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Lira Neto FT, Roque M, Esteves SC. Effect of varicocele and varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele. Minerva Obstet Gynecol 2024; 76:49-69. [PMID: 36222786 DOI: 10.23736/s2724-606x.22.05169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Varicocele is the leading cause of male infertility. It can affect sperm quantity and quality through various non-mutually exclusive pathophysiological mechanisms, mainly oxidative stress. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress and harm the sperm's DNA. Excessive sperm DNA breaks, so-called sperm DNA fragmentation, result from the oxidative stress cascade and are commonly found in the ejaculates of men with varicocele and fertility-related issues. Measuring sperm DNA fragmentation can provide valuable information on the extent of harm and might help select candidates for surgical treatment. Varicocelectomy is beneficial for alleviating oxidative stress-associated infertility and improving sperm DNA integrity. However, reproductive outcomes of infertile men with elevated sperm DNA fragmentation rates and surgically treated varicoceles remain poorly studied, and there is a need for well-designed trials to determine the impact of sperm DNA fragmentation reduction on natural and medically assisted reproduction.
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Affiliation(s)
- Filipe T Lira Neto
- AndrosRecife, Andrology Clinic, Recife, Brazil
- Department of Urology, Prof. Fernando Figueira Institute of Integrative Medicine, Recife, Brazil
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil -
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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2
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Kang C, Punjani N, Lee RK, Li PS, Goldstein M. Effect of varicoceles on spermatogenesis. Semin Cell Dev Biol 2021; 121:114-124. [PMID: 33965333 DOI: 10.1016/j.semcdb.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/05/2021] [Indexed: 12/12/2022]
Abstract
Varicoceles are dilated veins within the spermatic cord and a relatively common occurrence in men. Fortunately, the large majority of men are asymptomatic, however, a proportion of men with varicoceles can suffer from infertility and testosterone deficiency. Sperm and testosterone are produced within the testis, and any alteration to the testicular environment can negatively affect the cells responsible for these processes. The negative impact of varicoceles on testicular function occurs mainly due to increased oxidative stress within the testicular parenchyma which is thought to be caused by scrotal hyperthermia, testicular hypoxia, and blood-testis barrier disruption. Management of varicoceles involves ligation or percutaneous embolization of the dilated veins. Repair of varicoceles can improve semen parameters and fertility, along with serum testosterone concentration. In this review, we discuss the pathophysiology of varicoceles, their impact on testicular function, and management.
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Affiliation(s)
- Caroline Kang
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
| | - Nahid Punjani
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
| | - Richard K Lee
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
| | - Philip S Li
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
| | - Marc Goldstein
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, NY 10065, United States.
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Dcunha R, Hussein RS, Ananda H, Kumari S, Adiga SK, Kannan N, Zhao Y, Kalthur G. Current Insights and Latest Updates in Sperm Motility and Associated Applications in Assisted Reproduction. Reprod Sci 2020; 29:7-25. [PMID: 33289064 PMCID: PMC7721202 DOI: 10.1007/s43032-020-00408-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/08/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
Spermatozoon is a motile cell with a special ability to travel through the woman’s reproductive tract and fertilize an oocyte. To reach and penetrate the oocyte, spermatozoa should possess progressive motility. Therefore, motility is an important parameter during both natural and assisted conception. The global trend of progressive reduction in the number and motility of healthy spermatozoa in the ejaculate is associated with increased risk of infertility. Therefore, developing approaches for maintaining or enhancing human sperm motility has been an important area of investigation. In this review we discuss the physiology of sperm, molecular pathways regulating sperm motility, risk factors affecting sperm motility, and the role of sperm motility in fertility outcomes. In addition, we discuss various pharmacological agents and biomolecules that can enhance sperm motility in vitro and in vivo conditions to improve assisted reproductive technology (ART) outcomes. This article opens dialogs to help toxicologists, clinicians, andrologists, and embryologists in understanding the mechanism of factors influencing sperm motility and various management strategies to improve treatment outcomes.
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Affiliation(s)
- Reyon Dcunha
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Reda S Hussein
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.,Department of Obstetrics and Gynecology, Assiut University, Assiut City, Egypt
| | - Hanumappa Ananda
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Sandhya Kumari
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Satish Kumar Adiga
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Nagarajan Kannan
- Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.,Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, 55905, USA.,Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN, 55905, USA
| | - Yulian Zhao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Guruprasad Kalthur
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India. .,Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Neto FTL, Marques RA, de Freitas Cavalcanti Filho A, Araujo LCN, Lima SVC, Pinto L, Silva RO. 1H NMR-based metabonomics for infertility diagnosis in men with varicocele. J Assist Reprod Genet 2020; 37:2233-2247. [PMID: 32715373 PMCID: PMC7492286 DOI: 10.1007/s10815-020-01896-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE "Omics" techniques have been used to understand and to identify biomarkers of male infertility. We report on the first metabonomics models created to diagnose varicocele and infertility among men with varicocele. METHODS We recruited 35 infertile men with varicocele (VI group), 21 fertile men with varicocele (VF group) and 24 fertile men without varicocele (C group). All men underwent standard semen analysis, scrotal duplex ultrasonography, and sexual hormone level measurement. Hydrogen-1 nuclear magnetic resonance (1H NMR) spectra of seminal plasma were used to create metabonomics models to discriminate between men with and without varicocele, and between fertile and infertile men with varicocele. RESULTS Using the statistical formalisms partial least square discriminants analysis and genetic algorithm-based linear discriminant analysis (GA-LDA), we created two models that discriminated the three groups from each other with accuracy of 92.17%. We also created metabonomics models using orthogonal partial least square discriminants analysis and GA-LDA that discriminated VF group from VI group, with an accuracy of 94.64% and 100% respectively. We identified 19 metabolites that were important in group segregation: caprate, 2-hydroxy-3-methylvalerate, leucine, valine, 3-hydroxybutyrate, lactate, alanine, 4-aminobutyrate, isoleucine, citrate, methanol, glucose, glycosides, glycerol-3-phosphocoline, n-acetyltyrosine, glutamine, tyrosine, arginine, and uridine. CONCLUSIONS 1HNMR-based metabonomics of seminal plasma can be used to create metabonomics models to discriminate between men with varicocele from those without varicocele, and between fertile men with varicocele from those infertile with varicocele. Furthermore, the most important metabolites for group segregation are involved in the oxidative stress caused by varicocele.
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Affiliation(s)
- Filipe Tenorio Lira Neto
- Department of Surgery, Universidade Federal de Pernambuco, Rua Guilherme Salazar, n 150, apt 601E, Recife, PE ZIP 52061-275 Brazil
- Instituto de Medicina Integral Prof. Fernando Figueira, Rua dos Coelho, 300, Coelhos, Recife, PE ZIP 50070-902 Brazil
| | - Ronmilson Alves Marques
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
| | | | | | - Salvador Vilar Correia Lima
- Department of Surgery, Universidade Federal de Pernambuco, Hospital das Clínicas - Campus UFPE, Av. Prof. Moraes Rego,”s/n° - Bloco “A” - Térreo Cidade Universitária, Recife, PE ZIP 50670-420 Brazil
| | - Licarion Pinto
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
| | - Ricardo Oliveira Silva
- Fundamental Chemistry Department, Universidade Federal de Pernambuco, Av. Jornalista Anibal Fernandes, s/n° Cidade Universitária, Recife, PE ZIP 50740-560 Brazil
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Santana VP, James ER, Miranda-Furtado CL, Souza MFD, Pompeu CP, Esteves SC, Carrell DT, Aston KI, Jenkins TG, Reis RMD. Differential DNA methylation pattern and sperm quality in men with varicocele. Fertil Steril 2020; 114:770-778. [PMID: 32709382 DOI: 10.1016/j.fertnstert.2020.04.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the global DNA methylation pattern in spermatozoa of patients with varicocele as well as investigate their semen quality. DESIGN Prospective observational case-control study. SETTING University-affiliated hospital. PATIENT(S) A total of 26 men with varicocele and 26 fertile men without the disorder. INTERVENTIONS Analysis of semen quality and sperm DNA methylation patterns. MAIN OUTCOME MEASURE(S) Semen quality evaluated by semen analysis, and sperm DNA methylation patterns investigated using the Infinium MethylationEPIC BeadChip platform. RESULT(S) Men with varicocele displayed decreased semen quality. The sperm DNA methylation analysis showed that men with varicocele exhibit global hypomethylation in comparison with the control group. A total of 59 differentially methylated CpG sites were identified, most of them hypomethylated in the varicocele group. In regional analyses, 1,695 DNA regions were differentially methylated in men with varicocele. These regions show associations with gamete generation, meiotic and meiosis cell cycle, and semen quality based on gene ontology analysis. CONCLUSION(S) Gene ontology results suggest that changes in methylation may be associated with the low semen quality phenotype observed in some varicocele patients because the observed differentially methylated regions in varicocele patients are related to male reproductive pathways. Additionally, the varicocele grade may influence the magnitude of global sperm DNA methylation change. To our knowledge, this is the first report analyzing changes at a regional or CpG-specific level in men with varicocele.
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Affiliation(s)
- Viviane Paiva Santana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Emma Rae James
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Cristiana Libardi Miranda-Furtado
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil; Drug Research and Development Center, Postgraduate Program in Medical and Surgical Sciences, Federal University of Ceara, Fortaleza, Brazil
| | - Mateus Felipe de Souza
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | | | - Douglas T Carrell
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Kenneth Ivan Aston
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Timothy Gerald Jenkins
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah; Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
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Rezaei-Agdam H, Moshari S, Nahari E, Minas A, Daliri Z, Hallaj M, Razi M. Zeta and hyaluronic acid assessments, novel sperm selection procedures, in animal model for male infertility. Andrologia 2019; 51:e13447. [PMID: 31617612 DOI: 10.1111/and.13447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/18/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022] Open
Abstract
Considering varicocele (VCL)-induced severe, progressive DNA damage, histone-protamine anomalies and low sperm production, in the current study, the experimental VCL was induced and the efficiency of hyaluronic acid (HA)-binding method (HABM) and zeta preparation procedure (ZPP) in selection of appropriate spermatozoa was compared with those spermatozoa from intact animals. Following 2 and 4 months, the histological alterations in testicular tissue, sperm count and viability were assessed to prove the VCL condition. The spermatozoa were undergone simple wash, HABM and ZPP. The chromatin condensation, active caspase-3 expression, DNA fragmentation and apoptosis index were analysed after applying selection techniques and compared with the spermatozoa from intact and VCL-induced animals, which were undergone a simple wash. Observations showed that both HABM and ZPP effectively prepared the spermatozoa with higher chromatin condensation and lower DNA damage. Meanwhile, the ZPP exerted a more preferable effect by preparing the spermatozoa with higher chromatin condensation, and lower caspase-3 expression, and DNA disintegrity versus the HABM, especially after 4 months. In conclusion, ZPP seems to exert much more reliable efficiency in selecting appropriate spermatozoa for ICSI processes, while more studies are needed to find out which one is more useful in the clinical assisted reproductive technique (ART) process.
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Affiliation(s)
- Hamed Rezaei-Agdam
- Molecular and Genetic Division, Rasta Diagnostic and Research Center, Urmia, Iran
| | - Sana Moshari
- Division of Histology and Embryology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Elaheh Nahari
- Molecular and Genetic Division, Rasta Diagnostic and Research Center, Urmia, Iran
| | - Aram Minas
- Division of Histology and Embryology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Zeynab Daliri
- Department of Biology, Faculty of Sciences, Islamic AZAD University, Science and Research Branch, Tehran, Iran
| | - Mahsa Hallaj
- Division of Histology and Embryology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Mazdak Razi
- Division of Histology and Embryology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
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Santana VP, Miranda-Furtado CL, Pedroso DCC, Eiras MC, Vasconcelos MAC, Ramos ES, Calado RT, Ferriani RA, Esteves SC, dos Reis RM. The relationship among sperm global DNA methylation, telomere length, and DNA fragmentation in varicocele: a cross-sectional study of 20 cases. Syst Biol Reprod Med 2019; 65:95-104. [DOI: 10.1080/19396368.2018.1557762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Viviane Paiva Santana
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Daiana Cristina Chielli Pedroso
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Matheus Credendio Eiras
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Ester Silveira Ramos
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Tocantins Calado
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rui Alberto Ferriani
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Rosana Maria dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels: A Study of 7035 Healthy Young Men from Six European Countries. Eur Urol 2016; 70:1019-1029. [DOI: 10.1016/j.eururo.2016.06.044] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/30/2016] [Indexed: 11/23/2022]
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9
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Spermatogenesis in humans and its affecting factors. Semin Cell Dev Biol 2016; 59:10-26. [PMID: 27143445 DOI: 10.1016/j.semcdb.2016.04.009] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 12/13/2022]
Abstract
Spermatogenesis is an extraordinary complex process. The differentiation of spermatogonia into spermatozoa requires the participation of several cell types, hormones, paracrine factors, genes and epigenetic regulators. Recent researches in animals and humans have furthered our understanding of the male gamete differentiation, and led to clinical tools for the better management of male infertility. There is still much to be learned about this intricate process. In this review, the critical steps of human spermatogenesis are discussed together with its main affecting factors.
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CURRENT STATE OF THE MALE INFERTILITY PROBLEM:THE REVIEW OF EUROPEAN ASSOCIATION OF UROLOGY CLINICAL GUIDELINES. КЛИНИЧЕСКАЯ ПРАКТИКА 2016. [DOI: 10.17816/clinpract7139-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The article highlights the problem of male infertility on the basis of review of the latest guidelines of European Association of urology
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Kwon CS, Lee JH. Is semen analysis necessary for varicocele patients in their early 20s? World J Mens Health 2014; 32:50-5. [PMID: 24872952 PMCID: PMC4026234 DOI: 10.5534/wjmh.2014.32.1.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To determine whether it is necessary to analyze the semen of varicocele patients in their early 20s who are not complaining of infertility. MATERIALS AND METHODS Data was collected retrospectively from 128 men with varicocele with no complaint of infertility, but with complaints of pain/discomfort or a mass/swelling during a 4-year period beginning in January 2009. The varicocele cases were matched 4 : 1 by age to 32 hemospermia controls. RESULTS The median patient age was 22.0 years in the case group and 24.0 years in the control group. The median values of the percentage of normal motility, normal morphology, and density in the case group were 42.5%, 40.0%, and 51.0×10(6)/mL, respectively. The median serum testosterone level was 4.2 ng/mL and 7.0% of the total patients had low serum testosterone levels in the case group. The number of patients with asthenospermia (17.2%), oligospermia (10.9%), and teratospermia (5.5%), and those with at least one abnormal semen parameter (19.5%) was significantly higher in the case group than the control group. The median values of the motility, morphology, and density of the case group were significantly lower than those of the control group. The multivariate analysis showed that patient characteristics (age, presence of pain, duration of symptoms, and grade of varicocele) cannot help to predict abnormal semen parameters (asthenospermia, oligospermia, teratospermia, or cases of at least 1 abnormal semen parameter) or serum testosterone levels <3.0 ng/mL. CONCLUSIONS Semen analysis is required as a screening test for semen abnormalities regardless of the chief complaint in varicocele patients in their early 20s.
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Affiliation(s)
- Choon Sig Kwon
- Department of Economics and Finance, College of Business Administration, Kwandong University, Gangneung, Korea
| | - Jun Ho Lee
- Department of Urology, National Police Hospital, Seoul, Korea
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12
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Baazeem A. Varicocele: How this condition and its management affects men's health. World J Meta-Anal 2014; 2:17-23. [DOI: 10.13105/wjma.v2.i2.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 02/19/2014] [Indexed: 02/05/2023] Open
Abstract
Varicocele is a relatively common condition that can impact men’s health in various ways. Unfortunately, its prevalence and the availability of various different methods of repairing it might lead to unnecessary treatment. An understanding of the various ways that this condition can impact men’s health is necessary in order to manage it appropriately. At present, there is substantial evidence to support varicocele repair in men who present with infertility, abnormal semen parameters, clinical varicocele and a female partner with normal fertility (or one with a potentially correctable abnormality). Varicocele repair appears to improve seminal fluid quality and might improve pregnancy rates. It might also have a role in managing men with non-obstructive azoospermia. Varicocele can also be a cause of scrotal pain that is usually of a dull character. Varicocele repair is an effective method of managing this type of pain, especially once proper measures have been taken to exclude other possible causes of orchalgia. Conservative measures are generally not effective in managing varicocele-related scrotal pain. There is growing evidence to suggest that varicocele repair might have a role in improving the serum testosterone level in men with hypogonadism, especially in the subfertile population. Well-designed prospective studies are needed to support the utilization of varicocele repair in managing these patients, as well as in preventing testicular dysfunction on a prophylactic basis.
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13
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Abstract
Up to 20% of adolescents have a varicocele. Often a varicocele is an incidental finding during a physical examination. However, adolescents with a varicocele might suffer from pain or they may have noticed a difference in the volume of the testes. The diagnostic investigation of the ejaculate in adolescents is difficult because no age-dependent spermiogram standard values exist. Endocrinological tests are also difficult because of the physiological variability of testosterone and gonadotropins during adolescence. The difference in testes volume normalizes in half of the boys without any therapy during maturation. Most adolescents with a varicocele have a normal semen analysis. The sperm parameters are the most important factor for treatment decision making.If sperm concentration, motility, and morphology are normal, active surveillance with regular control examinations are recommended even if the volume of the testis is divergent. Pathologic sperm parameters should lead to an operative treatment. The microsurgical subinguinal technique is the method of choice due to the low complication and reoperation rates. The sperm concentration, morphology, and motility increase postoperatively as well as the volume of the testis. It is not clear whether the improved sperm parameters lead to improved spontaneous pregnancy rates later in life. Whether scrotal pain decreases after operative therapy is uncertain because of the subjectivity of pain.Until now there are only a few studies with small and very heterogeneous case numbers so that no clear recommendation for the treatment of a varicocele in adolescents can be made. The difficulty in the treatment decision-making is preventing reduced fertility, while avoiding overtreatment.
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14
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Mortimer D, Barratt CLR, Björndahl L, de Jager C, Jequier AM, Muller CH. What should it take to describe a substance or product as 'sperm-safe'. Hum Reprod Update 2013; 19 Suppl 1:i1-45. [PMID: 23552271 DOI: 10.1093/humupd/dmt008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Male reproductive potential continues to be adversely affected by many environmental, industrial and pharmaceutical toxins. Pre-emptive testing for reproductive toxicological (side-)effects remains limited, or even non-existent. Many products that come into direct contact with spermatozoa lack adequate testing for the absence of adverse effects, and numerous products that are intended for exposure to spermatozoa have only a general assumption of safety based on the absence of evidence of actual harm. Such assumptions can have unfortunate adverse impacts on at-risk individuals (e.g. couples who are trying to conceive), illustrating a clear need for appropriate up-front testing to establish actual 'sperm safety'. METHODS After compiling a list of general areas within the review's scope, relevant literature and other information was obtained from the authors' personal professional libraries and archives, and supplemented as necessary using PubMed and Google searches. Review by co-authors identified and eliminated errors of omission or bias. RESULTS This review provides an overview of the broad range of substances, materials and products that can affect male fertility, especially through sperm fertilizing ability, along with a discussion of practical methods and bioassays for their evaluation. It is concluded that products can only be claimed to be 'sperm-safe' after performing objective, properly designed experimental studies; extrapolation from supposed predicate products or other assumptions cannot be trusted. CONCLUSIONS We call for adopting the precautionary principle, especially when exposure to a product might affect not only a couple's fertility potential but also the health of resulting offspring and perhaps future generations.
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Affiliation(s)
- David Mortimer
- Oozoa Biomedical Inc., Caulfeild Village, West Vancouver, BC, Canada.
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15
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Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, Krausz C. European Association of Urology guidelines on Male Infertility: the 2012 update. Eur Urol 2012; 62:324-32. [PMID: 22591628 DOI: 10.1016/j.eururo.2012.04.048] [Citation(s) in RCA: 537] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 04/24/2012] [Indexed: 12/11/2022]
Abstract
CONTEXT New data regarding the diagnosis and treatment of male infertility have emerged and led to an update of the European Association of Urology (EAU) guidelines for Male Infertility. OBJECTIVE To review the new EAU guidelines for Male Infertility. EVIDENCE ACQUISITION A comprehensive work-up of the literature obtained from Medline, the Cochrane Central Register of Systematic Reviews, and reference lists in publications and review articles was developed and screened by a group of urologists and andrologists appointed by the EAU Guidelines Committee. Previous recommendations based on the older literature on this subject were taken into account. Levels of evidence and grade of guideline recommendations were added, modified from the Oxford Centre for Evidence-based Medicine Levels of Evidence. EVIDENCE SUMMARY These EAU guidelines are a short comprehensive overview of the updated guidelines of male infertility as recently published by the EAU (http://www.uroweb.org/guidelines/online-guidelines/), and they are also available in the National Guideline Clearinghouse (http://www.guideline.gov/).
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Zini A, Dohle G. Are varicoceles associated with increased deoxyribonucleic acid fragmentation? Fertil Steril 2011; 96:1283-7. [PMID: 22035729 DOI: 10.1016/j.fertnstert.2011.10.016] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To perform a literature search on the association between varicocele and sperm DNA fragmentation. DESIGN Systematic review. PATIENT(S) Men with a varicocele and infertility. INTERVENTION(S) Varicocele repair. MAIN OUTCOME MEASURE(S) Does the presence of a varicocele increase seminal oxidative stress and sperm DNA fragmentation? RESULT(S) In men with a varicocele increased levels of reactive oxygen species and sperm DNA damage can be found. This is probably related to defective spermatogenesis in these patients. Seminal oxidative stress is believed to be the source of sperm DNA damage. Patients with a varicocele and oligospermia may also have a diminished seminal antioxidant capacity. After varicocele repair sperm DNA fragmentation decreases. CONCLUSION(S) Varicocele is associated with sperm DNA damage, and this sperm pathology may be secondary to varicocele-mediated oxidative stress. The beneficial effect of varicocelectomy on sperm DNA damage further supports the premise that varicocele may impair sperm DNA integrity.
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Affiliation(s)
- Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada.
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Dohle GR. Varicocoele repair: the role of the duration of infertility. ACTA ACUST UNITED AC 2011; 34:193-4. [PMID: 21545431 DOI: 10.1111/j.1365-2605.2010.01139.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cho SY, Kim TB, Ku JH, Paick JS, Kim SW. Beneficial effects of microsurgical varicocelectomy on semen parameters in patients who underwent surgery for causes other than infertility. Urology 2011; 77:1107-10. [PMID: 21208647 DOI: 10.1016/j.urology.2010.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/30/2010] [Accepted: 10/13/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate whether clinical varicoceles are associated with abnormal semen parameters and whether varicocelectomy could improve the parameters in patients with causes other than infertility. METHODS A total of 268 adult men with clinical varicocele underwent microsurgical varicocelectomy resulting from causes other than infertility. A retrospective analysis of total sperm count, total motile sperm count, sperm concentration, motility, and morphology were performed. RESULTS Of 268 patients, at least 1 abnormal parameter (concentration, motility, or morphology) was found on preoperative semen analysis in 169 (63.1%) patients for whom 121 postoperative analyses were available. Abnormal sperm concentration was observed in 49 (40.5%) patients, motility in 112 (92.6%) patients, and morphology in 82 (67.8%) patients. Total sperm count, total motile sperm count, sperm concentration, and motility showed statistically significant improvement after microsurgical varicocelectomy, however, sperm morphology did not. Subgroup analysis of patients with oligospermia, asthenospermia, or teratospermia showed significant improvement in all semen parameters after varicocelectomy. The highest improvement rate was observed in sperm concentration of patients with oligospermia when a greater than 20% change in preoperative value was defined as improvement or deterioration in semen parameters. Overall, 92 (76.0%) patients showed improvement in at least 1 semen parameter. CONCLUSIONS The majority of varicocele patients with causes other than infertility had abnormal semen parameters, and most semen parameters showed significant improvement after microsurgical varicocelectomy. Therefore, regardless of the chief complaint, semen analysis should be performed in men with clinical varicocele.
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Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Increased levels of oxidants and reduced antioxidants in semen of infertile men with varicocele. Fertil Steril 2010; 94:1531-1534. [DOI: 10.1016/j.fertnstert.2009.12.039] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/11/2009] [Accepted: 12/14/2009] [Indexed: 11/18/2022]
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Al-Ali BM, Marszalek M, Shamloul R, Pummer K, Trummer H. Clinical Parameters and Semen Analysis in 716 Austrian Patients With Varicocele. Urology 2010; 75:1069-73. [PMID: 20138656 DOI: 10.1016/j.urology.2009.11.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 11/15/2009] [Accepted: 11/21/2009] [Indexed: 11/16/2022]
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Expression of the Fas-ligand gene in ejaculated sperm from adolescents with and without varicocele. J Assist Reprod Genet 2010; 27:103-9. [PMID: 20165911 DOI: 10.1007/s10815-010-9384-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To assess FasL mRNA levels in ejaculated sperm from adolescent patients with and without varicocele. METHODS Semen was obtained by masturbation following 2-4 days of ejaculatory abstinence, from 14 adolescents with varicocele grades II and III (study group), and 20 adolescents without varicocele (control group). Seminal analysis was done according to World Health Organization guidelines and morphology using Kruger's strict criteria. The Fas-ligand (FasL) gene expression was performed using reverse transcription and real-time quantitative polymerase chain reaction (RQ-PCR) analysis, according to the expression level of the housekeeping cyclophilin A gene. A Student's t-test was applied to compare the groups, and Spearman's rank test in order to verify possible correlations (p < 0.05). RESULTS Quantitative RQ-PCR demonstrated that the expression of FasL mRNA in sperm from the varicocele group was higher than in the control group. Also, sperm concentration was higher in the controls, when compared to the varicocele group. When submitted to correlation analysis, adolescents with varicocele presented a correlation between sperm concentration and FasL gene expression levels (r = -0.470), not observed in controls. CONCLUSION Our results allow us to conclude that, in adolescents with varicocele presenting lower sperm concentration, FasL mRNA levels are higher than in adolescents without varicocele.
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Clinical significance of asymptomatic urogenital Mycoplasma hominis and Ureaplasma urealyticum in relation to seminal fluid parameters among infertile Jordanian males. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2010. [DOI: 10.1016/j.mefs.2010.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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