Article

Varicocele-induced infertility: Newer insights into its pathophysiology

Department of Urology, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
Indian Journal of Urology 01/2011; 27(1):58-64. DOI: 10.4103/0970-1591.78428
Source: PubMed

ABSTRACT The association between varicoceles and male infertility has been known since the 1950s; however, the pathophysiology of the process remains uncertain. The primary proposed hypotheses involve hyperthermia, venous pressure, testicular blood flow, hormonal imbalance, toxic substances, and reactive oxygen species. It is difficult to identify a single or dominant factor, and it is likely that many of these factors contribute to the infertile phenotype seen in clinical practice. Moreover, patient lifestyle and genetic factors likely affect patient susceptibilities to the varicocele insult. While the current studies have weaknesses, they provide building blocks for futures studies into the pathophysiology of the varicocele.

0 Followers
 · 
88 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Antisperm antibodies (ASA) are a cause of male infertility. ASA are often found in varicocele patients. The study objective was to assess the ASA role in fertility recovery after varicocelectomy. The longitudinal study involved 99 patients with varicocele. Patients were examined according to the WHO recommendations; ASA level was measured using the direct method of Sperm MAR test: 66 patients were ASA-negative, 33 had MAR-IgG ≥ 10%. All patients underwent microsurgical varicocelectomy. Student's t-test, Wilcoxon test, Chi-squared test and signed rank test were used for data analysis. The retrospective analysis of all operated patients data showed that the patients without spermiogram improvement after varicocelectomy had higher ASA levels. 3 months after the surgery, the initially ASA-negative varicocele patients demonstrated 2.5 times increase in number of progressive motile spermatozoa in the ejaculate (p < 0.001), accompanied by 6% decrease in abnormal sperm count (p < 0.05); the spermiogram parameters improved in 77% of cases (p < 0.01). After the surgery, ASA developed in 16% of cases (Max - MAR-IgG = 12%). The patients who were initially ASA-positive demonstrated ASA decrease only in half of the cases (16 of 33; p > 0.05). The main outcome in this group was a favourable response to the surgery (ASA level decrease) vs. no reduction in autoimmune process. The improvement in the ASA-positive group was demonstrated in the patients with higher varicocele grade (median - 2 vs. 1; p < 0.05) and lower ASA level (MAR-IgG = 48% vs. 92%; p < 0.01). The pregnancy rate within a year after surgery was 2.8 times more frequent in couples with ASA-negative men: 39% (25 of 65) in the ASA-negative group compared to 14% (4 of 28) in the ASA-positive group (p < 0.05). Thus, antisperm immune response decreases the varicocelectomy efficacy for reproductive function recovery: the higher percentage of ASA and lower grade of varicocele are associated with an unfavourable prognosis.
    Andrology 09/2014; 2(6). DOI:10.1111/j.2047-2927.2014.00254.x · 3.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this paper was to assess whether the beneficial effects of a varicocelectomy on fertility are transitory or definitive after a first fathering. This was a retrospective study which involved seven andrological centers. The files of 2223 patients who underwent subinguinal ligation of a high grade left varicocele for (oligo)±(astheno)±(terato)-spermia and infertility between January 1(st), 2002 and January 1(st) 2013 were reviewed. Inclusion criteria for the patients were the following: Sperm count improvement and fathering a child after an uneventful left varicocelectomy; 745 patients were considered. Patients who had undergone three assessments for (in-) fertility: Before surgery, before the first fathering and after the first fathering were included in the study. Each assessment included: Clinical history, physical examination, two sperm analyses, bilateral scrotal Duplex scans, blood hormonal levels [follicle stimulating hormone (FSH), luteinising hormone (LH), testosterone (T) and prolactin (PRL)]. Forty patients were finally studied; they all had an improved sperm count and had fathered once after surgery. Fifteen had fathered twice and still had their sperm count increased after the second fathering. Twenty-five patients could not father twice; 13 patients had their sperm count decreased after the first fathering and 12 did not. A decrease in testicular volume and an increase in FSH paralleled the worsening of sperm concentration, motility and morphology after fathering. No other differences could be observed between the groups. Our data indicated that the beneficial effects of a varicocelectomy might be transitory in some cases.
    Urology Annals 01/2015; 7(1):79-85. DOI:10.4103/0974-7796.148625
  • [Show abstract] [Hide abstract]
    ABSTRACT: Experimental rat varicocele was usually developed by the conventional technique but with varied success; and microsurgical rat varicocele model was an effective alternative. In this study we further analyzed differential outcome of experimental rat model with and without microsurgery. One hundred and twenty male Sprague-Dawley rats were randomly assigned to two groups. In Group A, experimental rat varicocele model was developed with conventional technique. The left renal vein was partially ligated with concurrent ligation of communicating branches between the left spermatic vein and common iliac vein. In Group B, all the above procedures were finished with microsurgical manipulation under operating microscope. Before and after model development, the mean diameter of the left internal spermatic vein was compared; and at 8 weeks after initial surgery the mean sperm concentration and motility in both groups was analyzed. The baseline mean diameter of the left internal spermatic vein in Group A and Group B was 0.14 ± 0.04 and 0.15 ± 0.03 mm, respectively (P =0.3157). In Group A 9 rats had severe complications resulting in model failure; while in Group B all rats had successful model except for one died of anesthetic accident (P = 0.008). At 8 weeks after initial surgery the mean left internal spermatic vein, sperm concentration and motility in both groups was 1.65 mm, 321.5×10(6)/gm and 51.9%; and 1.65 mm, 318.9×10(6)/gm and 53.5% respectively. There was nonsignificant difference of internal spermatic vein diameter, sperm concentration and motility between two groups. Microsurgery makes developing experiment rat varicocele model easy. Compared with conventional technique, microsurgical rat varicocele model has higher success rate and less complication.
    BMC Urology 12/2015; 15(1):12. DOI:10.1186/s12894-015-0012-y · 1.94 Impact Factor