Correctable Cause Of Male Infertility Research Articles

Evaluating the Efficacy of Microscopic Varicocelectomy in the Treatment of Primary and Recurrent Varicocele

Objectıve: Varicocele is the most common and correctable cause of male infertility. Microscopic subinguinal varicocelectomy is the golden standard in the treatment of this disease, and recurrence is the most common complication. The aim of this study was to investigate the outcomes of microscopic varicocelectomy in primary and recurrent varicocele.

Effect of selenium on testicular damage induced by varicocele in adult male Wistar rats

ProjectVaricocele is an abnormal tortuosity and distension of the veins of the pampiniform plexus in the spermatic cord. It is the most common surgically correctable cause of male infertility. Several studies have revealed the effects of increased oxidative stress on serum, semen, and testicular tissues in patients with varicocele or in animal models. The aim of this study was to investigate the effects of sodium selenite on testicular damage induced by experimental left varicocele in male Wistar rats. ProcedureIn the present study, the effects of oral administration of sodium selenite (at doses of 0.05, 0.1, 0.2, and 0.4mg/kg bw) were assessed in normal and varicocelized rats. ResultsThe varicocelized control rats showed decrease in sperm quality parameters, decreased activity of testes CAT, GPX and SOD, increased levels of MDA, and damage in testicular architecture. Administration of sodium selenite significantly reduced these changes to nearly normal levels, but did not change these parameters in normal rats. Histopathological studies further confirmed the protective effects of sodium selenite on varicocele-induced testicular damage in rats. Administrations of sodium selenite did not change these parameters in normal rats. ConclusionsTaken together, the results of this study suggest that sodium selenite treatment may have beneficial effect on the testes of varicocelized rats.

Varicocele and male infertility.

The link between varicoceles and male infertility has been a matter of debate for more than half a century. Varicocele is considered the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention. In addition, improvements in semen quality after varicocelectomy do not always result in spontaneous pregnancy. Studies regarding possible pathophysiological mechanisms behind varicocele-induced infertility have tried to address these controversies. Oxidative stress seems to be a central mechanism; however, no single theory is able to explain the differential effect of varicoceles on infertility. As a consequence, careful patient selection for treatment based on couple fertility status, varicocele grade, and semen quality is critical for achieving a chance of a subsequent pregnancy. A substantial amount of data on the effects of varicocelectomy has been gathered, but inadequate study design and considerable heterogeneity of available studies mean that these data are rarely conclusive. Current evidence suggests a beneficial effect of varicocelectomy on semen quality and pregnancy outcomes in couples with documented infertility only if the male partner has a clinically palpable varicocele and affected semen parameters.

Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele.

Varicocele is characterized by an abnormal dilatation and retrograde blood flow in the spermatic veins. Varicocele is the leading correctable cause of male infertility. Although it is highly prevalent in infertile men, it is also observed in individuals with normal fertility. Determining which men are negatively affected by varicocele would enable clinicians to better select those men who will benefit from treatment. To assess the functional status of the testes in men with varicocele, color Doppler sonographic parameters were evaluated. Testicular arterial blood flow was significantly reduced in men with varicocele, reflecting an impairment of spermatogenesis. An improvement in the testicular blood supply was found after varicocelectomy on spectral Doppler analysis. Testicular contrast harmonic imaging and elastography might improve our knowledge about the influence of varicocele on intratesticular microcirculation and tissue stiffness, respectively, providing possible information on the early damage of testicular structure by varicocele. Magnetic resonance imaging (MRI), with measurement of apparent diffusion coefficient has been used to assess the degree of testicular dysfunction and to evaluate the effectiveness of varicocele repair. Large prospective studies are needed to validate the possible role of functional sonography and MRI in the assessment of early defects of spermatogenesis in testes with varicocele.

Clinical Outcomes of Varicocele Repair in Infertile Men: A Review.

Varicoceles are a major cause of impaired spermatogenesis and the most common correctable cause of male infertility. They are found in approximately 40% of men with primary infertility and 80% of men with secondary infertility, although they also occur in 12% of men with normal semen parameters. The presence of a varicocele does not always affect spermatogenesis, as it has been reported that only 20% of men with documented varicoceles suffer fertility problems. However, varicocele repair appears to have beneficial effects in men with impaired semen parameters and palpable varicoceles. Currently, the main procedures employed for varicocele repair are microsurgical subinguinal or inguinal varicocelectomy, laparoscopic varicocelectomy, and radiological percutaneous embolization. Microsurgical varicocelectomy appears to be the optimal treatment in most cases, whereas the other procedures are useful only in specific cases. After treatment, it typically takes 3 to 6 months for patients' semen parameters to improve; thus, other therapies, including assisted reproductive technology, should be considered if infertility persists after this interval, especially in older couples. Controversies still remain regarding how varicoceles in certain subgroups, such as adolescents or men with azoospermia, should be treated. Due to their relatively high prevalence rate among the general population, varicoceles can occur concomitantly with other conditions that cause impaired spermatogenesis. Further studies are necessary in order to identify the patients who are most likely to benefit from treatment. In this review, we sought to summarize the issues currently associated with varicocele treatment in infertile men.

Foreword: varicocele - unraveling the enigma

It was more than 40 years ago, as a first-year Urology resident, that I performed my first varicocele ligation (a Palomo procedure1) under the watchful eye and able hands of my staff physician. I dutifully read all I could the night before the procedure and became familiar with the names of Barfield, Macomber and Sanders, Tulloch, MacLeod, Ivanissevich, Palomo, Amelar and Dubin and others who had written about varicoceles being associated with abnormal semen parameters and a potentially surgically correctable cause of male infertility. During and after our uneventful surgical procedure, I was grilled as to the anatomy and known pathophysiology of a varicocele. I felt well-versed from my reading and proudly regurgitated all I had learned about the anatomy of the left testicular vein and pampiniform plexus, incompetent or absent valves in the vein, increased testicular temperature, sluggish flow of blood from the left testis and possible toxins from the opposing left adrenal gland vein entering the dilated, incompetent testicular vein – any or all of which could contribute to disturb spermatogenesis and cause infertility. It all seemed simple enough! I pretty much thought we knew all we needed to know about this so-called “bag of worms.”

Expression and Subcellular Localization of Retinoic Acid Receptor-α (RARα) in Healthy and Varicocele Human Spermatozoa: Its Possible Regulatory Role in Capacitation and Survival.

Varicocele, an abnormal tortuosity and dilation of veins of the pampiniform plexus, is the most common identifiable and correctable cause of male infertility. It is now becoming apparent that signaling through vitamin A metabolites, such as all-trans retinoic acid (ATRA), is indispensable for spermatogenesis and disruption of retinoic acid receptor-α (RARα) function may result in male sterility and aberrant spermatogenesis. Herein, we investigated by Western blot and immunogold electron microscopy the expression profiles and subcellular localization of RARα in healthy and varicocele human sperm; in addition, we analyzed the effects of ATRA on cholesterol efflux and sperm survival utilizing enzymatic colorimetric CHOD-PAP method and Eosin Y technique, respectively. In varicocele samples, a strong reduction of RARα expression was observed. Immunogold labeling evidenced cellular location of RARα also confirming its reduced expression in "varicocele" samples. Sperm responsiveness to ATRA treatment was reduced in varicocele sperm. Our study showed that RARα is expressed in human sperm probably with a dual role in promoting both cholesterol efflux and survival. RARα might be involved in the pathogenesis of varicocele as its expression is reduced in pathologic samples. Thus, ATRA administration in procedures for artificial insemination or dietary vitamin A supplementation might represent a promising therapeutic approach for the management of male infertility.

Scrotal sonography in early management of subclinical varicocele and male infertility

Background: Varicocele is the most common cause of male infertility. About 20–30% men with varicocele are infertile. The clinically obvious varicocele is identifiable and correctable cause of male infertility, but less is known about the subclinical varicocele and its relationship to infertility. However, subclinical varicocele seems to be an important cause of infertility and hence scrotal ultrasonography is increasingly used in the diagnosis of subclinical varicocele. This study was undertaken to reveal incidence of subclinical varicocele in patients with severely impaired fertility potential. Objectives: To find the prevalence of subclinical varicocele in subjects of severely impaired fertility potential. Materials and Methods: The semen samples were obtained from 31 male partners (age 25–40 years) of infertile couples (sperm count less than 1 million/ml) attending the OPD Smt. SCL Hospital, Ahmedabad. They were analyzed for routine seminogram parameters. In this study, we evaluated male subjects with severely impaired fertility potential using scrotal ultrasonography, follicle-stimulating hormone, luteinizing hormone, and free testosterone. Results: The subclinical varicocele was present in 12 of 31 infertile male subjects evaluated. Percentage prevalence of subclinical varicocele was observed to be 39%. Hormonal levels of all the subjects studied were within normal limit. There was no significant difference in testicular volume of affected side and contralateral side of infertile male subjects. Conclusion: Scrotal ultrasonography is an important technique to reveal the subclinical varicocele for early diagnosis and management of these infertile male subjects.

Comparison of arterial blood supply to the testicles in the preoperative and early postoperative period in patients undergoing subinguinal varicocelectomy

Objective. Varicocele, which is the abnormal dilatation of internal spermatic veins, is known as the most surgically correctable cause of male infertility. In the evaluation of testicular arterial and venous blood supply, the scrotal colour Doppler ultrasound (CDU) is a valuable diagnostic method. The aim of this study was to investigate how the testicular blood flow is affected after varicocelectomy, and the place of scrotal CDU in the follow-up after varicocelectomy. Material and methods. Thirty male patients who were diagnosed with left-sided varicocele were prospectively included in the study. Before the varicocelectomy, semen analyses were carried out, and peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were measured by CDU. In the third postoperative month, scrotal CDU and semen analysis were performed again and compared with the preoperative results. Results. The arterial flow parameters PSV and EDV increased significantly, and the resistance parameters RI and PI decreased significantly, compared with the preoperative values. Sperm concentration, progressive motility and normal morphology improved in the postoperative semen analysis compared with the preoperative results. The increases in all three parameters were statistically significant. No statistically significant difference in vascular parameters was seen between the patients with improved and unimproved semen analysis. Conclusions. As confirmed by the results of semen analysis and CDU, testicular blood flow increases after varicocelectomy, resulting in the recovery of the haemodynamics of the testicle. CDU, which is generally used for diagnosis in the varicocele, can also be a valuable method of determining treatment success after surgery.

Varicocoele among 1 300 000 Israeli adolescent males: time trends and association with body mass index

Scarce data are available on epidemiology of varicocoele, the most common surgically correctable cause of male infertility. The objectives of this study were to evaluate the association between body mass index (BMI) and varicocoele and to assess trends in prevalence over time. We conducted a nationwide population-based long-term (1967-2010) study among 1323061 Israeli adolescent males using data from mandatory medical examination. BMI was grouped into underweight, normal weight, overweight and obese categories by percentiles adjusted for age in months and by further classification to five categories within normal weight. Univariable and multivariable logistic regression models were constructed, adjusting for possible confounders. Varicocoele prevalence (N=47398) increased during the study period from 1.6% for the 1950-1954 birth cohort to 4.6% for the 1990-1993 birth cohort, with the steepest rise in the normal weight group. Varicocoele unadjusted rates were highest (4.1%) among underweight and lowest (1.6%) among obese. In a multivariable model, adjusted for birth cohort, height, age and socio-demographic factors, we found a decreased risk for varicocoele in the overweight group [odds ratio (OR)=0.51, 95% confidence interval (CI): 0.49, 0.54] and the obese group (OR=0.34, 95% CI: 0.32, 0.37), compared with the normal weight group. Within the normal weight group, a monotonic inverse association between BMI percentile and varicocoele was observed, most notable among 75-84.9percentile compared to 25-49.9percentile (OR=0.65, 95% CI: 0.63, 0.68). In conclusion, varicocoele is common among adolescents in Israel, and its prevalence had increased in recent decades, providing clues to direct further andrological research on the role of modern lifestyle and environment in the aetiology of varicocoele. BMI, across percentiles, was found to be monotonically inversely associated with varicocoele, thus directing research and clinical efforts.

Prostatitis and male infertility

The prostate gland plays an important role in male reproduction. Inflammation of the prostate gland (prostatitis) is a common health problem affecting many young and middle aged men. Prostatitis is considered a correctable cause of male infertility, but the pathophysiology and appropriate treatment options of prostatitis in male infertility remain unclear. This literature review will focus on current data regarding prostatitis and its impact on male infertility.

Infrared digital thermography of scrotum in early selection of progressive varicocele

Varicocele is frequent but correctable cause of male infertility. Varicocelectomy is the most commonly performed operative procedure for varicocele. Majority of varicocele patients do not have fertility problem, therefore surgical correction is not recommended in all prevalent cases. On the other hand, varicocele is a progressive condition in some cases and individual with varicocele is at risk for developing impairment which can ultimately lead to semen deterioration and consequent infertility.Selection of patients with varicocele that will progress and cause infertility is beyond our current diagnostic capabilities. Diagnostic assessment of varicocele depends on physical examination and scrotal ultrasound/doppler. Infrared digital thermography of scrotum is a non-invasive and objective diagnostic method for early varicocele detection by means of temperature measurement on the scrotal skin surface. The criteria for diagnostic use of scrotal thermography were recently presented. We hypothesize that the infrared digital thermography of scrotum could be the cornerstone in detection of varicoceles that tend to progress with impairment of semen quality and will require surgical correction, among all prevalent varicocele cases.

Adolescent varicocoele management controversies

Varicocoele is defined as excessive dilatation of the pampiniform venous plexus of the spermatic cord. Varicocoele frequently appears during early puberty and is recognized to be the most common surgically correctable cause of male infertility. However, the actual incidence in adolescents, pathophysiology and the association with male factor infertility all remain somewhat controversial. The most accurate diagnostic technique for identifying young men who will benefit from surgical treatment has yet to be established. Observations of testicular asymmetry and deteriorating semen quality helped establish current guidelines and recommendations for surgical treatment. Further studies, comparing observation with surgical intervention, are needed to refine the current indications for varicocoele repair in the adolescent male.

Varicocele and male infertility

Varicoceles are the most frequent physical findings in infertile men. Although the varicocele is generally regarded to be the most common correctable cause of male infertility, whether varicocelectomy is an effective treatment for male factor infertility has been the focus of intense debate. A great deal of evidence indicates that varicocelectomy is clearly associated with a significant improvement in semen parameters (concentration, motility, and morphology). Varicocelectomy also appears to reduce seminal oxidative stress and sperm DNA damage. In contrast, the positive effect of varicocelectomy on improving natural pregnancy rates is less clear based on a few randomized controlled trials. Therefore, the need persists for well-designed, properly conducted randomized controlled trials to address this issue. Considering the beneficial effects of varicocelectomy on semen parameters, varicocelectomy should be considered in men with palpable lesions, at least one abnormal semen parameter and otherwise unexplained infertility. Microsurgical inguinal or subinguinal varicocelectomy techniques have been shown to result in fewer recurrences and postoperative complications than other techniques.

UP-01.132 Ligation of the Dilated External Spermatic Veins Improves the Outcome of Microscopic Subinguinal Varicocelectomy

Varicoceles have been associated with impaired semen quality and decreased Leydig cell function, and this impairment has been shown to be progressive in nature. However, varicocele repairs have been shown to improve not only spermatogenesis but also Leydig cell function. A varicocele is the most surgically correctable cause of male infertility, and a varicocele repair is the most commonly performed surgical procedure in treatment of male infertility. Evaluation of the outcome of ligation of the dilated external spermatic veins as a crucial step with subinguinal microscopic varicocelectomy to minimize the recurrence of varicocele and improve the testicular functions.

Surgery for azoospermia in the Indian patient: Why is it different?

Obstructive azoospermia is one of the few surgically correctable causes of male infertility. The outcomes of surgery in these patients are variable and often dependent upon the diagnosis and surgical expertise. We aimed to review the reported outcomes in Indian patients and evaluate potential reasons why these outcomes may be different from those reported from other regions. A search was performed on Medline/Pubmed using relevant keywords to identify publications from India on surgical management of azoospermia. The same search was repeated on Google and on the website of the Indian Journal of Urology. Personal emails were sent to prominent urologists performing surgery for azoospermia in India to obtain their opinions and reprints of their published articles. These were then reviewed. Very few articles were identified that pertained to the original search. A large majority of patients are diagnosed with idiopathic infertility. The outcomes of surgery where a clear diagnosis can be made are generally good and often comparable with the published literature. Infections are probably an under-diagnosed etiology. More research and publications are required to determine the etiology of obstructive azoospermia in the Indian men. These would help appropriate patient counseling and treatment.

Early Experience of Bilateral Laparoscopic Varicocelectomy

The varicocele is the most common correctable cause of male infertility. Most studies report approximately 10% prevalence of bilateral varicoceles. The ideal method of varicocele treatment is still a matter of controversy. Laparoscopic varicocelectomy is also one of the surgical options that has recently gained popularity. From June 2004 to August 2006, three patients with bilateral varicoceles were treated with laparoscopy. The operation was performed with 3 trocars system through transperitoneal approach. The mean operative times was 61.7 minutes. There was no abnormal parameters in the postoperative semen analysis for 13.0 months of the mean follow-up. Our series supports that a laparoscopic approach to the bilateral varicoceles can be performed with short operating times, minimal operative morbidity, rapid convalescence, and a cosmetically pleasing result as small three incisions for trocars.

Clinical and Radiological Evaluation of Ejaculatory Duct Obstruction

Ejaculatory duct obstruction (EDO) is a rare but surgically correctable cause of male infertility. With the advent and increased use of transrectal ultrasonography and magnetic resonance imaging, abnormalities of the ejaculatory duct (ED) related to infertility have been diagnosed more frequently. Recently, with the increased awareness of functional obstruction of ED, reports have been focusing on the diagnosis of partial or functional EDO. We present 2 review of the ED pathologies, imaging modalities and treatment options.

Beneficial Effect of Microsurgical Varicocelectomy is Superior for Men With Bilateral Versus Unilateral Repair

Varicocele represents the most common correctable cause of male infertility, and most reports indicate that varicocelectomy has a beneficial effect on male fertility and pregnancy outcome. Little is known about the differential effect of bilateral, compared to unilateral varicocelectomy, on male fertility potential. A total of 369 consecutive varicocelectomies were performed for male factor infertility between July 1996 and July 2002. The outcomes measured include postoperative changes in semen parameters, pregnancy rates (assisted and unassisted) and use of assisted reproductive technology (intrauterine insemination and in vitro fertilization with intracytoplasmic sperm injection). There were 157 men who underwent bilateral and 212 who underwent unilateral left varicocelectomy. Both groups had comparable male and female ages, and baseline semen parameters. Semen parameters improved significantly after surgery in the bilateral and unilateral groups. Moreover, the improvement in percent motility was significantly greater in the bilateral compared to the unilateral group (8.0% +/- 1.7% compared to 4.4% +/- 1.5% improvement, respectively, p <0.01). In addition, the spontaneous pregnancy rate was significantly higher in the bilateral compared to the unilateral group (49% vs 36%, respectively, p <0.05). Assisted reproductive technology was comparable in the unilateral and bilateral groups (64% vs 51%, respectively, p >0.05). Our data indicate that bilateral varicocelectomy (for clinically palpable bilateral varicoceles) is associated with a significantly greater improvement in sperm quality (motility) and male fertility potential than unilateral varicocelectomy. The greater improvement in semen parameters and pregnancy outcome associated with bilateral varicocelectomy support the concept of a detrimental dose-effect of varicocele on male fertility potential.

Subinguinal Microsurgical Varicocelectomy: Evaluation of the Results

Introduction: Varicoceles have been established to be the commonest correctable cause of male infertility. Among the various methods available, microsurgical varicocelectomy has one of the lowest complication rates with low failure. Patients and Methods: Over a 4-year period, 100 patients underwent microsurgical varicocelectomy at our center. One hundred and forty-four surgeries were performed on 90 of these patients through a subinguinal approach and these form the study group. Only clinically diagnosed varicoceles were operated. Pre-operative semen values were compared with the post-operative values and statistical analysis performed using a non-parametric test. All 90 patients provided at least 1 post-operative semen report 3 months after surgery while 50 are on complete follow-up. Results: Sperm count improved in 71% patients, normal motility in 60% and normal morphology in 49%. Seventeen of the 50 patients on full follow-up (34%) achieved pregnancy, with 16 of these being spontaneous. All patients achieving pregnancy showed improvement in sperm count, 13 improved in motility and 12 in morphology. All improvements were statistically significant. There were 21 (14.6%) minor complications with no testicular atrophy and 1 recurrence. Conclusion: Microsurgical varicocelectomy is a safe and effective option for the managment of varicocele-induced male infertility. It leads to improvement in all semen parameters and increases the possibility of spontaneous pregnancies.