentation. Pregnancy outcomes improved postoperatively for both spontaneous (32.3%) & assisted reproduction (25.2%). No significant change was found in hormones postoperatively. Limitations, reasons for caution Retrospective study, single center experience. Wider implications of the findings It is important in patients’ counselling & choose the best management for this group of patients. Trial registration number NA

The role of testicular stiffness derived from shear wave elastography in the assessment of spermatogenesis in men with varicocele.

Varicocele is a major correctable cause of male infertility. Shear wave elastography (SWE) represents a valuable approach for assessing spermatogenesis in infertile men; however, its application in infertile men with varicocele remains unreported in the literature to date. The objective of this study was to investigate the correlation between testicular stiffness and spermatogenesis in individuals with varicocele. A total of 568 participants with left-side varicocele and 475 age-matched healthy controls were enrolled. The mean, left, and right testicular volumes (Volume-mean, Volume-L, and Volume-R), the mean elastic modulus of bilateral, left, and right testes (Emean, Emean-L, and Emean-R); the maximum elastic modulus of bilateral, left, and right testes (Emax, Emax-L, and Emax-R); the minimum elastic modulus of bilateral, left, and right testes (Emin, Emin-L, and Emin-R) were calculated. Receiver operating characteristic (ROC) curves for Volume-R and Emax were constructed to identify participants with sperm concentrations below 5 million/mL. The areas under the ROC curves (AUCs) were 0.801 and 0.775, respectively. Combining these 2 markers improved their diagnostic value with an AUC of 0.820 and sensitivity and specificity of 94.6% and 59.8% [95% confidence interval (CI): 0.772-0.867, P<0.01], respectively. A total of 69 participants underwent microsurgical varicocelectomy (including 42 cases with improved semen results and 27 without). The ROC curves of Emax-L and Volume-L were constructed for the differential diagnosis between the improved and unimproved groups; the AUCs were 0.723 and 0.855, respectively. Combining these 2 markers improved their diagnostic value with an AUC of 0.867 (95% CI: 0.772-0.961, P<0.01) and sensitivity and specificity of 81.5% and 81.0%, respectively. Our findings suggest that SWE can be used for varicocele to assess testicular parenchyma damage and Volume-L combined with Emax-L offers a more accurate method for predicting semen parameter improvement after microscopic subinguinal varicocelectomy in men with varicocele.

Predictive parameters of the efficacy of varicocele repair: a review.

Varicocele has a prevalence of 15% in the population and represents a primary cause of infertility in 40% of cases and a secondary cause in approximately 80% of cases. It is considered the major correctable cause of male infertility. Despite its high prevalence in the infertile population, a large number of patients with varicocele do not experience reproductive difficulties. For this reason, it is still highly debated which parameters could be used to predict which patients with varicocele will be most likely to benefit from its repair. The main international and European guidelines state that treatment should only be considered in infertile patients with abnormal sperm quality. However, these guidelines do not help physicians to identify which of these patients may benefit from the treatment. Therefore, this narrative review collects the evidence in the literature on the usefulness of some factors as predictors of improvement, highlighting how some of them may be effective in an initial selection of patients to be treated, while others are promising but further studies are needed. Finally, a brief consideration on the possible role of artificial intelligence is proposed.

Clinical application and nursing experience of the plan-do-check-act cycle in daytime varicocelectomy

BackgroundVaricocele is the most prevalent correctable cause of male infertility. Currently, surgical treatment is the primary method to enhance fertility.For many young varicocele patients who have postponed surgery due to time constraints, daytime surgery is especially crucial. Thus, this study aims to investigate the clinical and nursing application value of the Plan-Do-Check-Act (PDCA) cycle in daytime varicocelectomy.MethodsRetrospective collection of clinical data was conducted on 130 patients undergoing laparoscopic varicocelectomy in the Third Affiliated Hospital of Southern Medical University, Guangzhou,China.Among them, 65 patients who underwent daytime surgery were assigned to the observation group, while 65 patients who underwent routine hospital surgeries were assigned to the control group.The former also implemented PDCA cycle management.A comparison was made between the two groups regarding hospitalization time, hospitalization costs, and patient satisfaction.ResultsThe observation group exhibited a shorter hospitalization time and lower hospitalization costs compared to the control group, with higher patient satisfaction and pre-discharge visual analog scale (VAS) scores noted (P < 0.05).No significant difference was observed in the incidence of postoperative complications between the two groups during hospitalization (P > 0.05). The implementation of the PDCA cycle in the observation group has demonstrated its effectiveness, ensuring the smooth conduct of the daytime varicocelectomy.ConclusionIn conclusion,daytime varicocelectomy can reduce hospitalization time,lower hospitalization costs, improve patient satisfaction. The PDCA Cycle enhances the rationality and efficacy of the daytime varicocelectomy procedure and is highly recommended. Furthermore, it offers valuable reference for the application of the PDCA Cycle in various other diseases and nursing management approaches.Trial RegistrationThe Trial Registration Number: ChiCTR2300077465;Date of registration: November 9, 2023.

Review of various surgical approaches for varicocele management

Varicocele is one of the most common correctable causes of male infertility. Varicocele can also cause scrotal pain or discomfort. Treatment of varicocele is proved to have benefits in terms of fertility and pain. There are many treatment options for varicocele. This review aims to describe the treatment procedures and determine the outcomes, advantages and disadvantages for each treatment option.

Bilaterality of varicocele: The overlooked culprit in male infertility. Case series study.

Varicocele is the most common correctable cause of male infertility that always has been a debatable subject as regards how it affects fertility and the best way to treat it. Proper assessment of the disease bilaterality is crucial not to miss one side and not to jeopardize treatment outcome. This study aimed to objectively assess varicocele bilaterality in infertile men aiming to improve treatment outcome in this cohort of patients. This prospective study was conducted between January 2019 and January 2022 including infertile males with varicoceles. Assessment of missed concomitant contralateral varicocele done pre-operatively by Color Doppler Ultrasound and intraoperatively by intraoperative Doppler device and measurement of maximal vein diameter of contralateral side. A total of 329 cases completed the study. A hundred cases (30.4%) were initially referred as unilateral varicoceles and 229 (69.6%) as bilateral varicoceles. After reassessment of the study population, bilaterality of varicocele was found to be as high as 98.5% (324/329). Repeat CDUS strongly correlated with the intraoperative measured varicocele diameter (r = 0.9, p < 0.001). Moreover, sperm parameters showed significant improvement 3 and 6 months post varicocelectomy. Normal pregnancy after 1 year of surgery occurred in 118 cases (35.9%). Varicocele bilaterality in infertile men is underreported. Thorough assessment by expert radiologists and andrologists is of paramount importance not to miss significant pathology or hazard treatment outcome.

The effect of systemic inflammatory index and systemic inflammatory response index on success of varicoselectomy.

Varicocele is the most common correctable cause of male infertility. The treatment of varicocele is surgery. However, which patients will benefit from the surgery is controversial. Our aims to investigate the effect of systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) on varicocelectomy success. Patients who underwent varicocelectomy in our clinic between January 2016 and June 2022 were analyzed retrospectively. Varicocelectomy success was defined as >50% increase in post-operative total motile sperm count (TMSC) in those with pre- operative TMSC > 5 million and at least 100% increase in those with <5 million. The patients were divided into two groups as benefiting from the treatment (Group 1) and no benefits (Group 2). Of the 207 patients who underwent varicocelectomy, 144 (69.6%) of them improved their semen parameters, and 63 (30.4%) did not. The optimum cut-off value of SII was 334.6, with an AUC of 0.733 (95% CI: 0.665-0.813). The best cut-off value for SIRI of 0.882, with an AUC of 0.692 (95% CI: 0.607-0.772). The highest sensitivity and specificity were 0.692 and 0.601 (p < 0.001). In the multivariate analysis, only SII (OR: 3.152, 95% CI: 1.316-7.358; p = 0.003) and SIRI (OR: 2.919, 95% CI: 1.472-5.774; p = 0.002) were independent predictive factors for varicocelectomy success. Our results showed that preoperative SII and SIRI values were lower in infertile patients who underwent successful varicocelectomy. Therefore, we think that these parameters will be useful in identifying patients who will benefit before varicocelectomy.

MP43-15 MICROSURGICAL VARICOCELE REPAIR IMPROVES SPERM CAPACITATION AND PROBABILITY OF GENERATING A PREGNANCY, AS MEASURED BY PRE- AND POST-OPERATIVE TESTING WITH CAP-SCORE

You have accessJournal of UrologyCME1 Apr 2023MP43-15 MICROSURGICAL VARICOCELE REPAIR IMPROVES SPERM CAPACITATION AND PROBABILITY OF GENERATING A PREGNANCY, AS MEASURED BY PRE- AND POST-OPERATIVE TESTING WITH CAP-SCORE Muhamed Qalawena, Eric Seaman, Jared Johnson, Ahmed El-Sakka, and Joshua Bodie Muhamed QalawenaMuhamed Qalawena More articles by this author , Eric SeamanEric Seaman More articles by this author , Jared JohnsonJared Johnson More articles by this author , Ahmed El-SakkaAhmed El-Sakka More articles by this author , and Joshua BodieJoshua Bodie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infertility is a worldwide problem, with up to 40-50% of cases involving male infertility. Varicocele represents the most common correctable cause of male infertility. While semen analysis (SA) remains the primary diagnostic tool of infertility, it does not provide information about sperm function. The Cap-Score is designed to assess sperm capacitation via localization patterns of ganglioside GM-1, which has been shown to be a viable surrogate of capacitation-competent human sperm. The predicted probability of generating a pregnancy (PGP) is a validated metric based on semen volume, concentration, and Cap-Score. PGP is defined as the percent chance of obtaining a pregnancy within three consecutive rounds of intrauterine insemination (IUI). The objective of this study was to determine the effect of microscopic varicocelectomy on sperm capacitation and the probability of generating a pregnancy. METHODS: Data were collected prospectively of 40 consecutive adult men who presented with infertility confirmed by SA and found to have a varicocele on exam or ultrasound who underwent unilateral or bilateral subinguinal microscopic varicocelectomy. We recorded pre and post-operative SA, Cap-Score, and PGP with a 3-month follow up. Values were compared using paired t-test and Wilcox rank-sum test. RESULTS: Of the 40 men enrolled, 29 (72.5%) demonstrated improved Cap-Score with an average increase of 4% (p=0.001). The absolute change in probability of generating a pregnancy was 6% higher (p=0.001) after varicocelectomy, which represents a 25% relative increase in PGP. The change in Cap-Score was not associated with the grade of varicocele (p=0.0703) or whether the patient had a unilateral or bilateral repair (p=0.9682). There were no differences in semen volume (p=0.061) or morphology (p=0.091), however, there was improvement in sperm motility (p=0.021), total sperm count (p=0.030) and concentration (p=0.004). CONCLUSIONS: It is known that varicocelectomy improves semen parameters and chances of conception in the majority of cases, including pregnancies via intercourse or via assisted reproduction. This study confirms that varicocelectomy augments male fertility by improving sperm capacitation, and that varicocele repair improves the probability of generating an IUI pregnancy to a statistically-significant degree. The improvement in sperm capacitation ability may explain how varicocele repair may improve the chance of pregnancy, regardless of standard semen parameter improvements. Source of Funding: This study did not receive industry support. The only external funding for the study came from doctor M. Qalawena, a scholar visiting the University of Minnesota from the faculty of Medicine Suez Canal University, Egypt, whose personal educational grant by the Egyptian ministry of higher education funded the sixteen tests for the eight patients contributed from the University of Minnesota. Patients from the New Jersey site had received Cap-Score testing by Androvia LifeSciences Lab at patient expense. Physicians received no funding from Androvia for running the study, and the Androvia Labs did not have editorial control of the study results © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e607 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muhamed Qalawena More articles by this author Eric Seaman More articles by this author Jared Johnson More articles by this author Ahmed El-Sakka More articles by this author Joshua Bodie More articles by this author Expand All Advertisement PDF downloadLoading ...

Dynamic contrast-enhanced MRI in the assessment of testicular perfusion in infertile men with clinical varicocele.

Varicocele represents the most common correctable cause of male infertility. The presence of non-invasive imaging parameters providing evidence as to which patients with varicocele are at risk for infertility would be important. To explore the role of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) using semi-quantitative parameters in the assessment of testicular perfusion in infertile men with clinical varicocele. The study cohort included 11 infertile men with clinical varicocele and six controls, with prior paternity. Subtraction DCE-MRI was performed after gadolinium administration, using a three-dimensional fast field-echo sequence. Time-signal intensity curves were created and semi-quantitative parameters were calculated. The independent samples t-test was used to compare basic T1 perfusion parameters between infertile testes with clinical varicocele and normal testes. Logistic regression analysis was performed to assess the most significant predictor of the diagnosis of clinical varicocele. Both testes with clinical varicocele and normal testes enhanced moderately and homogeneously, with a linear increase of enhancement throughout the examination. Higher mean values of maximum enhancement (P = 0.026), maximum relative enhancement (P = 0.024), and wash-in rate (P = 0.013) were detected in the testes of infertile men with clinical varicocele, compared to the normal population. The wash-in rate proved the most significant predictor of the diagnosis of clinical varicocele (P = 0.013). DCE-MRI may provide a valuable insight into the testicular perfusion of infertile men with clinical varicocele. The wash-in rate proved a strong and independent predictor of the diagnosis of clinical varicocele.

Effects of alpha-lipoic acid on sperm quality in patients with varicocele-related male infertility: study protocol for a randomized controlled clinical trial

BackgroundVaricocele is a high incidence and is considered to be the most common and correctable cause of male infertility. Oxidative stress (OS) plays a central role in the pathogenesis of varicocele-related male infertility. In addition to varicocelectomy, antioxidant supplementation seems to be an effective scheme for the treatment of varicocele-related male infertility, but it is still controversial. The purpose of this study is to determine the effects of alpha-lipoic acid (ALA) supplementation on sperm quality in patients with varicocele-related male infertility.MethodsIn this randomized controlled clinical trial, we will randomize 80 patients with varicocele-related male infertility from Guilin People’s Hospital. The non-surgical observation group (n = 20) will receive ALA, the non-surgical control group (n = 20) will receive vitamin E, the surgical observation group (n = 20) will receive ALA after the operation, and the surgical control group (n = 20) will receive vitamin E after the operation. The course of treatment will be 3 months. The results will compare the changes in semen parameters, sex hormones, testicular volume, sperm DNA fragment index (DFI), seminal plasma malondialdehyde (MDA), and total antioxidant capacity (TAC) between the groups at baseline and after 3 months of antioxidant supplementation.DiscussionWhether it is necessary to use antioxidants in varicocele-related male infertility, how potent antioxidants should be used, postoperative application or non-surgical independent application still needs to be explored. This study attempts to compare the effects of two antioxidants (ALA and vitamin E) on sperm quality in patients with varicocele-related male infertility (surgical or non-surgical) and attempted to answer the above questions.Trial registrationChinese Clinical Trial Registry (ChiCTR) ChiCTR2100054958. Registered on 29 December 2021

Successful pregnancy after hCG/hMG treatment in an azoospermic male with idiopathic hypogonadotropic hypogonadism

Idiopathic hypogonadotropic hypogonadism (IHH) is one of the correctable causes of male infertility. Although there have been several previous reports about fertility treatment for IHH, there are no established guidelines of therapeutic method yet. We present an azoospermic male of IHH who succeeded in pregnancy and full term live birth after 18 months of treatment with human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG), and then changed his treatment into testosterone replacement therapy to maintain an appropriate male hormone level. This case report shows that a thorough and careful examination of whether it is a reversible cause is necessary and important in the approach to male infertility. In addition, it further proves that, in the case of IHH, a continuous long-term gonadotrophic stimulation therapy contributes to successful pregnancy and may need a testosterone replacement therapy after birth.

Prediction of semen analysis parameter improvement after varicocoelectomy using 1 H NMR-based metabonomics assays.

Varicocoele is the most common correctable cause of male infertility; however, predicting varicocoelectomy outcomes is difficult. "Omics" techniques have been increasingly used to develop new diagnostic and prognostics tools for several male infertility causes, and could be applied to study varicocoele. The objective is to create metabolomics models capable of segregating men who improved semen analysis (SA) parameters or achieved natural pregnancy after microsurgical varicocoelectomy (MV) from those who did not, using hydrogen-1 nuclear magnetic resonance (1 H NMR) spectra of seminal plasma of pre-operative samples. We recruited 29 infertile men with palpable varicocoele. 1 H NMR spectra of seminal plasma were obtained from pre-operative samples and used to create metabonomics models. Improvement was defined as an increase in the total motile progressive sperm count (TMC) of the post-operative SA when compared to the baseline, and pregnancy was assessed for 24 months after MV. Using linear discriminant analysis (LDA), we created a model that discriminated the men who improved SA from those who did not with accuracy of 93.1%. Another model segregated men who achieved natural pregnancy from men who did not. We identified seven metabolites that were important for group segregation: caprylate, isoleucine, N-acetyltyrosine, carnitine, N-acetylcarnitine, creatine, and threonine. We described the use of metabonomics model to predict with high accuracy the outcomes of MV in infertile men with varicocoele. The most important metabolites for group segregation are involved in energy metabolism and oxidative stress response, highlighting the pivotal role of these mechanisms in the pathophysiology of varicocoele. 1 H NMR spectroscopy of seminal plasma can be used in conjunction with multivariate statistical tools to create metabonomics models useful to segregate men with varicocoele based on the reproductive outcomes of MV. These models may help counseling infertile men with varicocoele regarding their prognosis after surgery.

Varicocele and male infertility: Historical, anatomical and urological perspectives – a mini review

Varicocele is defined as an abnormal dilatation of the pampiniform plexus of the spermatic cord. This is seen in 10 to 20% of general population and is one of the most common correctable causes of male infertility. The history of varicocele dates back to the era of Ancient Greeks to about 600 BC, who had sculptured varicocele in their statues as a tortuous bag of wormsin the scrotum. It was Ambrose Pare who gave a poetic description to the pooling of blood in the spermatic cords and subsequently Curling coined the term Varicocele The intricacy of the venous drainage of the scrotum and its contents and the criss crossing of the veins makes the thermo-regulatory mechanism regulating spermatogenesis, even more complex. The Cremaster and Dartos greatly aid in facilitating the thermo-regulatory mechanism of scrotal wall, which forms the anatomical basis of oligospermia in patients with varicocele. Apart from a visible change in seminal parameters, the benefits of varicocelectomy have extended on to an improvement in serum testosterone and enhancement of erectile and ejaculatory functions. With a greater knowledge of the pathophysiology of varicocele and with better understanding of the roles of gene polymorphisms and reactive oxygen species, the indications for varicocelectomy gain more support and evidence. A sound anatomical knowledge and an in-depth understanding of the events that take place at molecular level might shift the treatment focus in future from varicocelectomy to molecular targeted therapies.

The Effect of Varicocelectomy on the Pregnancy Rate in Patients with Severe Oligospermia.

Varicocele is the most common correctable cause of male infertility. But, it is still controversial in patients with severe oligospermia. The aim of this study is to evaluate how varicocelectomy impacts pregnancy rates (natural or assisted reproductive techniques) in infertile couples when the male partner has severe oligospermia and history of varicocele. A retrospective examination was made of males with total motile sperm count <5 million/mL with varicocele in the period April 2013 to October 2019. Pregnancy rates were compared at the end of 1-year follow-up of 52 patients (Group 1) who underwent varicocelectomy and 36 patients (Group 2) who applied for assisted reproductive techniques without surgery. The postoperative third-month sperm parameters were compared for Group 1. Spontaneous pregnancy and conception rates with assisted reproductive techniques for Groups 1 and 2 were also investigated after 1 year. In the semen analysis performed in the 3rd month, a statistically significant increase was observed in sperm number, motility, and morphology of the patients in Group 1. Spontaneous pregnancy was obtained in 7 (13.4%) of the 56 Group 1 patients who underwent varicocelectomy, in 7 (13.4%) patients with intrauterine insemination, and in 6 (11.5%) patients with intracytoplasmic injection (ICSI). In Group 2, pregnancy occurred with the help of ICSI in 4 of 32 patients (11.1%). Varicocele surgery before assisted reproductive techniques will be more beneficial in terms of both cost-effectiveness and pregnancy rates.

Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading.

Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.Key Points• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. • Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. • This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.

Semen parameter improvements after microsurgical subinguinal varicocele repair are durable for more than 12 months.

Varicoceles account for the most common correctable cause of male infertility, with varicocele repair leading to improvements in semen quality. However, there is little evidence to establish the durability of varicocele repair. We analyzed the durability of improvements in postoperative semen parameters following microsurgical subinguinal varicocele repair. We evaluated all men who underwent microscopic subinguinal varicocelectomy from 2015-2019. Patients were included if they desired fertility and had a followup of at least 12 months. We assessed the baseline characteristics of these patients, as well as semen volume, total motile sperm count (TMSC), concentration, percent motility, and morphology. Semen parameters were analyzed at baseline (preoperative) and at approximately three months and ≥12 months postoperatively. Of 105 men who underwent varicocelectomy, 18 men had a followup of at least 12 months. These men presented with median age of 34.5 (27-38) years for a median followup duration of 14.5 (13-22.5) months. TMSC levels increased from 6.4 (1.1-24.5) million at baseline to 11.1 (2.4-38.4) million at approximately three months and remained similar at 12.5 (1.6-31.5) million at ≥12 months. The study is limited by its retrospective nature and limited sample size. Microscopic subinguinal varicocele repairs can result in durable improvements of semen quality beyond one year, as demonstrated by upgrade in median TMSC. Further studies should be performed to confirm our findings.

Expression of claudin‑11 in a rat model of varicocele and its effects on the blood‑testis barrier.

Varicocele (VC) is an abnormal tortuosity and venous distension of the pampiniform plexus in the spermatic cord. VC is the most common surgically correctable cause of male infertility. The purpose of the present study was to investigate the effects of VC on the tight junctions and the blood-testis barrier (BTB) of Sertoli cells in the bilateral testes of rats. A model of VC was established by left renal vein narrowing in Sprague-Dawley rats; control rats underwent dissection of the vein without narrowing. The bilateral testes were harvested at 4, 6 and 8 weeks after the operation. The relative expression of claudin-11 and transforming growth factor (TGF)-β in the testis was determined by reverse transcription-polymerase chain reaction analysis and immunohistochemistry (IHC). The expression level of claudin-11 was prominently downregulated in the VC model group compared with the control group, while the level of TGF-β in the testes was higher in the VC group. IHC examination demonstrated that VC led to destruction of the integrity of the BTB, and the degree of destruction increased with time. Furthermore, it was also observed that unilateral VC affected contralateral testicular function. In conclusion, the present study partially explained the molecular mechanisms underlying the pathogenesis of VC and provided grounds for further research into the treatment of male infertility.

The prevalence of midline prostatic cysts and the relationship between cyst size and semen parameters among infertile and fertile men.

When is the investigation and treatment of midline prostatic cysts (MPC) of clinical value in the work-up of males of infertile couples? With a prevalence of 10.2% in infertile men, MPC should be investigated according to a seminal algorithm detecting a MPC volume >0.117 ml, which may impair semen parameters, and could be treated to improve sperm count and achieve natural pregnancy. MPC are frequent and are considered a correctable cause of male infertility. However, they have been poorly investigated in an infertility setting. In addition, no study has investigated clinical and ultrasound (US) characteristics of men with MPC. A cross-sectional analysis was carried out of 693 consecutive subjects consulting for couple infertility from September 2012 to March 2017. As a control group, 103 age-matched healthy, fertile men were studied. Furthermore, a longitudinal evaluation of 11 infertile men undergoing trans-rectal ultrasonically-guided cyst aspiration (TRUCA), semen analyses 1 and 3 months after TRUCA and a follow-up 1 year after TRUCA to assess natural pregnancy were performed. All subjects underwent, in our outpatient clinic, clinical, hormonal, scrotal and transrectal US evaluation and semen analysis within the same day. Of 693 males of infertile couples, 648 (37.1 ± 7.9 years, mean+SD) without genetic abnormalities were studied, along with 103 fertile men (36.6 ± 5.0 years). Eleven infertile men underwent TRUCA and were followed-up as reported above. A MPC was present in 66/648 (10.2%) males of infertile couples and in 6/103 (5.8%) fertile men. MPC occurrence and volume were higher in patients with severe oligo- or azoospermia than in fertile men (all P < 0.05). Infertile men with a MPC showed a lower seminal volume and sperm count and a higher prevalence of azoospermia than the rest of the infertile sample or fertile men, and a higher frequency of US signs suggestive of ejaculatory duct obstruction. MPC volume was negatively associated with total sperm count (r = -0.452, P < 0.0001). In fertile men, the highest MPC volume was 0.117 ml, suggesting it as a biological threshold not compromising semen quality. In infertile men, using receiver operating characteristic curve analyses, a MPC volume >0.117 ml identified subjects with severe oligo- or azoospermia with an overall accuracy of ~75% (both P < 0.005). Eleven men with infertility, semen abnormalities and large MPC (>0.250 ml) underwent TRUCA, which led to sperm count improvement in all patients 1 month after surgery. Three months after TRUCA a lower sperm count and a higher MPC volume than 2 months before were observed (P < 0.005 and P < 0.05, respectively), although improved when compared to baseline. After TRUCA a natural pregnancy occurred in four couples. Finally, we propose an algorithm, based on semen parameters, useful in identifying a MPC in males of infertile couples. Although in line with the sample size of previous studies (n = 7-20), the number of infertile men with MPC evaluated longitudinally after treatment is limited (n = 11). In addition, although a MPC volume >0.117 ml can negatively affect the sperm count, only MPC > 0.250 ml have been treated in this study. First, the algorithm proposed is easy to use and useful for selecting patients who can benefit from a prostate US in the infertility work-up. Second, a MPC volume ≤0.117 ml may not impair semen quality, while a larger volume can lead to severe oligo- or azoospermia and could be treated. Third, TRUCA is effective, and simpler and less invasive than other surgical techniques for MPC treatment. Finally, since the MPC can increase in size and sperm count decrease over time after TRUCA, semen cryopreservation should be considered 1 month after TRUCA. Grants from the Ministry of University and Scientific Research (SIR project to F.L., protocol number: RBSI14LFMQ). No conflicts of interest.