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Du B, Liu B, Fang YK, Zheng JZ, Wu J, Tao FZ, Zhang MY, Zhang TJ. Shugan Tongluo Qiangjing recipe protects against varicocele of EVC rats through modulating sperm DNA damage, telomere expression and oxidative stress. Tissue Cell 2024; 89:102414. [PMID: 38865824 DOI: 10.1016/j.tice.2024.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/06/2024] [Accepted: 05/20/2024] [Indexed: 06/14/2024]
Abstract
Varicocele (VC) refers to expansion and tortuosity of spreading venous plexus in spermatic cord due to poor blood flow. This study aimed to investigate effects of Shugan Tongluo Qiangjing recipe (SGTL) on sperm DNA damage and oxidative stress in experimental VC (EVC) rats. EVC model was established by partial ligation of left renal vein. Spermatic vein diameter, testicular weight, sperm DNA fragmentation index (DFI) were evaluated. Telomere reverse transcriptase (TERT) expression, telomere gene transcription, and testicular tissue morphology were determined·H2O2, catalase, SOD, T-AOC were measured with colorimetry. SGTL significantly decreased spermatic vein diameter (P=0.000) and increased testicular weight (P=0.013) of rats compared those of EVC rats. SGTL maintained testicular tissue morphology in EVC rats. SGTL markedly reduced sperm DFI value in sperm of rats compared to EVC rats (P=0.000). SGTL significantly enhanced TERT expression and telomere gene transcription (P=0.028) in testis of rats compared to EVC rats. SGTL reduced H2O2 levels (P=0.001) and promoted CAT activity (P=0.016), SOD activity (P=0.049), and T-AOC activity (P=0.047) of rats, compared to EVC rats. In conclusion, SGTL could reduce pathogenic process of EVC by reducing sperm DNA damage and regulating telomere length in EVC rats, which may be related to oxidative stress regulation.
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Affiliation(s)
- Baoxin Du
- Department of Gynecology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Bing Liu
- Department of Andrology, Xuzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou, China
| | - Yue-Kun Fang
- Andrology Department, Wenzhou City Hospital of traditional Chinese medicine and Western medicine combined, Wenzhou, China
| | - Jun-Zhuang Zheng
- Andrology Department, Cixi integrated Traditional Chinese and Western Medicine Medical & Health Group, Cixi, China
| | - Jun Wu
- Andrology Department, Ningbo Hospital of Traditional Chinese Medicine, Ningbo, China
| | - Fang-Ze Tao
- Department of Urology Surgery, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Ming-Yang Zhang
- College of Traditional Chinese Medicine of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tai-Jun Zhang
- Department of Nephrology, Chongqing Hospital of Traditional Chinese Medicine, China.
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Mei Y, Ji N, Feng X, Xu R, Xue D. Don't wait any longer, conceive in time: a systematic review and meta-analysis based on semen parameters after varicocelectomy. Int Urol Nephrol 2024:10.1007/s11255-024-04080-y. [PMID: 38761331 DOI: 10.1007/s11255-024-04080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Varicocelectomy was considered to be beneficial to patients with varicocele-related infertility. However, there are only a few researchers who have explored the relationship between better timing and postoperative semen improvement in patients. METHODS We conducted this meta-analysis by enrolling published prospective studies to find out the best waiting time after varicocelectomy to wait for better improvement of semen quality. An extensive search was conducted in PubMed, Web of Science, and Cochrane Library to identify eligible studies. The included studies were then analyzed comprehensively using STATA software and standardized mean differences (SMDs) and their corresponding 95% confidence intervals were calculated. RESULTS Our comprehensive analysis showed that after varicocelectomy, follow-up results within 3 months or longer showed a significant improvement in semen parameters compared to the preoperative period. Notably, no further improvement in semen parameters was observed when the follow-up period reached six months or longer (semen volume: WMD: - 0.07 (- 0.29, 0.16); sperm concentration: WMD: - 1.33 (- 2.33, - 4.99); sperm motility: WMD: 2.31 (- 0.55, 5.18); sperm morphology: WMD: 1.29 (- 0.66, 3.24); sperm total motile count: WMD: 3.95 (- 6.28, 14.19)). CONCLUSIONS Three months after varicocelectomy may be the optimal time for semen parameters compared to six months or even longer, which means it is also the preferable time for conception. However, more well-designed prospective studies are needed in the future to validate our conclusion.
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Affiliation(s)
- Yangyang Mei
- Department of Urology, Jiangyin People's Hospital of Jiangsu Province, Jiangyin, Jiangsu, China
| | - Nuo Ji
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xingliang Feng
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| | - Renfang Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| | - Dong Xue
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
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Erdogan O, Ok F. The effect of systemic inflammatory index and systemic inflammatory response index on success of varicoselectomy. Urologia 2024; 91:170-175. [PMID: 37632401 DOI: 10.1177/03915603231192739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Omer Erdogan
- Urology Department, Kocaeli State Hospital, Kocaeli, Turkey
| | - Fesih Ok
- Urology Department, Siirt Training and Research Hospital, Siirt, Turkey
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Munoz-Lopez C, Wong A, Lewis K, Bole R, Vij SC, Lundy SD. The Evolving Landscape of Male Varicocele Pathophysiology in the Era of Multi-Omics: A Narrative Review of the Current Literature. BIOLOGY 2024; 13:80. [PMID: 38392299 PMCID: PMC10886418 DOI: 10.3390/biology13020080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024]
Abstract
Male-factor infertility is implicated in over half of the millions of cases of infertility worldwide, and varicoceles are the most common correctable cause of male-factor infertility. The pathophysiologic mechanism for varicoceles is complex and next-generation technologies offer promising insights into the molecular underpinnings of this condition. In this narrative review, we highlight historical and contemporary paradigms associated with varicoceles, with an emphasis on the biological underpinnings of this disease. Specifically, we review the literature describing the underlying causes of varicoceles, discuss the molecular and cellular mechanisms causing pathological changes in some (but not all) men, and highlight key articles regarding the next-generation analyses (e.g., transcriptome, epigenome, proteome, and microbiome) being applied to better understand the condition and its treatment. These data demonstrate an ongoing evolution of the knowledge of varicoceles and the potential for improved personalized care in the future for men with this condition.
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Affiliation(s)
- Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
| | - Anne Wong
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
| | - Raevti Bole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sarah C Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Scott D Lundy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Greenberg DR, Hudnall MT, Goyette BN, Fantus RJ, Dubin JM, Brannigan RE, Halpern JA. Predictors of Semen Parameters Decline Following the Microsurgical Varicocelectomy. Cureus 2023; 15:e45061. [PMID: 37829944 PMCID: PMC10567203 DOI: 10.7759/cureus.45061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Objective Varicocele is considered the most common reversible cause of male infertility. However, some men do not clinically improve after surgical repair. We aimed to identify preoperative factors associated with decreased semen parameters and clinical "downgrading" of total motile sperm count (TMSC) following varicocelectomy. Methods We examined men with preoperative laboratory testing and pre- and postoperative semen analyses (SA) who underwent varicocelectomy between 2010 and 2020. Ejaculate volume, sperm motility, sperm concentration, TMSC, and clinical grade of TMSC (in vitro fertilization: <5M sperm, intrauterine insemination: 5-9M sperm, natural pregnancy: >9M sperm) were used to determine postoperative outcomes. Demographic and clinical factors were compared between cohorts. Results Among 101 men who underwent varicocelectomy, 35 (34.7%) had decreased postoperative TMSC with a median follow-up of 6.6 months (interquartile range 3.9-13.6 months). Eleven (10.9%) men experienced TMSC clinical "downgrading" following surgery. Clinical grade III varicocele was significantly associated with decreased sperm motility on postoperative SA (OR 4.1, 95% CI 1.7-10.0, p=0.002), and larger left testicle volume (OR 1.4, 95% CI 1.1-1.8, p=0.02) was associated with clinical "downgrading" after varicocelectomy. Conclusion A small but significant proportion of men experienced a "downgrading" of semen parameters after varicocelectomy. Larger left testis size was associated with clinical downgrading, whereas clinical grade III varicoceles were associated with lower post-treatment sperm motility. These data are critical for preoperative patient counseling.
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Affiliation(s)
- Daniel R Greenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Matthew T Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | | | - Justin M Dubin
- Department of Urology, Memorial Healthcare, Aventura, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Alasmi R. Case report of testicular failure and azoospermia after antegrade embolization of varicocele: A rare complication. Int J Surg Case Rep 2023; 106:108269. [PMID: 37148725 DOI: 10.1016/j.ijscr.2023.108269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Varicocele is a common condition affecting males of reproductive age and accounting for the most frequent cause of secondary infertility in males. PRESENTATION A young male presented with second infertility and bilateral varicoceles and underwent antegrade angioembolization. He developed testicular ischemia and testicular failure with new onset hypogonadism and cryptozoospermia. CONCLUSION Antegrade embolization is a valid option in patients with varicoceles but has its own unique risks of complications.
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Affiliation(s)
- Raed Alasmi
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.
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7
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Pitrone P, Silipigni S, Stagno A, Cinquegrani A, Cattafi A, Bottari A. Retrograde sclerotherapy of male varicocele with veno-venous shunts - incidence and management: a single-centre experience. Br J Radiol 2023; 96:20221061. [PMID: 36745115 PMCID: PMC10161912 DOI: 10.1259/bjr.20221061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of our study is to compare the incidence of veno-venous shunts in male varicocele and evaluate the possibility to exclude them with manual compression or/and scrotal ligation in order to carry out the procedure of retrograde sclero-embolization. METHODS In our retrospective study, all patients undergone retrograde sclerotherapy for varicocele in our Interventional Radiology Unit in the last four years were evaluated. Collaterals toward other venous shunts were identified and how many and which patients would be able to complete the procedure safely were considered. RESULTS Of the 91 patients, as many as 22 (i.e., 24.17%) patients presented anatomical variants, consisting on shunting into left iliac vein (9 [9.89%]), lumbar left veins (3 [3.29%]), right iliac vein (1 [1.09%]), both iliac veins (1 [1.09%]), left femoral vein (1 [1.09%]) or a more proximal portion of the ISV itself without shunting (3 [3.29%]). Patients with duplication could benefit from a more distal injection in order to prevent back-flow; of the 19 left, nine successfully underwent sclerotherapy with manual compression or/and scrotal ligation, whereas in 10 flow through the collaterals could not be interrupted and patients were demanded for surgery. CONCLUSIONS Many patients with abnormal communications between the internal spermatic vein and the iliac veins (that is, shunts towards the iliac veins) may as well undergo retrograde sclerotherapy safely if compression/ligation is applied. ADVANCES IN KNOWLEDGE No large previous study highlighted the impact of veno-venous shunts in technical feasibility of retrograde sclerotherapy of varicocele.
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Affiliation(s)
- Pietro Pitrone
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Salvatore Silipigni
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Alberto Stagno
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Antonella Cinquegrani
- Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
| | - Antonino Cattafi
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy
| | - Antonino Bottari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, Section of Radiological Sciences, University of Messina, Messina, Italy.,Department of Imaging, Interventional Radiology Unit, University Hospital "G. Martino", Messina, Italy
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Cao W, Han H, Guan X, Lyu C, Zhou Q, Tian L, Guo R. Elastography and contrast-enhanced ultrasound to assess the effect of varicocelectomy: A case-controlled study. Andrologia 2022; 54:e14586. [PMID: 36217608 DOI: 10.1111/and.14586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/25/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022] Open
Abstract
To evaluate the changes in testicular stiffness and microcirculation caused by spermatic vein ligation in patients with varicocele, we conducted a case-controlled study. A total of 27 grade III left varicocele cases were enrolled. Testicular stiffness and perfusion were evaluated by shear wave elastography and contrast-enhanced ultrasound during subinguinal microscopic varicocelectomy. The external and the internal parenchyma of bilateral testes were selected to compare the shear wave velocity of bilateral testes during the spermatic vein ligation. We mapped and compared the intensity-time curves following bolus contrast injection three times in the same region of interest. Initially, the shear wave velocity of the left internal parenchyma was higher than the right side (1.10 ± 0.06 m/s vs. 1.00 ± 0.03 m/s). It decreased (1.09 ± 0.06 m/s) (p < 0.05) after ligation. Meanwhile, the left epididymis had the higher agent peak intensity (0.90 × 10E-5 AU), the largest area under the curve (80.20 × 10E-5 AU s), and the longest washout area (54.35 × 10E-5 AU s). In addition, the left internal parenchyma presented a sharper slope (0.18 × 10E-5 AU/s) (p < 0.05). In conclusion, the spermatic vein ligation improved the perfusion of the internal testicular parenchyma, but it could temporally deteriorate the stasis of the epididymis. These changes caused softer testicular parenchyma.
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Affiliation(s)
- Wen Cao
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hu Han
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xing Guan
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chaoyang Lyu
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qian Zhou
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Long Tian
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ruijun Guo
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Chakraborty S, Roychoudhury S. Pathological Roles of Reactive Oxygen Species in Male Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1358:41-62. [PMID: 35641865 DOI: 10.1007/978-3-030-89340-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reactive oxygen species (ROS) are free radicals that have at least one unpaired electron and play specific roles in the human body. An imbalance of ROS and antioxidant levels gives rise to a condition called oxidative stress. High levels of ROS in the male reproductive tract can interfere with its normal functioning and can even pose as toxic to the sperm, inhibiting sperm functioning (including motility) and metabolism. Oxidative stress resulting from ROS and lipid peroxidation is one of the major causes of male infertility including infertility in varicocele patients. These may cause DNA and peroxidative damage and apoptosis. Production of ROS in excess also leads to erectile dysfunction (ED). In recent years, studies have also linked oxidative stress with the development, progress, and therapy response of prostate cancer patients. The present study summarizes the pathological roles of ROS in male reproductive problems such as infertility, ED, and prostate cancer and also provide an insight into the probable mechanism through which ROS exert their pathological impact.
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Zhang S, Li H, Du J, Xv L, Li F, Jiang L. Is it important to measure the internal spermatic vein diameter after varicocelectomy? A self‐controlled trial. Andrologia 2022; 54:e14484. [PMID: 35624551 DOI: 10.1111/and.14484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shijun Zhang
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Hongli Li
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Jing Du
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Li Xv
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Fenghua Li
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Lixin Jiang
- Department of Ultrasound, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
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Kandevani NY, Namdari F, Hamidi M, Dialameh H, Behzadi A. Developing a novel prediction model for the impact of varicocelectomy on postoperative fertility. Eur J Transl Myol 2022; 32. [PMID: 35502854 PMCID: PMC9295180 DOI: 10.4081/ejtm.2022.10411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to evaluate inflammatory markers as predictors of fertility after varicocelectomy and to develop a prediction model. This prospective cohort was conducted on patients with varicoceles who were presented to the clinic of Imam Reza hospital of Tehran during 2019-2020. Semen analysis, complete blood count (CBC), and scrotal ultrasonography was requested. Patients with abnormalities of semen analysis were chosen as candidates for varicocelectomy. 6 months after the operation, semen analysis was repeated. Hematologic and semen analysis parameters were recorded at baseline and follow-up visits. Treatment success was defined as 50% increase in total motile sperm count (TMSC) in cases with preoperative TMSC> 5 million/cc or 100% increase in TMSC in cases with preoperative TMSC< 5 million/cc. Patients were then categorized into two groups based on treatment success and statistical analysis was performed on these two groups. 124 infertile patients with varicocele were evaluated in our study. 52 patients (41.93%) showed improvements in semen analysis after varicocelectomy. After univariate and multivariate analysis three parameters were used in our predictive model as body mass index (BMI)>23.70 kg/m2 (4 scores), neutrophil-lymphocyte ratio (NLR) >1.80 (3 scores), and TMSC<14.69 million (2 scores). A cut-off value of 5 was associated with an 87.5% sensitivity and an 84.6% specificity for the prediction of failure of varicocelectomy. Varicocelectomy can improve semen analysis parameters in almost all infertile men with varicocele. Using BMI, NLR, and baseline TMSC as the suggested scoring system can predict the success of varicocelectomy for improving fertility and determine the appropriate infertile candidates for surgery.
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12
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Li M, Li J, Zhang C, Hou S, Weng B. MIR210HG is aberrantly expressed in the seminal plasma of varicocele patients and associated with varicocele-related dyszoospermia. Andrologia 2022; 54:e14277. [PMID: 35146790 DOI: 10.1111/and.14277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 02/06/2023] Open
Abstract
This study aimed to confirm the expression of the seminal plasma long noncoding RNAs (lncRNAs) microRNA210 host gene (MIR210HG) in varicocele (VC) patients, to further explore the association between MIR210HG and VC severity and to evaluate whether MIR210HG can predict VC-related dyszoospermia. Semen samples from 188 VC patients and 92 healthy men were collected. Quantitative reverse transcriptase PCR detected seminal plasma MIR210HG levels. Receiver operating characteristic analysis assessed the ability of MIR210HG to screen patients with VC, or to screen VC patients with abnormal semen quality. Logistic analysis assessed the value of MIR210HG in predicting dyszoospermia in VC patients. The levels of MIR210HG in seminal plasma of VC patients were upregulated, which could screen VC patients. In addition, the levels of seminal plasma MIR210HG were upregulated with VC severity and were downregulated at 6 months after surgery in VC patients. Moreover, elevated MIR210HG levels in VC patients with abnormal semen quality could screen patients with abnormal semen quality and could independently predict the occurrence of dyszoospermia in VC patients. Seminal plasma MIR210HG expression is upregulated in VC patients, is associated with the severity of VC and may function as an independent predictor of VC-related dyszoospermia.
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Affiliation(s)
- Monong Li
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Jinli Li
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Changcun Zhang
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Sichuan Hou
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Bowen Weng
- Urology Surgery, Qingdao Municipal Hospital, Qingdao, China
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13
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Reactive Oxygen Species in the Reproductive System: Sources and Physiological Roles. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1358:9-40. [DOI: 10.1007/978-3-030-89340-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Rajak P, Roy S, Dutta M, Podder S, Sarkar S, Ganguly A, Mandi M, Khatun S. Understanding the cross-talk between mediators of infertility and COVID-19. Reprod Biol 2021; 21:100559. [PMID: 34547545 PMCID: PMC8407955 DOI: 10.1016/j.repbio.2021.100559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 12/13/2022]
Abstract
COVID-19 is the ongoing health emergency affecting individuals of all ages around the globe. Initially, the infection was reported to affect pulmonary structures. However, recent studies have delineated the impacts of COVID-19 on the reproductive system of both men and women. Hence, the present review aims to shed light on the distribution of SARS-CoV-2 entry factors in various reproductive organs. In addition, impacts of COVID-19 mediators like disrupted renin angiotensin system, oxidative stress, cytokine storm, fever, and the mental stress on reproductive physiology have also been discussed. For the present study, various keywords were used to search literature on PubMed, ScienceDirect, and Google Scholar databases. Articles were screened for relevancy and were studied in detail for qualitative synthesis of the review. Through our literature review, we found a multitude of effects of COVID-19 mediators on reproductive systems. Studies reported expression of receptors like ACE-2, TMPRSS2, and CD147 in the testes, epididymis, prostrate, seminal vesicles, and ovarian follicles. These proteins are known to serve as major SARS-CoV-2 entry factors. The expression of lysosomal cathepsins (CTSB/CTSL) and/ neuropilin-1 (NRP-1) are also evident in the testes, epididymis, seminal vesicles, fallopian tube, cervix, and endometrium. The binding of viral spike protein with ACE-2 was found to alter the renin-angiotensin cascade, which could invite additional infertility problems. Furthermore, COVID-19 mediated cytokine storm, oxidative stress, and elevated body temperature could be detrimental to gametogenesis, steroidogenesis, and reproductive cycles in patients. Finally, social isolation, confinement, and job insecurities have fueled mental stress and frustration that might promote glucocorticoid-mediated subnormal sperm quality in men and higher risk of miscarriage in women. Hence, the influence of COVID-19 on the alteration of reproductive health and fertility is quite apparent.
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Affiliation(s)
- Prem Rajak
- Department of Animal Science, Kazi Nazrul University, Asansol, West Bengal, India.
| | - Sumedha Roy
- Department of Biomolecular Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Moumita Dutta
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Sayanti Podder
- Post Graduate Department of Zoology, Modern College of Arts, Science and Commerce, Ganeshkhind, Pune, Maharashtra, India
| | - Saurabh Sarkar
- Department of Zoology, Gushkara Mahavidyalaya, Gushkara, Purba Bardhaman, West Bengal, India
| | - Abhratanu Ganguly
- Post Graduate Department of Zoology, A.B.N. Seal College, Cooch Behar, West Bengal, India
| | - Moutushi Mandi
- Toxicology Research Unit, Department of Zoology, The University of Burdwan, Purba Bardhaman, West Bengal, India
| | - Salma Khatun
- Department of Zoology, Krishna Chandra College, Hetampur, West Bengal, India
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15
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Chereshnev VA, Pichugova SV, Beikin YB, Chereshneva MV, Iukhta AI, Stroev YI, Churilov LP. Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine, and Endocrine Dysregulation. PATHOPHYSIOLOGY 2021; 28:471-488. [PMID: 35366245 PMCID: PMC8830464 DOI: 10.3390/pathophysiology28040030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
According to global data, there is a male reproductive potential decrease. Pathogenesis of male infertility is often associated with autoimmunity towards sperm antigens essential for fertilization. Antisperm autoantibodies (ASAs) have immobilizing and cytotoxic properties, impairing spermatogenesis, causing sperm agglutination, altering spermatozoa motility and acrosomal reaction, and thus preventing ovum fertilization. Infertility diagnosis requires a mandatory check for the ASAs. The concept of the blood–testis barrier is currently re-formulated, with an emphasis on informational paracrine and juxtacrine effects, rather than simple anatomical separation. The etiology of male infertility includes both autoimmune and non-autoimmune diseases but equally develops through autoimmune links of pathogenesis. Varicocele commonly leads to infertility due to testicular ischemic damage, venous stasis, local hyperthermia, and hypoandrogenism. However, varicocelectomy can alter the blood–testis barrier, facilitating ASAs production as well. There are contradictory data on the role of ASAs in the pathogenesis of varicocele-related infertility. Infection and inflammation both promote ASAs production due to “danger concept” mechanisms and because of antigen mimicry. Systemic pro-autoimmune influences like hyperprolactinemia, hypoandrogenism, and hypothyroidism also facilitate ASAs production. The diagnostic value of various ASAs has not yet been clearly attributed, and their cut-levels have not been determined in sera nor in ejaculate. The assessment of the autoimmunity role in the pathogenesis of male infertility is ambiguous, so the purpose of this review is to show the effects of ASAs on the pathogenesis of male infertility.
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Affiliation(s)
- Valeriy A. Chereshnev
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
| | - Svetlana V. Pichugova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
- State Autonomous Healthcare Institution of the Sverdlovsk Region “Clinical and Diagnostic Center” (GAUZ SO “CDC” Clinical Diagnostic Center), 620144 Yekaterinburg, Russia;
| | - Yakov B. Beikin
- State Autonomous Healthcare Institution of the Sverdlovsk Region “Clinical and Diagnostic Center” (GAUZ SO “CDC” Clinical Diagnostic Center), 620144 Yekaterinburg, Russia;
| | - Margarita V. Chereshneva
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia; (V.A.C.); (S.V.P.); (M.V.C.)
| | - Angelina I. Iukhta
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
- Correspondence:
| | - Yuri I. Stroev
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
| | - Leonid P. Churilov
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199304 Saint Petersburg, Russia; (Y.I.S.); (L.P.C.)
- Saint Petersburg Research Institute of Phthisiopulmonology, 191036 Saint Petersburg, Russia
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16
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Addar AM, Nazer A, Almardawi A, Al Hathal N, Kattan S. The yield of microscopic varicocelectomy in men with severe oligospermia. Urol Ann 2021; 13:268-271. [PMID: 34421263 PMCID: PMC8343284 DOI: 10.4103/ua.ua_53_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/05/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: Varicocele is detected in 35%–50% of men with primary infertility and up to 81% with secondary infertility. Various studies have shown that varicocele is related to testicular hypotrophy and impaired spermatogenesis. The effect of varicocelectomy in mild-to-moderate male factor infertility has been well reported. However, only a few studies addressed the impact of varicocelectomy in severe oligospermia. Methods: We included 45 patients with severe oligospermia (<5 million/mL) who underwent microsurgical varicocelectomy between May 2014 and November 2017. Results of semen analysis taken at 6 months after varicocelectomy were compared and patients were divided into responders and nonresponders. Chi-square was used to compare the preoperative and postoperative sperm count, motility, and volume. Results: After 6 months only one patient was found to be a responder with a pre- to post-operative motility of 45%–74% and a sperm concentration of 1 million/mL to 28.1 million/mL. There was a significant improvement in the mean sperm concentration after varicocelectomy which improved from 1.31 million/mL to 5.32 million/mL. However, a significant decrease in sperm motility was noted which decreased from 35.62% to 28.64% postoperatively. Postoperative semen volume increased from 2.56 mL to 3.19 mL, but this difference was not found to be statistically significant (P > 0.05). Four patients (8.9%) were found to have azoospermia after a 6-month follow-up. In these four patients who turned azoospermic had count <50,000 sperm/mL, two of them had a history of cryptospermia before varicocelectomy. Ejaculate sperm returned in two of these four patients in long-term follow-up (>6 months). Conclusion: The magnitude of improvement after microsurgical varicocelectomy for severely oligospermic patients is less profound than reported in mild male factor infertility.
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Affiliation(s)
- Abdulmalik M Addar
- Division of Urology, College of Medicine, King Abdullah Internationl Medical Reasearch Center, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Nazer
- Division of Urology, College of Medicine, King Abdullah Internationl Medical Reasearch Center, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Naif Al Hathal
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Said Kattan
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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17
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Watcho P, Tchatat BYP, Deeh PBD, Fozin GRB, Wankeu-Nya M. Dracaena arborea improves sperm characteristics and antioxidant enzymes in adult male rats with experimental varicocele. JBRA Assist Reprod 2021; 25:329-336. [PMID: 33667053 PMCID: PMC8312300 DOI: 10.5935/1518-0557.20200098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: We evaluated the preventive effects of aqueous and ethanolic extracts of Dracaena arborea on sperm characteristics and oxidative stress markers in adult male rats with varicocele. Methods: Thirty-six male Wistar rats were randomly distributed into 6 groups (6 animals/group) and treated for 30 days as follows: (1), normal rats receiving distilled water (10 ml/kg); (2), sham operated rats receiving distilled water (10 ml/kg); (3), varicocele rats receiving distilled water (10 ml/kg); (4), varicocele rats receiving vitamin E (150 mg/kg); (5-6), varicocele rats administered respectively with aqueous (500 mg/kg) and ethanolic (100 mg/kg) extracts of D. arborea. All rats (except normal and sham-operated groups) underwent varicocele induction. At the end of the treatment period, sexual organ weights, oxidative stress, sperm characteristics and some biochemical parameters were measured. Results: A significant decrease (p<0.01) in sperm density (137.81±7.76 vs. 175.83±4.86), sperm motility (55.43±4.49 vs. 77.96± 3.15) and sperm normality (44.75±2.80 vs. 79.25±1.84) was noticed in varicocele-untreated rats compared with controls. Varicocele also induced oxidative stress by decreasing superoxide dismutase (SOD) and catalase activities, and increasing malondialdehyde (MDA) levels. These alterations were prevented by D. arborea. For instance, the aqueous extract of D. arborea (500 mg/kg) significantly increased (p<0.05-0.001) testes and epididymis weights, sperm viability and sperm motility, while the ethanolic extract (100 mg/kg) increased sperm normality compared with varicocele-untreated rats. D. arborea extracts also decreased MDA levels, but elevated catalase activity. Conclusions: Dracaena arborea prevents the deleterious effects of varicocele and could be considered as an alternative treatment of this physiopathology.
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Affiliation(s)
- Pierre Watcho
- Animal Physiology and Phytopharmacology Laboratory, University of Dschang, Box 67 Dschang, Cameroon
| | | | - Patrick Brice Defo Deeh
- Animal Physiology and Phytopharmacology Laboratory, University of Dschang, Box 67 Dschang, Cameroon
| | | | - Modeste Wankeu-Nya
- Department of Animal Organisms Biology, University of Douala, P.O. BOX, 24157, Douala, Cameroon
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18
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Erdogan O, Ok F, Carkci S. What is the role of pre-operative blood parameters in forecasting varicocelectomy success? Andrology 2021; 9:916-921. [PMID: 33475240 DOI: 10.1111/andr.12976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/10/2020] [Accepted: 01/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We aimed to examine the effects of pre-operative blood values on varicocelectomy success. MATERIALS AND METHODS A total of 130 patients who underwent varicocelectomy in our clinic were retrospectively analyzed. Operation success was defined as the return of all semen parameters (concentration, progressive motility, and morphology) to normal values 6 months after surgery. The patients were separated as two groups as benefiting from the treatment (Group A) and not (Group B). RESULTS The best cut-off value for the neutrophil/lymphocyte ratio (NLR), which can predict varicocelectomy success, was assigned to be 2.27, with AUC of 0.859 (%95 CI 0.795-0.922). The highest sensitivity and specificity were 0.857 and 0.731 (p < 0.001). The best cut-off value for the mean platelet volüme (MPV) value, which can predict varicocelectomy success, was assigned to be 9.45, with AUC of 0.729 (%95 CI 0.639-0.819). The highest sensitivity and specificity were 0.655 and 0.635 (p < 0.001). Binary logistic regression analysis showed NLR ratio (odds ratio (OR): 11.2, p < 0.001) and MPV (OR: 2.65, p = 0.002) parameters as independent predictive factors in predicting varicocelectomy success. DISCUSSION AND CONCLUSION Our study showed that low NLR ratio (≤2.27) and high MPV (≥9.45) ratio levels may be a useful pre-operative predictive tool in identifying men who benefit most from varicocelectomy in infertile patients with varicocoele.
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Affiliation(s)
- Omer Erdogan
- Siirt Training and Research Hospital, Siirt, Turkey
| | - Fesih Ok
- Siirt Training and Research Hospital, Siirt, Turkey
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19
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Sharma A, Minhas S, Dhillo WS, Jayasena CN. Male infertility due to testicular disorders. J Clin Endocrinol Metab 2021; 106:e442-e459. [PMID: 33295608 PMCID: PMC7823320 DOI: 10.1210/clinem/dgaa781] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Male infertility is defined as the inability to conceive following 1 year of regular unprotected intercourse. It is the causative factor in 50% of couples and a leading indication for assisted reproductive techniques (ART). Testicular failure is the most common cause of male infertility, yet the least studied to date. EVIDENCE ACQUISITION The review is an evidence-based summary of male infertility due to testicular failure with a focus on etiology, clinical assessment, and current management approaches. PubMed-searched articles and relevant clinical guidelines were reviewed in detail. EVIDENCE SYNTHESIS/RESULTS Spermatogenesis is under multiple levels of regulation and novel molecular diagnostic tests of sperm function (reactive oxidative species and DNA fragmentation) have since been developed, and albeit currently remain as research tools. Several genetic, environmental, and lifestyle factors provoking testicular failure have been elucidated during the last decade; nevertheless, 40% of cases are idiopathic, with novel monogenic genes linked in the etiopathogenesis. Microsurgical testicular sperm extraction (micro-TESE) and hormonal stimulation with gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors are recently developed therapeutic approaches for men with the most severe form of testicular failure, nonobstructive azoospermia. However, high-quality clinical trials data is currently lacking. CONCLUSIONS Male infertility due to testicular failure has traditionally been viewed as unmodifiable. In the absence of effective pharmacological therapies, delivery of lifestyle advice is a potentially important treatment option. Future research efforts are needed to determine unidentified factors causative in "idiopathic" male infertility and long-term follow-up studies of babies conceived through ART.
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Affiliation(s)
- Aditi Sharma
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, London, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Channa N Jayasena
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
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20
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Razi M, Tavalaee M, Sarrafzadeh-Rezaei F, Moazamian A, Gharagozloo P, Drevet JR, Nasr-Eshafani MH. Varicocoele and oxidative stress: New perspectives from animal and human studies. Andrology 2020; 9:546-558. [PMID: 33145958 DOI: 10.1111/andr.12940] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Varicocoele (VCL), one of the main causes of male subfertility, negatively affects testicular function. Due to limited access to human testicular tissue, animal model studies have been used to evaluate molecular and, recently, epigenetic changes attributed to pathophysiology induced by VCL. OBJECTIVES This review aims to provide an update on the latest findings regarding the link between VCL-induced biochemical stress and molecular changes in germ cells and spermatozoa. Endocrine and antioxidant status, testicular chaperone-specific hemostasis failure, altered testicular ion balance, metabolic disorders, and altered carbon cycling during spermatogenesis are among the many features that will be presented. DISCUSSION Literature review coupled with our own findings suggests that ionic imbalance, hypoxia, hyperthermia, and altered blood flow could lead to severe chronic oxidative and nitrosative stress in patients with VCL leading to defective spermatogenesis and impairment of the integrity of all sperm cell components and compartments down to the epigenetic information they carry. CONCLUSION Since oxidative stress is an important feature of the reproductive pathology of VCL, therapeutic strategies such as the administration of appropriate antioxidants could be undertaken as a complementary non-invasive treatment line.
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Affiliation(s)
- Mazdak Razi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Marziyeh Tavalaee
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Farshid Sarrafzadeh-Rezaei
- Department of Surgery and Diagnostic Imaging, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | | | | | - Joël R Drevet
- Faculty of Medicine, GReD Institute, INSERM U1103, CNRS UMR6293, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Mohammad-Hossein Nasr-Eshafani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
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21
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Wang Q, Liu Y, Wang L. Open, Laparoscopic, and Microsurgical Varicocelectomy for Male Infertility: a Systematic Review and Meta-analysis. Indian J Surg 2020. [DOI: 10.1007/s12262-019-02011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations. J Ultrasound 2020; 23:487-507. [PMID: 32720266 PMCID: PMC7588576 DOI: 10.1007/s40477-020-00509-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/11/2020] [Indexed: 02/02/2023] Open
Abstract
Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.
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Li X, Yang X, Wang X, Wang L, Liu J, Cai F, Wang Y, Lu S. Comparison of outcomes in intrauterine insemination, in vitro fertilisation and intracytoplasmic sperm injection in men with and without varicocele. Int J Med Sci 2020; 17:2155-2162. [PMID: 32922176 PMCID: PMC7484661 DOI: 10.7150/ijms.48005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/16/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: To investigate the differences in clinical pregnancy, miscarriage, and live birth rates when male partners were diagnosed with a varicocele and to compare these outcomes to those without and study the outcomes based on the grade of varicocele. Methods: The retrospective study was based on a cohort of consecutive infertile couples undergoing assisted reproductive technology (ART) at the Reproductive Center of Shandong Provincial Hospital affiliated to the Shandong University during the period between January 2017 and December 2018. A total of 4203 couples comprised of men with and without varicocele undergoing the first ART cycle (1501 intrauterine inseminations (IUI), 1623 in vitro fertilisations (IVF) and 1079 intracytoplasmic sperm injections (ICSI)) were included. Semen parameters and ART outcomes were determined. Results: ICSI (26.5%) originated from men with a significant lower level in sperm concentration and motility but with a strict normal morphology had a higher prevalence of varicocele than men undergoing IUI (20.7%) and IVF (18.1%). In IUI, the odds ratios (ORs) for pregnancy and live birth were significantly lower for couples in men diagnosed with grades 1 or 2 varicocele as compared to those for men with grade 3 varicocele. In IVF, ORs for live birth where men were diagnosed with grades 1 or 2 varicocele were also lower than those for men with grade 3,whereas a higher miscarriage rate was found when men had grades 1 or 2 varicocele than when men had grade 3. However, for ICSI, no significant outcomes were found in grades 1, 2 or 3 varicocele versus the no varicocele group. Conclusions: The increasing grade of varicocele was negatively associated with sperm parameters and can alter the outcome of further IUI/IVF.
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Affiliation(s)
- Xiao Li
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, Shandong 250021, P.R. China
| | - Xiaoli Yang
- The Medical Scientific Research Center of Guangxi Medical University, Nanning, 530000, P.R. China
| | - Xianlong Wang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, Shandong 250021, P.R. China
| | - Li Wang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, Shandong 250021, P.R. China
| | - Jiaolong Liu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, Shandong 250021, P.R. China
| | - Feifei Cai
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, Shandong 250021, P.R. China
| | - Yaqing Wang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, Shandong 250021, P.R. China
| | - Shaoming Lu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, Shandong 250021, P.R. China
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24
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Elbardisi H, El Ansari W, Majzoub A, Arafa M. Does varicocelectomy improve semen in men with azoospermia and clinically palpable varicocele? Andrologia 2019; 52:e13486. [PMID: 31825116 DOI: 10.1111/and.13486] [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: 09/25/2019] [Revised: 10/26/2019] [Accepted: 10/31/2019] [Indexed: 01/12/2023] Open
Abstract
The effectiveness of varicocelectomy in nonobstructive azoospermia is controversial. The current study assessed the efficacy of microsurgical subinguinal varicocelectomy in nonobstructive azoospermic men with palpable varicocele and to evaluate predictive parameters of outcome. We reviewed the records of 723 patients who had microsurgical varicocelectomy and diagnostic testicular biopsy between 2012 and 2016 at a tertiary medical centre. Data pertaining to the physical, laboratory (semen analysis and hormonal profile) and histopathology features were examined, exploring the predictors of improvement in semen analysis post-varicocelectomy. In total, 42 patients with mean age 35.71 ± 6.35 years were included. After a mean varicocelectomy follow-up of 6.7 months, motile spermatozoa in the ejaculate could be observed in 11 patients (26.2). Out of all the factors examined, only testicular histopathology significantly predicted post-varicocelectomy outcome, where 8/11 patients exhibited hypospermatogenesis, and 3/11 Sertoli cell-only regained spermatozoa in semen. Microsurgical varicocelectomy in nonobstructive azoospermic men with clinically palpable varicocele can result in sperm appearance in the ejaculate with the highest success expected in hypospermatogenesis.
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Affiliation(s)
- Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,School of Health and Education, University of Skövde, Skövde, Sweden
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamad Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Andrology, Cairo University, Cairo, Egypt
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25
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Karna KK, Choi BR, You JH, Shin YS, Cui WS, Lee SW, Kim JH, Kim CY, Kim HK, Park JK. The ameliorative effect of monotropein, astragalin, and spiraeoside on oxidative stress, endoplasmic reticulum stress, and mitochondrial signaling pathway in varicocelized rats. Altern Ther Health Med 2019; 19:333. [PMID: 31771569 PMCID: PMC6880392 DOI: 10.1186/s12906-019-2736-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
Background Monotropein, astragalin, and spiraeoside (MAS) are active compounds extracted from medicinal herbs; monotropein from Morinda officinalis How (Rubiaceae), astragalin (kaempferol 3-O-glucoside) from Cuscuta chinensis Lamark (Convolvulaceae) and spiraeoside from the outer scales of Allium cepa L. (Liliceae) in a ratio of 6.69:0.41:3.61. Monotropein, astragalin, and spiraeoside are well-known antioxidants, anti-inflammatory, and antinociceptive agents. The current investigation aims to study the molecular mechanism of varicocele-induced male infertility and the underlying pharmacological mechanisms of MAS. Methods Four groups were included: control (CTR), MAS 200 group (MAS 200 mg/kg), varicocele group (VC), and VC + MAS 200 group (MAS 200 mg/kg). Sprague-Dawley (SD) rats were treated with 200 mg/kg MAS or vehicle once daily for 28 days. The possible signaling mechanism and effects of MAS were measured via histological staining, immunohistochemistry, western blot, and biochemical assays. Results Parameters such as sperm motility and count, Johnsen’s scores, spermatogenic cell density, serum testosterone, testicular superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx) and expression of the steroidogenic acute regulatory protein (StAR) improved significantly in the VC + MAS 200 group compared with the VC group. MAS treatment of varicocele-induced group significantly decreased the levels of serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH), as well as testicular interleukin-6 (IL6), tumor necrosis factor-α (TNF-α), ROS/RNS, and malondialdehyde (MDA). It also decreased the apoptotic index and reduced the expression of endoplasmic reticulum (ER) protein levels (Grp78, p-IRE1α, and p-JNK) and apoptotic markers such as cleaved caspase-3 and Bax/Bcl2 ratio. Conclusion This study suggests that the crosstalk between oxidative stress, ER stress, and mitochondrial pathway mediates varicocele-induced testicular germ cell apoptosis. MAS promotes spermatogenesis in varicocele-induced SD rat, probably by decreasing cytokines (IL-6, TNF-α) levels, regulating abnormal sex hormones, and decreasing oxidative stress, ER stress, and apoptosis.
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Karna KK, Choi BR, Kim MJ, Kim HK, Park JK. The Effect of Schisandra chinensis Baillon on Cross-Talk between Oxidative Stress, Endoplasmic Reticulum Stress, and Mitochondrial Signaling Pathway in Testes of Varicocele-Induced SD Rat. Int J Mol Sci 2019; 20:ijms20225785. [PMID: 31744253 PMCID: PMC6888522 DOI: 10.3390/ijms20225785] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/07/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022] Open
Abstract
Schisandra chinensis Baillon (SC) has been utilized for its antioxidants and anti-inflammatory activities in a broad variety of medical applications. However; SC uses for improving fertility in males and related disorders with proper scientific validation remain obscure. The present study aimed to investigate the effects of SC on varicocele (VC)-induced testicular dysfunction and the potential molecular mechanism associated with VC-induced germ cell apoptosis. The male Sprague–Dawley rats were equally divided into four groups consisting of 10 rats in a normal control group (CTR), a control group administered SC 200 mg/kg (SC 200), a varicocele-induced control group (VC), and a varicocele-induced group administered SC 200 mg/kg (VC + SC 200). Rats were administrated 200 mg/kg SC once daily for 28 days after induction of varicocele rats and sham controls. At the end of the treatment period, body and reproductive organ weight, sperm parameters, histopathological damages, proinflammatory cytokines, apoptosis markers, biomarkers of oxidative stress, endoplasmic reticulum (ER) stress, and steroidogenic acute regulatory protein (StAR) were evaluated. The effects of SC extract on human sperm motility were also analyzed. SC treatment reduces VC-induced testicular dysfunction by significantly increasing testicular weight, sperm count and sperm motility, serum testosterone level, Johnsen score, spermatogenic cell density, testicular superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase level, and steroidogenic acute regulatory protein (StAR) level. Furthermore, the effects of SC on malondialdehyde (MDA) level, reactive oxygen species (ROS)/reactive nitrogen species (RNS) level, apoptotic index, serum luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, Glucose-regulated protein-78 (Grp 78), phosphorylated c-Jun-N-terminal kinase (p-JNK), phosphorylated inositol-requiring transmembrane kinase/endoribonuclease 1α (p-IRE1α), cleaved caspase 3, and Bax:Bcl2 in VC-induced rats were significantly decreased. Treatment with SC extracts also increased sperm motility in human sperm. Our findings suggest that the SC ameliorate testicular dysfunction in VC-induced rats via crosstalk between oxidative stress, ER stress, and mitochondrial-mediated testicular germ cell apoptosis signaling pathways. SC promotes spermatogenesis by upregulating abnormal sex hormones and decreasing proinflammatory cytokines (interleukin-6; TNF-α).
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Affiliation(s)
- Keshab Kumar Karna
- Department of Urology, Institute for Medical Sciences, Chonbuk National University Medical School-Biomedical Research Institute and Clinical Trial Center of Medical Device, Chonbuk National University Hospital, Jeonju 54907, Korea;
| | - Bo Ram Choi
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 135-896, Korea;
| | - Min-Ji Kim
- College of Pharmacy, Kyungsung University, Busan 48434, Korea;
| | - Hye Kyung Kim
- College of Pharmacy, Kyungsung University, Busan 48434, Korea;
- Correspondence: (H.K.K.); (J.K.P.); Tel.: +82-51-663-4883 (H.K.K.); +82-63-250-1510 (J.K.P.); Fax: +82-51-663-4809 (H.K.K.); +82-63-250-1564 (J.K.P.)
| | - Jong Kwan Park
- Department of Urology, Institute for Medical Sciences, Chonbuk National University Medical School-Biomedical Research Institute and Clinical Trial Center of Medical Device, Chonbuk National University Hospital, Jeonju 54907, Korea;
- Correspondence: (H.K.K.); (J.K.P.); Tel.: +82-51-663-4883 (H.K.K.); +82-63-250-1510 (J.K.P.); Fax: +82-51-663-4809 (H.K.K.); +82-63-250-1564 (J.K.P.)
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Palmisano F, Moreno-Mendoza D, Ievoli R, Veber-Moisés-Da Silva G, Gasanz-Serrano C, Villegas-Osorio JF, Peraza-Godoy MF, Vives Á, Bassas L, Montanari E, Ruiz-Castañé E, Sarquella-Geli J, Sánchez-Curbelo J. Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: which subfertile patients benefit from surgery? Ther Adv Urol 2019; 11:1756287219887656. [PMID: 31741684 PMCID: PMC6843731 DOI: 10.1177/1756287219887656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/17/2019] [Indexed: 01/03/2023] Open
Abstract
Background The exact mechanism of varicocele-related infertility is still elusive, therefore, the current challenges for its management lie in determining which patients stand to benefit most from surgical correction. The authors aimed to assess the clinical factors affecting semen improvement after left microsurgical subinguinal varicocelectomy (MSV) in relation to patient age, ultrasound varicocele grading (USVG), and presence of a right subclinical varicocele (RSV). Methods From 2010 to 2017 a total of 228 infertile patients underwent left MSV for clinical varicocele. Descriptive statistics were used to describe the cohort and verify the surgical benefit in terms of semen improvement, in addition, subsets of patients were selected according to clinical covariates. Logistic regression modeling was applied to evaluate the presence of RSV, operative time, age, and USVG as explanatory variables. Results Sperm concentration (SC), progressive sperm motility (PSM), and normal sperm morphology (NSM) increased significantly after surgery (p = 0.002; p = 0.011; p = 0.024; respectively). Mean SC improved after MSV in ⩾35 year-old patients and the grade 3 USVG group (p = 0.01; p = 0.02; respectively). Logistic regression modeling showed a that the probability of SC improvement was 76% lower in subjects presenting RSV (p = 0.011). In addition, patients with a grade 3 USVG presented a three-times greater probability of SC improvement compared with patients with a lower USVG (p = 0.035). In addition, older patients showed a greater probability of SC improvement after MSV (p = 0.041). Conclusions MSV is an effective varicocele-related infertility treatment that should also be offered to older patients. In addition, patients with a higher USVG benefit from surgery. In infertile men with an RSV in association with a left clinical disease, a bilateral varicocele repair should be considered.
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Affiliation(s)
- Franco Palmisano
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via della Commenda, Milan, Italy
| | - Daniel Moreno-Mendoza
- Fundació Puigvert, Department of Andrology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Riccardo Ievoli
- Department of Statistics, University of Bologna, Bologna, Italy
| | | | - Carlos Gasanz-Serrano
- Fundació Puigvert, Department of Andrology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | | | - Álvaro Vives
- Fundació Puigvert, Department of Andrology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Lluís Bassas
- Fundació Puigvert, Department of Andrology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Eduard Ruiz-Castañé
- Fundació Puigvert, Department of Andrology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joaquim Sarquella-Geli
- Fundació Puigvert, Department of Andrology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Josvany Sánchez-Curbelo
- Fundació Puigvert, Department of Andrology, Universitat Autonoma de Barcelona, Barcelona, Spain
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A. S. V, Dhama K, Chakraborty S, Abdul Samad H, K. Latheef S, Sharun K, Khurana SK, K. A, Tiwari R, Bhatt P, K. V, Chaicumpa W. Role of Antisperm Antibodies in Infertility, Pregnancy, and Potential forContraceptive and Antifertility Vaccine Designs: Research Progress and Pioneering Vision. Vaccines (Basel) 2019; 7:E116. [PMID: 31527552 PMCID: PMC6789593 DOI: 10.3390/vaccines7030116] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023] Open
Abstract
Sperm of humans, non-human primates, and other mammalian subjects is considered to be antigenic. The effect of changes in autoimmunity on reproductive cells such as spermatozoa and oocytes play a critical but indistinct role in fertility. Antisperm antibodies (ASAs) are invariably present in both females and males. However, the degree of ASA occurrence may vary according to individual and gender. Although the extent of infertility due to ASAs alone is yet to be determined, it has been found in almost 9-12% of patients who are infertile due to different causes. Postcoital presence of spermatozoa in the reproductive tract of women is not a contributory factor in ASA generation. However, ASA generation may be induced by trauma to the vaginal mucosa, or by anal or oral sex resulting in the deposition of sperm inside the digestive tract. It is strongly believed that, in humans and other species, at least some antibodies may bind to sperm antigens, causing infertility. This form of infertility is termed as immunological infertility, which may be accompanied by impairment of fertility, even in individuals with normozoospermia. Researchers target ASAs for two major reasons: (i) to elucidate the association between ASAs and infertility, the reason ASAs causes infertility, and the mechanism underlying ASA-mediated infertility; and (ii) to assess the potential of ASAs as a contraceptive in humans in case ASAs influences infertility. Therefore, this review explores the potential application of ASAs in the development of anti-spermatozoa vaccines for contraceptive purposes. The usefulness of ASAs for diagnosing obstructive azoospermia, salpingitis, and oligoasthenoteratozoospermia has been reviewed extensively. Important patents pertaining to potential candidates for spermatozoa-derived vaccines that may be utilized as contraceptives are discussed in depth. Antifertility vaccines, as well as treatments for ASA-related infertility, are also highlighted. This review will address many unresolved issues regarding mechanisms involving ASAs in the diagnosis, as well as prognoses, of male infertility. More documented scientific reports are cited to support the mechanisms underlying the potential role of ASA in infertility. The usefulness of sperm antigens or ASAs (recombinant) in human and wild or captive animal contraceptive vaccines has been revealed through research but is yet to be validated via clinical testing.
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Affiliation(s)
- Vickram A. S.
- Department of Biotechnology, Saveetha School of Engineering, Young Scientist DST-SERB, Govt. of India, Saveetha Institute of Technical and Medical Sciences, Chennai 600077, Tamil Nadu, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Sandip Chakraborty
- Department of Veterinary Microbiology, College of Veterinary Sciences and Animal Husbandry, R.K. Nagar, West Tripura 799008, India;
| | - Hari Abdul Samad
- Division of Physiology and Climatology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Shyma K. Latheef
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Sandip Kumar Khurana
- ICAR-Central Institute for Research on Buffaloes, Sirsa Road, Hisar 125001, Haryana, India;
| | - Archana K.
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India; (A.K.); (V.K.)
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura 281001, India;
| | - Prakash Bhatt
- Teaching Veterinary Clinical Complex, College of Veterinary and Animal Sciences, Govind Ballabh Pant University of Agriculture and Technology, Pantnagar 263145 (Udham Singh Nagar), Uttarakhand, India;
| | - Vyshali K.
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India; (A.K.); (V.K.)
| | - Wanpen Chaicumpa
- Center of Research Excellence on Therapeutic Proteinsand Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Redmon JB, Drobnis EZ, Sparks A, Wang C, Swan SH. Semen and reproductive hormone parameters in fertile men with and without varicocele. Andrologia 2019; 51:e13407. [PMID: 31448444 DOI: 10.1111/and.13407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/20/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022] Open
Abstract
Although varicoceles are a widely accepted identifiable male factor in infertile couples, the benefit of varicocele repair in improving pregnancy and live birth rates remains uncertain. The Study for Future Families obtained semen and reproductive hormone samples from US men whose partners were currently pregnant. In our analysis cohort of 709 men, a varicocele was detected by clinical examination in 56 (8%) of men. Men with varicocele had smaller left testis, and lower total and total motile sperm counts than men without varicocele. Gonadotropin levels were higher as well in men with varicocele. Interestingly, testosterone levels were also slightly higher in men with varicocele. Despite these differences, there was no difference between the groups in the time to achieve the study pregnancy or percentage of men with a previous pregnancy. We conclude that even in fertile men, varicoceles are associated with some degree of testicular hypofunction. This would support current recommendations to consider varicocele repair in male partners in infertile couples who demonstrate both a varicocele and abnormal semen parameters and after evaluation for treatable female factors.
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Affiliation(s)
- J Bruce Redmon
- Department of Medicine and Urologic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Erma Z Drobnis
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | - Amy Sparks
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | - Christina Wang
- Clinical and Translational Science Institute, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Shanna H Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Freeman S, Bertolotto M, Richenberg J, Belfield J, Dogra V, Huang DY, Lotti F, Markiet K, Nikolic O, Ramanathan S, Ramchandani P, Rocher L, Secil M, Sidhu PS, Skrobisz K, Studniarek M, Tsili A, Tuncay Turgut A, Pavlica P, Derchi LE. 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. Eur Radiol 2019; 30:11-25. [DOI: 10.1007/s00330-019-06280-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/19/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
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Dutta S, Majzoub A, Agarwal A. Oxidative stress and sperm function: A systematic review on evaluation and management. Arab J Urol 2019; 17:87-97. [PMID: 31285919 PMCID: PMC6600059 DOI: 10.1080/2090598x.2019.1599624] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Abstract
Objective: To review and present the most distinct concepts on the association of reactive oxygen species (ROS) with male reproduction. Methods: The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines were used to search PubMed, Medline, EMBASE, and the Cochrane electronic databases for studies investigating the role of oxidative stress (OS) on sperm function. Results: The literature search yielded 1857 studies, of which 1791 articles were excluded because of irrelevance of data, non-English language, non-human nature or because they were case reports or commentaries. All included studies were reviews (46), meta-analyses (one), original research studies (18) and guideline articles (one). The studies were published between 1984 and 2018. Under normal physiological conditions, ROS are vital for sperm maturation, hyperactivation, capacitation, acrosome reaction, as well as fertilisation. However, a number of endogenous and exogenous causes may induce supra-physiological levels of ROS resulting in lipid peroxidation, sperm DNA fragmentation and apoptosis, and consequently infertility. Several laboratory testing methods can be used in infertile men to diagnose OS. Treatment usually involves antioxidant supplementation and, when possible, elimination of the causative factor. Conclusion: OS is an important cause of male factor infertility. Its assessment provides essential information that can guide treatment strategies aimed at improving the male’s reproductive potential. Abbreviations: bp: base-pair; CAT: catalase; LPO: lipid peroxidation; MDA: malondialdehyde; MiOXSYS: Male Infertility Oxidative System; mtDNA: mitochondrial DNA; NAD(PH): nicotinamide adenine dinucleotide (phosphate); NO: nitric oxide; 8-OHdG: 8-hydroxy-2’-deoxyguanosine; ORP: oxidation–reduction potential; OS: oxidative stress; PKA: protein kinase A; PLA2: phospholipase A2; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PUFA: poly-unsaturated fatty acid; ROS: reactive oxygen species; SOD: superoxide dismutase; TAC: total antioxidant capacity; TBA: thiobarbituric acid
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Affiliation(s)
- Sulagna Dutta
- Faculty of Dentistry, MAHSA University, Selangor, Malaysia
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, USA
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Morinda Officinalis Polysaccharides Attenuate Varicocele-Induced Spermatogenic Impairment through the Modulation of Angiogenesis and Relative Factors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:8453635. [PMID: 31110554 PMCID: PMC6487148 DOI: 10.1155/2019/8453635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/28/2019] [Indexed: 01/07/2023]
Abstract
Evidence supporting best treatment practices for varicocele is lacking. The effects of a water-soluble polysaccharide extracted from Morinda officinalis (MOP) on the progression of varicocele were evaluated in the present study. The extracted MOP was confirmed as having a high purity of 98% with scant protein contamination, and it mainly consisted of glucose, lactose, and xylose at a molar ratio of 7.63:1.23:0.95 glucose:lactose:xylose. MOPs were administered to experimental left varicocele rats immediately after surgery at doses ranging from 25 to 200 mg/kg. As detected by sperm analysis and histopathological staining, the intragastric administration of 100 mg/kg MOPs significantly improved the sperm parameters of bilateral cauda epididymis, attenuated seminiferous epithelial structures, and inhibited germ cell apoptosis. The results of immunofluorescence and immunoblot showed that administration of 100 mg/kg MOPs effectively inhibited angiogenesis in the bilateral testes but modulated the expression of vascular endothelial growth factor (VEGF), matrix metalloproteinase 2 (MMP2), and MMP9 mildly. These results indicate that inhibition of angiogenesis may be one of the mechanisms by which MOP exerts its inhibitive activities on the progression of varicocele, whereas a relative upregulation of VEGF and MMP-9 may be crucial for the spermatogenetic protective effects of 100 mg/kg MOP administration.
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Camargo M, Intasqui P, Belardin L, Antoniassi M, Cardozo K, Carvalho V, Fraietta R, Bertolla R. Molecular pathways of varicocele and its repair – A paired labelled shotgun proteomics approach. J Proteomics 2019; 196:22-32. [DOI: 10.1016/j.jprot.2019.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 12/28/2022]
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Agarwal A, Rana M, Qiu E, AlBunni H, Bui AD, Henkel R. Role of oxidative stress, infection and inflammation in male infertility. Andrologia 2018; 50:e13126. [DOI: 10.1111/and.13126] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/08/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine; Cleveland Clinic; Cleveland Ohio
| | - Mohit Rana
- American Center for Reproductive Medicine; Cleveland Clinic; Cleveland Ohio
| | - Emily Qiu
- American Center for Reproductive Medicine; Cleveland Clinic; Cleveland Ohio
| | - Hashem AlBunni
- American Center for Reproductive Medicine; Cleveland Clinic; Cleveland Ohio
| | - Albert D. Bui
- American Center for Reproductive Medicine; Cleveland Clinic; Cleveland Ohio
- Ohio University Heritage College of Osteopathic Medicine; Athens Ohio
| | - Ralf Henkel
- American Center for Reproductive Medicine; Cleveland Clinic; Cleveland Ohio
- Department of Medical Biosciences; University of the Western Cape; Bellville South Africa
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Zavattaro M, Ceruti C, Motta G, Allasia S, Marinelli L, Di Bisceglie C, Tagliabue MP, Sibona M, Rolle L, Lanfranco F. Treating varicocele in 2018: current knowledge and treatment options. J Endocrinol Invest 2018; 41:1365-1375. [PMID: 30284221 DOI: 10.1007/s40618-018-0952-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/11/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. METHODS We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: "varicocele", "varicocelectomy", "sclerotherapy", "male infertility", "subfertility", and "semen abnormalities". RESULTS Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. CONCLUSIONS Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.
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Affiliation(s)
- M Zavattaro
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Ceruti
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Allasia
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Di Bisceglie
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M P Tagliabue
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Sibona
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - L Rolle
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - F Lanfranco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
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Bardaweel SK, Gul M, Alzweiri M, Ishaqat A, ALSalamat HA, Bashatwah RM. Reactive Oxygen Species: the Dual Role in Physiological and Pathological Conditions of the Human Body. Eurasian J Med 2018; 50:193-201. [PMID: 30515042 DOI: 10.5152/eurasianjmed.2018.17397] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Reactive oxygen species (ROS) are well-known for playing a dual role as destructive and constructive species. Indeed, ROS are engaged in many redox-governing activities of the cells for the preservation of cellular homeostasis. However, its overproduction has been reported to result in oxidative stress, which is considered as a deleterious process, and is involved in the damage of cell structures that causes various diseased states. This review provides a concise view on some of the current research published in this topic for an improved understanding of the key roles of ROS in diverse conditions of health and disease. Previous research demonstrated that ROS perform as potential signaling molecules to control several normal physiological functions at the cellular level. Additionally, there is a growing body of evidence supporting the role of ROS in various pathological states. The binary nature of ROS with their profitable and injurious characteristics indicates the complexities of their specific roles at a biological compartment and the difficulties in establishing convenient intervention procedures to treat ROS-related diseases.
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Affiliation(s)
- Sanaa K Bardaweel
- Department of Pharmaceutical Sciences, University of Jordan School of Pharmacy, Amman, Jordan
| | - Mustafa Gul
- Department of Physiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Muhammad Alzweiri
- Department of Pharmaceutical Sciences, University of Jordan School of Pharmacy, Amman, Jordan
| | - Aman Ishaqat
- Department of Pharmaceutical Sciences, University of Jordan School of Pharmacy, Amman, Jordan
| | - Husam A ALSalamat
- Department of Pharmaceutical Sciences, University of Jordan School of Pharmacy, Amman, Jordan
| | - Rasha M Bashatwah
- Department of Pharmaceutical Sciences, University of Jordan School of Pharmacy, Amman, Jordan
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Ates E, Ucar M, Keskin MZ, Gokce A. Preoperative neutrophil-to-lymphocyte ratio as a new prognostic predictor after microsurgical subinguinal varicocelectomy. Andrologia 2018; 51:e13188. [DOI: 10.1111/and.13188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/24/2018] [Accepted: 10/03/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Erhan Ates
- Department of Urology; Aydin Adnan Menderes University School of Medicine; Aydin Turkey
| | - Murat Ucar
- Department of Urology; Izmir Tepecik Training and Research Hospital; Izmir Turkey
| | - Mehmet Zeynel Keskin
- Department of Urology; Izmir Tepecik Training and Research Hospital; Izmir Turkey
| | - Ahmet Gokce
- Department of Urology; Sakarya University School of Medicine; Sakarya Turkey
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Al-Mohammady AA, El-Sherbiny AF, Mehaney AB, Ghobara YA. Varicocele repair in patients prepared for intracytoplasmic sperm injection: To do or not to do? Andrologia 2018; 51:e13185. [PMID: 30375021 DOI: 10.1111/and.13185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study sought to evaluate the impact of varicocele repair on intracytoplasmic sperm injection outcomes. PATIENTS AND METHODS A prospective comparative study was conducted at the Assisted Reproduction Unit, International Islamic Center for Population Studies and Researches, Al-Azhar University. This study included 100 non-azoospermic infertile men with a history of varicocele who were scheduled for intracytoplasmic sperm injection, half of them had already undergone prior subinguinal varicocelectomy at least 12 months prior to ICSI without clinically evident recurrence (treated group 1), and the other half has any grade of an unrepaired clinical varicocele (untreated group 2) at sperm injection. All cases were clinically evaluated and eligible for analysis by using inclusion and exclusion criteria. ICSI outcomes compared between the two groups, including fertilisation rate, embryo development rate and pregnancy outcome. RESULTS Our study did not show any significant difference between treated and untreated groups regarding the mean values of fertilisation (0.7759 ± 0.2708 vs. 0.7119 ± 0.3057, p = 0.2708), embryo development (0.7759 ± 0.2708 vs. 0.6991 ± 0.3211, p = 0.1990) or different embryo grades. There was no statistically significant difference between groups regarding pregnancy occurrence rates (p = 0.0928). CONCLUSION Infertile men scheduled for ICSI do not seem to benefit from varicocele repair as regard to the outcomes of ICSI.
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Affiliation(s)
- Abdelshakour A Al-Mohammady
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed F El-Sherbiny
- Department of Andrology, International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo, Egypt
| | - Amira B Mehaney
- Department of Embryology, International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo, Egypt
| | - Yasser A Ghobara
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Cavallini G, Scroppo FI, Colpi GM. The clinical usefulness of a novel grading system for varicocoeles using duplex Doppler ultrasound examination based on postsurgical modifications of seminal parameters. Andrology 2018; 7:62-68. [PMID: 30354030 DOI: 10.1111/andr.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/28/2018] [Accepted: 09/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The existing classifications of varicocoeles have poor predictive value regarding the effects of surgery on sperm count. OBJECTIVE To develop a new grading system for varicocoeles, useful as an indication for surgery. MATERIALS AND METHODS This is a three-center prospective study which examined 173 men having clinically detectable left varicocoeles and oligo ± astheno ± terato-spermia. The patients underwent medical history collection, objective examination, duplex Doppler ultrasound scrotal examination, hormonal profiles, two semen analyses before surgery, and two semen analyses after surgery. Sperm concentration, motility, and morphology (standard semen parameters) were evaluated 6 months after surgery in function of the following preoperative variables: patient age, follicle-stimulating hormone, clinical grade of varicocoele, right and left testicular volume, extension of venous reflux, and semen parameters. The venous reflux was graded in two centers using duplex Doppler ultrasound: reflux visible only with Valsalva and continuous reflux. Spearman's rank semiquantitative analysis was used. All patients had their varicocoeles corrected according to the Colpi technique. RESULTS The variables capable of determining an improvement in semen parameters after varicocoele correction were in order of decreasing importance: venous reflux extent assessed by scrotal duplex Doppler ultrasound examination, varicocoele clinical grade, basal semen parameters, and follicle-stimulating hormone. Male age did not influence postoperative semen quality. Only patients with continuous reflux had their standard semen parameters improved after surgery. DISCUSSION Venous reflux extent is the most critical variable capable of predicting semen improvement after varicocoelectomy. CONCLUSIONS A correct duplex Doppler assessment of venous reflux is mandatory for predicting postoperative improvement of the sperm count.
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Affiliation(s)
- G Cavallini
- Andrological Section, Gynepro Medical Team, Bologna, Italy
| | - F I Scroppo
- Department of Urology and Andrology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - G M Colpi
- Andrology and IVF Department, Clinica San Carlo, Paderno Dugnano (Milano), Italy
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Baek SR, Park HJ, Park NC. Comparison of the clinical characteristics of patients with varicocele according to the presence or absence of scrotal pain. Andrologia 2018; 51:e13187. [PMID: 30357879 PMCID: PMC7379187 DOI: 10.1111/and.13187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/19/2018] [Accepted: 10/04/2018] [Indexed: 01/06/2023] Open
Abstract
We investigated the clinical characteristics of patients with varicocele according to the presence or absence of scrotal pain. We retrospectively reviewed the records of patients who underwent varicocelectomy. The age, body mass index, grade, laterality of varicocele, testicular volume difference, time to hospital visit, serum testosterone level and semen parameters were evaluated. A total of 954 patients were included. The painful group had lower mean age, lower BMI, higher grade of varicocele, smaller testicular volume difference and shorter time to hospital visit than the painless group. In addition, the median serum total testosterone level and total sperm count, concentration and motility were higher in the painful group than in the painless group. In multivariate analysis, there were significant differences between the two groups in age, grade of varicocele, testis volume difference, time to hospital visit, total sperm count and concentration. Patients with painful varicocele visited hospital earlier because of the pain and tended to start treatment sooner. They were also younger, had smaller testis atrophy and had higher sperm concentration, even though they had a higher grade of varicocele than patients without pain. Although scrotal pain in varicocele patients is difficult to treat, it leads to early diagnosis and treatment.
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Affiliation(s)
- Seung Ryong Baek
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Nam Cheol Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Medical Research Institute of Pusan National University Hospital, Busan, Korea
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Hassani-Bafrani H, Najaran H, Razi M, Rashtbari H. Berberine ameliorates experimental varicocele-induced damages at testis and sperm levels; evidences for oxidative stress and inflammation. Andrologia 2018; 51:e13179. [DOI: 10.1111/and.13179] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/15/2018] [Accepted: 09/05/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Hassan Hassani-Bafrani
- Gametogenesis Research Center; Kashan University of Medical Sciences; Kashan Iran
- Anatomical Sciences Research Center; Kashan University of Medical Sciences; Kashan Iran
| | - Hamed Najaran
- Gametogenesis Research Center; Kashan University of Medical Sciences; Kashan Iran
- Anatomical Sciences Research Center; Kashan University of Medical Sciences; Kashan Iran
| | - Mazdak Razi
- Department of Basic Science, Comparative Histology and Embryology Division, Faculty of Veterinary Medicine; Urmia University; Urmia Iran
| | - Hamid Rashtbari
- Gametogenesis Research Center; Kashan University of Medical Sciences; Kashan Iran
- Anatomical Sciences Research Center; Kashan University of Medical Sciences; Kashan Iran
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Gomaa MD, Motawaa MA, Al-Nashar AM, El-Sakka AI. Impact of Subinguinal Varicocelectomy on Serum Testosterone to Estradiol Ratio in Male Patients With Infertility. Urology 2018; 117:70-77. [DOI: 10.1016/j.urology.2018.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/04/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
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Vahidi S, Moein M, Nabi A, Narimani N. Effects of microsurgical varicocelectomy on semen analysis and sperm function tests in patients with different grades of varicocele: Role of sperm functional tests in evaluation of treatments outcome. Andrologia 2018; 50:e13069. [PMID: 29938821 DOI: 10.1111/and.13069] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/29/2018] [Accepted: 04/10/2018] [Indexed: 01/15/2023] Open
Abstract
It seems that varicocele play a role in male infertility, as such, their prevalence increases from 15% in the normal population to 80% in secondary infertility subjects. Varicoceles may have negative effects on semen quality. Our goal was to assess the effects of microsurgical varicocelectomy on semen analysis and sperm functional tests in men with different grades of varicoceles. Thirty infertile men with different grades of varicoceles (grades 1 to 3) were enrolled in our study. Semen quality was assessed by semen analysis according to the WHO guideline (WHO, 1999) and four different sperm functional tests (aniline blue, toluidine blue, chromomycin A3 and TUNEL test) were carried out before and 3 months after microsurgical varicocelectomy (M-varicocelectomy). When considered all three grades together, we showed that M-varicocelectomy had statistically significant effects on all four types of sperm functional tests (p value<0.05). It also had positive effects on conventional semen parameters, although the effects were not statistically significant for some parameters (for example sperm count). When analysed separately (based on varicocele grades) the surgery, although caused improvements in semen quality, but may have more statistically significant effects on patients with varicocele of higher grade. In addition, in varicocele of lower grade (for example grade 2), sperm function test may be a better predictor of surgical success than the conventional semen analysis. Thus, we show that not only M-varicocelectomy has significant positive effect on semen quality but also if sperm functional tests become more affordable in the future, because they yield more precise results, their use in daily practice may increase significantly in patients with varicoceles.
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Affiliation(s)
- Serajoddin Vahidi
- Department of Urology, Research & Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammadreza Moein
- Department of Urology, Research & Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Nabi
- Research & Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nima Narimani
- Department of Urology, Research & Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Sadeghi N, Tavalaee M, Nasr- Esfahani MH. A Cellular Perspective on the Importance of Oxidative Stress Effects on Sperm. JOURNAL OF ARDABIL UNIVERSITY OF MEDICAL SCIENCES 2018. [DOI: 10.29252/jarums.18.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Ariyati I, Mulyadi R, Birowo P, Wiweko B, Prihartono J. Association between varicocele grade and semen analysis parameter. MEDICAL JOURNAL OF INDONESIA 2018. [DOI: 10.13181/mji.v26i4.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: Varicocele is a condition characterized by elongation, dilatation and tortuousity of spermatic vein in pampiniform plexus. Approximately 50% of infertility cases among men are caused by varicocele. The varicocele may affect the components of sperm. This study aimed to determine the association between varicocele grade based on ultrasound Doppler examination and sperm concentration, sperm motility, and sperm morphology based on semen analysis examination.Methods: This was a descriptive, cross-sectional study which used secondary data from 85 patients that visited Department of Urology, Cipto Mangunkusumo Hospital, then underwent ultrasonography examination at Department of Radiology, Cipto Mangunkusumo Hospital and semen analysis examination at Department of Obstetrics and Gynecology, Cipto Mangunkusumo General Hospital.Results: Varicocele grade was significantly associated with sperm morphology, concentration and motility (all p<0.05). Significant association was found between maximum condition and semen analysis component.Conclusion: Varicocele grade may affect semen analysis component.
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Al-Kandari AM, Khudair A, Arafa A, Zanaty F, Ezz A, El-Shazly M. Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis. Arab J Urol 2018; 16:181-187. [PMID: 29713549 PMCID: PMC5922226 DOI: 10.1016/j.aju.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/02/2017] [Accepted: 12/11/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the detailed vascular anatomy of the spermatic cord during subinguinal microscopic varicocelectomy and to assess the outcome of the cases with regard to varicocele recurrence and hydrocele formation. Patients and methods In all, 100 varicocele cases including 74 left-sided and 26 bilateral, comprising 126 spermatic cord units with clinically palpable varicoceles underwent microscopic subinguinal varicocelectomy. Detailed description of vascular anatomy of the spermatic cords was reported. The number of spermatic, cremasteric, and inguinal veins was recorded. A record of testicular arteries and lymphatics was noted. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, as well as scrotal Doppler ultrasonography, to detect varicocele recurrence and hydrocele formation. The mean (range) postoperative evaluation period was 6 (3–12) months. Results The mean number of spermatic veins was 14 on both sides. The mean number of spermatic arteries on both sides was 1.3. For lymphatics, the mean number was around three on both sides. The gubernacular veins were noted in 75% of the cases on the left side (mean number of 1.2) and in 85% on the right-side, (mean number of 1). The mean number of cremasteric veins on the left and right sides was 1.4 and 1.2, respectively. Finally, inguinal floor vessels were noted in 9% on the left-side and were not seen in the right-side cases. The incidence of varicocele recurrence was 2% and for hydrocele that was not clinically significant was 0.07%. Conclusion Microscopic subinguinal varicocelectomy accurately evaluated the detailed vascular anatomy of the spermatic cord, achieving excellent surgical outcome with minimal varicocele recurrence and hydrocele formation. Microscopic subinguinal varicocelectomy should be the ‘gold standard’ for varicocelectomy.
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Affiliation(s)
| | | | | | - Fouad Zanaty
- Department of Urology, Menoufia University, Menofia Governorate, Egypt
| | - Ahmed Ezz
- Department of Urology, Al-Salam Hospital, Kuwait City, Kuwait
| | - Mohamed El-Shazly
- Department of Urology, Menoufia University, Menofia Governorate, Egypt
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Pallotti F, Paoli D, Carlini T, Vestri AR, Martino G, Lenzi A, Lombardo F. Varicocele and semen quality: a retrospective case-control study of 4230 patients from a single centre. J Endocrinol Invest 2018. [PMID: 28647897 DOI: 10.1007/s40618-017-0713-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the present study is to assess impairment of spermatogenesis induced by varicocele in, to our knowledge, the largest single-centre caseload available to date. MATERIALS AND METHODS We conducted a retrospective study on 4230 consecutive patients attending our Department for andrological outpatient assessment and preconception check-ups between 2011 and 2014. A total of 2113 patients had varicocele (Group V), while the remaining 2117 were selected as the control group (Group C). All patients were divided into age classes (<17, 18-28, 29-39 and ≥40 years), and Group V patients were classified as "low" (I-II) or "high" (III-IV) grade. RESULTS Varicocele patients had a higher mean height than controls, as well as lower BMI. There was also a statistically significant reduction in the concentration/mL and the total sperm number in Group V against Group C. When stratified by age, values for all semen parameters were significantly worse in the older than in the younger age classes in both Group V and Group C, except for concentration/mL and total sperm number in the 29-39 and ≥40 age classes in both groups. A multivariable logistic regression analysis showed that factors independently predicting the presence of varicocele were older age, higher BMI and smoking for more than 10 years. CONCLUSIONS Varicocele patients show worse semen parameters compared to controls, although their values were still within WHO reference limits. Semen quality is further worsened by increased age, grade and chronic smoking.
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Affiliation(s)
- F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - T Carlini
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A R Vestri
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - G Martino
- Department of Surgical Sciences "R. Paolucci", "Sapienza" University of Rome, Rome, Italy
| | - A Lenzi
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Hosseini K, Nejatifar M, Kabir A. Comparison of The Efficacy and Safety of Palomo, Ivanissevich and Laparoscopic Varicocelectomy in Iranian Infertile Men with Palpable Varicocele. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2018; 12:81-87. [PMID: 29334212 PMCID: PMC5767938 DOI: 10.22074/ijfs.2018.5158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/24/2017] [Indexed: 11/18/2022]
Abstract
Background This study aimed to compare the effects of three commonly used varicocelectomy techniques
namely, open retroperitoneal ligation (Palomo), open inguinal ligation (Ivanissevich) and laparoscopy, in
Iranian infertile men.
Materials and Methods This retrospective study was conducted on 70 infertile men with palpable varicocele who
underwent one of the varicocelectomy techniques namely, Palomo, Ivanissevich, or laparoscopy. Basic information
about semen parameters were collected and registered prior to the surgery. Three months after the surgery, semen
parameters and surgical complications were investigated in all patients. Results The Palomo technique was significantly associated with fewer complications compared to other techniques
(P=0.006). The means of sperm concentration, normal motility and normal morphology were significantly different
among the three groups after surgery (P=0.025, 0.023 and 0.047, respectively). However, after adjustment for potential confounders, in addition to the baseline values of semen parameters, significant differences were observed only
in sperm concentration among the groups (P=0.040). Conclusion Varicocelectomy improved sperm parameters. The Ivanissevich technique was more effective in improving sperm concentration compared to the laparoscopic method. The lowest rates of complications were related to
the Palomo technique.
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Affiliation(s)
- Kamal Hosseini
- Department of Urology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Nejatifar
- Shahid Beheshti University of Medical Sciences, Faculty of Public Health, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
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Varicocelectomy to “upgrade” semen quality to allow couples to use less invasive forms of assisted reproductive technology. Fertil Steril 2017; 108:609-612. [DOI: 10.1016/j.fertnstert.2017.07.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/08/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
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50
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Nagler HM, Stember DS. Editorial Comment. Urology 2017; 110:108-109. [PMID: 28958761 DOI: 10.1016/j.urology.2016.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Harris M Nagler
- Department of Urology, Beth Israel Medical Center, Philips Ambulatory Care Center, New York, NY
| | - Doron S Stember
- Sol and Margaret Berger Department of Urology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
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