The endocrinology of varicoceles

Varicocele: An Endocrinological Perspective

Varicocele affects 15% of male population but it is more frequently identified in patients searching medical care for infertility. The impact of varicocele on semen production and fertility is known, but the relationship between clinical varicocele and impaired hormonal production is not clear. In published literature there are some studies regarding hormonal alterations in patients with varicocele but no review in which all the hormonal findings are explained. The aim of this review is to evaluate, by most common search engine, what is known about hormonal alterations in varicocele-bearing patients, to verify if a cause-effect relationship is documented and to give a useful contribution to in clinical management of this kind of patients. We found contradictory results about hormonal status from literature. Some studies confirmed a decrease of testosterone levels and higher FSH and LH levels that normalize after varicocelectomy, others found lower than normal levels of dihydrotestosterone due to decreased activity of epididymal 5-α-reductase. Lower circulating Anti-Müllerian Hormone levels, accompanied by a decreased Inhibin-B level, were reported as indicators of the decreased Sertoli cells function in varicocele-bearing adult patients. The finding of higher basal 17-OH-progesterone concentrations in patients with varicocele was explained by some authors with a testicular C-17,20-lyase deficiency. There is no doubt that varicocele could led to hormonal alterations. This review proposes that the impaired free sexual steroid levels are the result of a slight, deep-rooted defect in the testes of a certain amount of men with varicocele but further multicentre, randomized controlled studies remain mandatory to better clarify the hormonal features of patients with varicocele and to assess the utility of hormonal evaluation for establishing the duration of varicocele and for better identifying patients who need surgical correction.

Relationship between Varicocele and Male Hypogonadism: A Review with Meta-Analysis

The relationship between varicocele and hypogonadism becomes clearer everyday thanks to the most recent literature, particularly with regards to the impact of varicocele repair on serum testosterone level improvement in hypogonadal patients. We selected English articles published from 1964 to September 2021. The search terms “varicocele” and “hypogonadism” were used as filters. A total of 102 studies have been obtained. For the meta-analysis, the pooled mean differences (MDs) for continuous variables and the ln(OR) were used for data pooling observational studies. A total of 15 articles have been finally included: nine retrospective and six observational. Testosterone levels pre- and after surgery were reported in four studies. There was statistically significant heterogeneity in these studies (chi2 = 267.09, I2 = 72%; p = 0.01). Mean differences of total testosterone was statistically different in men pre- and after-surgery (mean difference = 106.76; p < 0.0001). It is indeed established that altered environments caused by varicocele cause pantesticular insult, but it has not been unequivocally determined whether men with varicocele are at increased risk for the development of clinical hypogonadal symptoms.

Relationship between penile erection and the ratio of estradiol to testosterone: A retrospective study

Previous studies have found that the ratio of estradiol to testosterone (E2/T ratio) has a negative effect on sexual function, but the relationship between the E2/T ratio and erection of the penis is not clarified. We conducted a retrospective study of 183 patients with erectile dysfunction and 52 healthy men to investigate the relationship between penis base erection and tip erection. All participants underwent nocturnal penile tumescence tests and medical history checks and had relevant biochemical and endocrine indicators measured. The ratio of estradiol to testosterone was calculated. The relationship between E2/T ratio and erectile time of penile tip and penile base was determined by univariate analysis, multivariate analysis and stratification analysis. After adjusting for mixed factors, the results showed that the E2/T ratio had a more significant negative effect on the base of the penis compared with the tip of the penis (Hazard ratio: -4.34 95% CI: -6.52, -2.16 p = .0001). Moreover, when the effective erection time was ≥10 min, the negative effect of E2/T on penile root erection was more obvious (HR ratio: -4.46 95% CI: -6.50, -2.43 p < .0001). In summary, our study demonstrated a negative relationship between E2/T ratio and penile erection, particularly at the root of the penis.

Semen and reproductive hormone parameters in fertile men with and without varicocele

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.

When is a varicocele repair indicated: the dilemma of hypogonadism and erectile dysfunction?

In the past, the indications for varicocelectomy are primarily for infertility with abnormal semen parameters, testicular hypotrophy/atrophy in adolescents, and/or pain. The surgical treatment of varicocele for hypogonadism is controversial and debated. Recently, multiple reports in the literature have suggested that varicocele is associated with hypogonadism and varicocele repair can increase testosterone levels. Men with hypogonadal symptoms should have at least two serum testosterone levels. Microsurgical varicocelectomy may be beneficial for men with clinically palpable varicoceles with documented hypogonadism. In this review, we summarize the most recent literature linking varicocele to hypogonadism and sexual dysfunction and the impact of repair on serum testosterone levels. We performed a search of the published English literature. The key words used were “varicocele and hypogonadism” and “varicocele surgery and testosterone.” We included published studies after 1998. We, also, evaluated the effect of surgery on the changes in the serum testosterone level regardless of the indication for the varicocele repair.

Varicocele and testicular function

Testicular varicocele, a dilation of the veins of the pampiniform plexus thought to increase testicular temperature via venous congestion, is commonly associated with male infertility. Significant study has clarified the negative impact of varicocele on semen parameters and more recent work has shed light on its detrimental effects on the molecular and ultrastructural features of sperm and the testicular microenvironment, as well as more clearly defined the positive impacts of treatment on couples’ fertility. The relationship between varicocele and testicular endocrine function, while known for some time based on histologic evaluation, has become more apparent in the clinical setting with a growing link between varicocele and hypogonadism. Finally, in the pediatric setting, while future study will clarify the impact of varicocele on fertility and testicular function, recent work supports a parallel effect of varicocele in adolescents and adults, suggesting a re-evaluation of current treatment approaches in light of the progressive nature of the condition and potential increased risk of future disease.

Morphological and surgical overview of adolescent testis affected by varicocele

Varicocele is a common pathology of the testis frequently associated with infertility. For its management, a fine morphological study of the testis, both macroscopically and microscopically, and an accurate choice of surgical procedure are mandatory. The present review focuses its attention on the anatomic substrates of adolescent varicocele and its pathophysiologic modifications. The comprehensive assessment of all the reported alterations should be considered by the clinician before deciding the type of treatment and the timing.

Endocrine cells of the adenohypophysis in severe acute respiratory syndrome (SARS)

It is known that severe acute respiratory syndrome (SARS), a severe infectious illness, which caused an epidemic in Asia in 2003, has extensive and complex effects on human organ systems. It has been reported that the serum levels of prolactin (PRL), follicle stimulating hormone (FSH), and luteinizing hormone (LH) of SARS patients are significantly higher than those of control groups, while estradiol (E2), pregnancy hormone (P), and thyroid stimulating hormone (TSH) are considerably lower than those of normal controls. This phenomenon suggests that the adenohypophyseal endocrine cells in SARS patients may be damaged. However, up to now there has been no direct histological investigation on the endocrine cells of patients' pituitary. Here we investigated the endocrine cells in the adenohypophysis obtained from autopsies of 5 SARS patients. The immunohistochemistry and quantitative image results showed that compared with control cases, both the number of positive cells and the staining intensity of immunoreactivity for growth hormone, TSH, and adrenocorticotrophic hormone in these cells were remarkably decreased, while that of PRL, FSH, and LH were significantly increased in all SARS cases studied. These findings indicated that alterations occurred in the patients' adenohypophyseal endocrine cells, and these changes were consistent with the serum levels of relevant endocrine hormones reported previously. It appears that changes in these endocrine cells and their hormones are affected by the severity of this new infectious disease.

VARICOCELE LIGATION ON FREE TESTOSTERONE LEVELS IN INFERTILE MEN WITH VARICOCELE

We have analyzed the effects of varicocele ligation on free testosterone levels, and investigated the interrelationships between free testosterone and fertility. The records were retrospectively evaluated for 42 infertile patients who underwent varicocele ligation, with serum free testosterone levels, follicle stimulating hormone (FSH), lutenizing hormone (LH), testosterone, estradiol, prolactin, ejaculated volume, sperm concentration and motility before and after surgery. Serum free testosterone levels increased from 12.97+/-4.16 to 13.59+/-3.93 pg/mL, but the difference was insignificant. The differences before and after surgery of patients in sperm concentration and motility were also insignificant. However, in free testosterone increasing group, the sperm concentration and motility increased significantly, from 4.05+/-4.35 to 7.90+/-8.19 million/mL (P=0.01) and from 30.64+/-21.87% to 41.00+/-22.00%, respectively (P=0.03). The increase in serum free testosterone level by varicocele ligation results in a significant improvement in sperm concentration and motility.

Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate--outcome in 244 patients

PURPOSE

To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam.

MATERIALS AND METHODS

The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test.

RESULTS

Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months +/- 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P < .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months +/- 7.77).

CONCLUSION

TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.

Baseline follicle-stimulating hormone is a strong predictor for the outcome of the gonadotrophin-releasing hormone test in young men with unilateral medium- or high-grade varicocele

OBJECTIVE

To investigate whether the gonadotrophin-releasing hormone (GnRH) test is an adequate diagnostic tool to identify testicular dysfunction in men with strictly unilateral varicocele and defined testicular volume; and to identify any peripheral venous variable which would predict the result of the GnRH test.

PATIENTS AND METHODS

In all, 102 GnRH tests were done in men with a left-sided varicocele. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were determined. After intravenous administration of 100 microg GnRH, stimulated LH and FSH levels were measured. FSH levels of >8.2 U/L and LH levels of >51.7 U/L were considered exaggerated.

RESULTS

In all, 50 men had an exaggerated GnRH test result; all had an exaggerated FSH response and six also had an elevated LH response. The baseline FSH levels were higher (P < 0.001) and the testicular volume was smaller (P < 0.01) in men with an exaggerated GnRH test response. All men with a baseline FSH level of >5.6 U/L had an exaggerated GnRH test response.

CONCLUSION

A baseline FSH level of >5.6 U/L is a good predictor of the GnRH test outcome. Leydig cell function seems mainly undisturbed.

Somatic angiotensin converting enzyme in varicocele

The ACE is found as two isozymes in the body. A somatic isozyme found in blood and several other tissues, and a testis-specific isozyme found only in developing spermatids and mature sperm. In this study, we investigated the ACE activity in left spermatic vein blood samples of infertile patients with varicocele and its correlation to spermatologic parameters. The somatic ACE activities were determined in the peripheral and left spermatic vein blood samples from 31 infertile patients who underwent variococelectomy, and 11 fertile control subjects underwent left inguinal herniorraphy. The somatic ACE activity was measured by kinetic spectrophotometric assay. Semen analyses were performed according to WHO guidelines. The mean somatic ACE activities of peripheral and left spermatic veins of the varicocele group were 60.3 +/- 23.0 and 60.2 +/- 23.2 U/L, respectively. In control group, peripheral and left spermatic vein ACE activities were found as 56.8 +/- 17.1 and 56.5 +/- 15.5 U/L, respectively. There was no significant difference between the ACE activity in peripheral and left spermatic vein blood sample from the varicocele and control group. There was no statistically significant correlation between the spermatologic parameters and ACE activities in the spermatic and peripheral vein in both of varicocele and control groups. As a result, it may be suggested that the somatic ACE has no causative role in pathophysiology of varicocele and varicocele related infertility.

Effect of age and grade on surgery for patients with varicocele

OBJECTIVES

To assess the seminal characteristics, hormonal levels, and pathologic findings in patients of various age groups with varicocele before and after ligation to establish the presence of an aging effect in patients with varicocele on those characteristics.

METHODS

The records were retrospectively evaluated for 70 infertile patients with azoospermia or oligospermia who underwent microsurgical left inguinal varicocele ligation. The mean +/- SD patient age was 33.9 +/- 5.5 years. Left varicocele was detected in 70 patients. We divided our patients into three groups according to age: group 1, 20 to 29 years old (n = 17); group 2, 30 to 39 years old (n = 41); and group 3, older than 40 years (n = 12).

RESULTS

Before ligation, no significant differences were seen among the three groups in luteinizing hormonal level, prolactin level, estradiol level, right testicular volume, semen volume, and sperm concentration and sperm motility. Significant differences were seen in the follicle-stimulating hormonal level, testosterone level, and left testicular volume. After ligation, even in group 3, the sperm concentration and motility increased from 6.38 +/- 5.47 to 13.07 +/- 9.05 million/mL (P = 0.042) and from 28.42% +/- 23.22% to 39.92% +/- 22.06%, respectively. No significantly greater degree of improvement in semen characteristics was observed between grade II and grade III after varicocele ligation.

CONCLUSIONS

The results of our study have shown that age is not a significant predictive factor of improvement in semen characteristics before ligation. It is reasonable to perform ligation to improve the semen characteristics in patients older than 40 years old.

Does the gonadotropin-releasing hormone stimulation test predict clinical outcomes after microsurgical varicocelectomy?

OBJECTIVES

To examine the predictive value of the gonadotropin-releasing hormone (GnRH) stimulation test in a large cohort of infertile men undergoing varicocelectomy.

METHODS

We examined the records of 144 consecutive infertile couples in whom the man underwent microsurgical varicocelectomy between September 1998 and December 2002. All men underwent a GnRH stimulation test before surgery. Data on the preoperative and postoperative semen parameters, pregnancy outcome, and follicle-stimulating hormone (FSH) and luteinizing hormone increase after GnRH stimulation were recorded.

RESULTS

The mean (+/-SE) sperm concentration and motility 6 months after varicocelectomy were significantly greater than the preoperative values (25.3 +/- 2.4 versus 19.7 +/- 2.1 x 10(6)/mL and 29.2% +/- 1.4% versus 25.3% +/- 1.3%, respectively, P <0.05). Overall, 28% of the couples achieved a spontaneous pregnancy at a mean of 22 months of follow-up. The median elevation in the FSH and luteinizing hormone value 60 minutes after GnRH administration was 1.8 and 5.6 times the baseline level, respectively. No statistically significant relationship was found between the FSH or LH response to GnRH stimulation and improvement in the semen parameters or positive pregnancy outcome in our population.

CONCLUSIONS

Our data showed that the FSH response to bolus GnRH stimulation does not predict improvement in semen parameters or unassisted pregnancy outcome in couples in whom the man undergoes varicocelectomy (for treatment of varicocele). The study was the largest of its type and sufficiently powered to validate these findings. The results indicate that the bolus GnRH stimulation test is of no clinical value in the treatment of infertile men with varicoceles.

Varicocele: current concepts in pathophysiology, diagnosis, and treatment

Although significant advances have been made in the understanding of varicoceles, a clear pathophysiologic mechanism remains elusive. Most likely, a varicocele is the result of a multifactorial process. Appreciation of the complex venous drainage of the testis remains a key to maximizing the chances for treatment success. Likewise, the advent of microsurgical repair has minimized complications. Fortunately, times have improved since the early nineteenth century, when the French surgeon Delpech (1772-1832) was killed by a disgruntled patient on whom he had performed a varicocele repair.

Nitric oxide synthase patterns in normal and varicocele testis in adolescents

OBJECTIVE

To determine if the testes of normal adolescents can produce nitric oxide (NO), by assessing NO synthase (NOS) activity, and whether this activity changes in adolescents with left idiopathic varicocele.

PATIENTS AND METHODS

After obtaining informed consent, testicular biopsies were obtained from eight adolescents (mean age 16.4 years; controls) who underwent surgery for inguinal hernia or hydrocele, and from 20 adolescents (mean age 16.2 years) operated for left idiopathic varicocele. Inducible and endothelial NOS (iNOS and eNOS) isoforms were investigated in the biopsy specimens by immunohistochemical localization and Western blot analysis using specific fluorescein-conjugated antibodies.

RESULTS

Both normal and pathological samples expressed eNOS at the level of vessels and Leydig cells. The iNOS was expressed in Leydig cells of normal testes and over-expressed in Leydig cells of varicocele testes.

CONCLUSION

Leydig cells of adolescent testes constitutively express iNOS. Under pathological conditions, e.g. varicocele, iNOS is up-regulated and is a possible source of NO overproduction. These results could be useful in explaining the pathogenesis of both testis and sperm dysfunction in varicocele.

Increased serum inhibin B levels after varicocele treatment

OBJECTIVE

Inhibin B is secreted by Sertoli cells in response to FSH and is the major feedback regulator of FSH secretion in man. The serum inhibin B level has emerged as a good marker of spermatogenesis and Sertoli cell function. Varicocele has been associated with infertility and disturbed spermatogenesis. We have studied the effect of varicocele treatment on serum inhibin B levels, with the aim of investigating the effect on spermatogenesis and the involvement of the Sertoli cell in varicocele pathophysiology.

DESIGN AND PATIENTS

In a pre-post test design, the effect of varicocele surgery on inhibin B levels was studied in 30 infertile men.

MEASUREMENTS

Endocrinology (inhibin B, FSH, LH, SHBG and testosterone) and semen analysis (sperm concentration, motility and morphology).

RESULTS

In men receiving varicocele treatment, a significant increase in serum inhibin B levels was observed from 133.9 +/- 13.4 pretreatment to 167.8 +/- 16.1 ng/l after treatment (mean +/- SEM, P < 0.0001). No significant changes were observed in serum levels of FSH, LH and testosterone. The serum SHBG level decreased from 32.9 +/- 3.5 to 28.6 +/- 3.4 nmol/l (mean +/- SEM, P = 0.04) and the free androgen index was significantly increased from 66 +/- 5.9 pretreatment to 85 +/- 6.8 after treatment (P = 0.02, mean +/- SEM). Semen analysis showed a significant improvement in sperm concentration, from 6.5 +/- 1.9 pretreatment to 19.3 +/- 4.9 x 106/ml after treatment (P = 0.003, mean +/- SEM), and in sperm motility from the baseline level of 17 +/- 3 to 32 +/- 4% after treatment (P = 0.001, mean +/- SEM).

CONCLUSIONS

Varicocele treatment can increase serum inhibin B levels, indicating improvement of spermatogenesis and Sertoli cell function. This finding suggests that the pathophysiology of varicocele involves impairment of Sertoli cell function or a different distribution of germ cell stages.

FSH treatment improves sperm function in patients after varicocelectomy

One-hundred and eighty-three patients affected with idiopathic left varicocele, aged between 18 and 45 years, surgically treated have been studied. They were divided in 3 subsets according to sperm count: group A: <10 x 10(6)/ml, group B: 10-20 x 10(6)/ml, group C: >20 x 10(6)/ml. Six months after surgery 115 patients were treated for 3 months with pure human FSH: 75 IU i.m. every other day, while 68 patients treated with placebo served as control group. After therapy, group A showed a significant clear-cut improvement of sperm parameters: count, forward progression, swollen tails and cervical mucus penetration test (CMPT). In group B a significant improvement of sperm motility, viability, DNA integrity and CMPT was observed, while in group C only a significant improvement of CMPT was observed. In conclusion, it can be suggested that FSH treatment in patients after varicocelectomy could improve spermatogenesis, particularly in those who previously have more compromised sperm quality. On the contrary, no significant difference of sperm patterns was recorded in the control group before and after placebo.

Pituitary and testicular function in adolescents with varicocele

The LH and FSH responses post GnRH, and the sex steroid hormone responses post hCG stimulation were evaluated in a group of 41 adolescents (mean age 15.09 +/- 2.27) with unilateral varicocele to study the relation between the pituitary gonadotropin and sex steroid hormone responses to the patients' age and pubertal stages. Twenty-two normal boys (mean age 14.90 +/- 1.97) also were studied. In both groups a GnRH stimulation test was performed. Besides this, an hCG test was performed in 7 patients and 7 controls. No significative differences in the LH and FSH responses to the GnRH stimulus were observed in 14 patients at Tanners' pubertal stages 3 to 4 compared to the controls. Twelve (44.44%) patients at Tanners' pubertal stage 5 presented an excessive LH response at 30 and 60 min after GnRH stimulation compared to 12 age- and pubertal stage-matched controls (p < .001 and p < .05, respectively). They also presented an excessive FSH response at 30 min (p < .05) post-GnRH stimulation. Correlation analysis in these 12 patients revealed a tendency toward a positive association between the patients' age and the LH response post-GnRH stimulation. In this group of adolescents with varicocele the gonadotropin response to the GnRH stimulus was influenced by the patients' age and by their pubertal stage of development independently of the venous dilatation.

Evaluation of the relationship between semen parameters, pregnancy rate of wives of infertile men with varicocele, and gonadotropin-releasing hormone test before and after varicocelectomy

OBJECTIVES

To determine whether the gonadotropin-releasing hormone (GnRH) test can serve as an indicator for the need and timing of surgery in infertile men with varicocele.

METHODS

The GnRH test was performed in 121 infertile men with varicocele before surgical correction and 4 to 6, 9 to 12, and 16 to 18 months after. Levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were evaluated immediately before the test and 45 minutes after intravenous injection of 100 jig Relisorm L (a synthetic GnRH analogue). Eighteen fertile men with normal semen parameters served as control patients for defining the preoperative hormone levels. A more than twofold increase in FSH and a more than fivefold increase in LH was considered a positive result. Findings were correlated with semen parameters and rate of pregnancy in the patients' wives at 18 months postoperatively.

RESULTS

Of the 121 patients, 89 (73.5%) had a positive GnRH test result, and 32 had a negative result. Semen parameters were improved postoperatively in 72 of the GnRH-positive patients (80.9%) and in only 6 of the GnRH-negative patients (1 8.7%). Corresponding pregnancy rates at 18 months in the two subgroups were 60 (67.4%) and 3 (9.3%), respectively.

CONCLUSIONS

A positive preoperative GnRH test is a good predictor of improvement in semen parameters and pregnancy after varicocele surgery. We suggest that the GnRH test can serve as an additional indicator for varicocelectomy.

Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes

PURPOSE

To compare the success of percutaneous varicocele embolization to surgical ligation with regard to changes in semen characteristics and pregnancy outcome.

MATERIALS AND METHODS

Infertility records from 346 men who underwent correction of their varicocele for infertility (surgical ligation 149; embolization 197) were reviewed retrospectively. Preprocedural and postprocedural semen analyses and pregnancy outcomes were obtained with use of chart and telephone follow-up.

RESULTS

In men who successfully impregnated their partners, there were significant improvements in sperm density, percent total improvement, motility, and progression. Postprocedural (embolization vs surgery) percentage increases in seminal parameters were density, 156.8% versus 138.5%; total, 168.8% versus 157.91%; and motility, 2.7% versus 3.2%. The percent of individuals who had a change in sperm progression was 31% versus 41%. There was no statistical difference between the techniques based on t tests. The pregnancy rates were similar for the two groups, 39% and 34% for embolization and surgery, respectively.

CONCLUSION

There is no significant statistical difference in seminal values or pregnancy outcome between the two techniques.

Ligation of the left renal vein in epm1-Wistar rats: functional and morphologic alterations in the kidneys, testes and suprarenal glands

OBJECTIVE

The ligation of the left renal vein (LLVR) in man is a controversial procedure in view of the risks of lesion to the renal parenchyma. With the objective of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats.

MATERIAL AND METHODS

64 male adult EPM1-WISTAR rats were used, divided into 8 groups-4 for LLRV and four for control. Each LLRV group and corresponding control group were sacrificed progressively on the 7th, 15th, 30th and 60th day after the initial surgery.

RESULTS

We found morphofunctional alterations only in animals that underwent LLRV in the four periods of sacrifice. The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also present in these groups, but no sufficient to demonstrate statistical significance.

CONCLUSION

Based on these results we can conclude that the ligation of the left renal vein is a procedure of high risk in these animals.

Diurnal variations in scrotal temperature of normal men and patients with varicocele before and after treatment

Scrotal temperature was monitored using a portable data recorder for periods of 24 h in six normal volunteers and 48 infertile patients with unilateral varicocele while subjects pursued their regular daily activities. Temperatures during sleep (TS) were generally higher than daytime values (TD), probably as a consequence of thermal insulation in bed. These diurnal variations were found to be less pronounced in the infertile patients than in volunteers (TS - TD = 0.29 degrees C +/- 0.06 degrees C vs 0.88 degrees C +/- 0.12 degrees C; P < 0.01). Moreover, scrotal temperatures at night of patients and volunteers were indistinguishable statistically, but were different during daytime hours. After successful ligation or embolization of the spermatic-vein in 16 patients, no change in scrotal temperature was observed. Although sperm counts were higher after treatment, this difference was not significant (67.4 +/- 17.2 x 10(6) vs 105.8 +/- 25.5 x 10(6); P > 0.05). The data support the view that varicocele-related damage to the testis results from a lack of adequate cooling, and that treatment does not normalize the temperature pattern.

Effects of thymosin on the secretion of the sexual hormone in rats with experimental varicocele

Hormonal abnormality in experimental varicocele induced by partial ligation of left renal vein and the effect of thymosin (fraction 5) on the secretion of the sexual hormone were studied in rats. Serum testosterone level was lowered after varicocele formation, but could be reversed or increased by intraperitoneal administration of thymosin 5 mg/rat twice a week for 4 weeks with concomitant increase of testicular testosterone content. Changes in FSH and LH both in serum and testis, determined with immunoassay method as that of testosterone, were insignificant as compared with control or thymosin treated groups.

Pubertal varicocele: correlation between clinical, Doppler, and hormonal findings

Clinical, Doppler, and hormonal findings in puberal patients with unilateral and bilateral varicocele were evaluated. No correlation was found between clinical and hormonal findings. A significant increase was found in LH response to LH-RH in patients with bilateral varicocele as well as an increase in T to hCG in those with unilateral varicocele with prolonged reflux. Further longitudinal, hormonal, and Doppler studies in puberal patients might provide information about the most useful parameters to define those individuals at higher risk of having future problems.

The peritubular myoid cells in the testes from men with varicocele: an ultrastructural, immunohistochemical and quantitative study

Ultrastructural and some immunophenotypic features of the peritubular myoid cells of testes from normal men and from men with varicocele were studied. The seminiferous tubules were classified into five types (a-e), related to the progressive degree of sclerosis measured as thickening of the lamina propria. In normal testes only type a and b tubules were found, whereas the testes from men with varicocele showed type b-e tubules. Myoid cells in tubule types a and b showed slender cytoplasmic projections with abundant, parallel arranged microfilament bundles and electron-dense bodies. In c tubules, the myoid cells showed the same ultrastructure. The myoid cells of tubules with advanced (type d) or complete (type e) sclerosis showed irregularly outlined nuclei, scant microfilament bundles and absence of electron-dense bodies. Immunostaining of myoid cells with anti-actin antibodies was intense in types a-c tubules and scant in types d and e. Immunostaining with anti-desmin antibodies was intense in tubules types a-d, but the immunoreactive cells in types c and d tubules were irregularly shaped and distributed and were scanty in tubule type e. Immunostaining with anti-vimentin antibodies was weak in types a-c tubules and intense in types d and e tubules. Quantitative studies revealed that, with the progression of sclerosis, the numbers of both actin- and desmin-immunoreactive cells per cross-sectioned tubule, and the surface area occupied by the immunostained portion of these cells, decreases while the number of vimentin-immunoreactive cells and their immunostained surface area increases.

Luteinizing hormone secretion by male rat pituitary cells perifused in vitro: effect of experimental left varicocele and orchiectomy

It has been shown previously that experimental left varicocele in the rat, results in a bilateral decrease in intratesticular testosterone. In the present work, pituitary responsiveness to GnRH as a possible mediator of this effect has been examined. Unilateral varicoceles were created in adult rats. A second group of animals underwent a sham operation and a third underwent bilateral orchiectomy. Thirty days after surgery, rats from all three groups were sacrificed and their pituitaries were removed. Dispersed pituitary cells were perifused in Bio-Gel columns with varying concentrations of GnRH. The concentration of LH in the collected eluent was determined by radioimmunoassay. The mean, overall GnRH-stimulated LH immunoreactive secretion rate (ng/min/10(7) cells) by pituitary cells from rats with varicocele (0.062 +/- 0.11) was no different from the overall release from the sham-operated controls (0.051 +/- 0.007). The dose-response curves for GnRH-stimulated release of LH by dispersed pituitary cells in the two groups also were not different. The overall GnRH-stimulated LH release by cells from the orchiectomized rats (0.171 +/- 0.032) was significantly greater than release by cells from the sham-operated and varicocele rats, and the concentration-response curve from the orchiectomy group was significantly elevated over those of the other two groups. These results indicate that GnRH-stimulated immunoreactive LH release is not altered in rats with experimental left varicocele and, thus, is not the source of an endocrinopathy that leads to decreased intratesticular testosterone concentrations in these animals.

The impact of spermatic vein ligation on the male factor in in vitro fertilization-embryo transfer and its relation to testosterone levels before and after operation

Criteria for improved semen quality after varicocele operations are not clear, as they do not express sperm fertilization capacity, its most important qualification. Twenty-two couples, 12 with mechanical female infertility (group I) and 10 with normal female fertility (group II), in whom the husband had subfertile semen in the presence of varicocele, and who had failed preoperative in vitro fertilization-embryo transfer (IVF-ET) attempts, were readmitted for the IVF-ET procedure following the repair of varicocele. In group I, a 20% pregnancy rate was achieved after the operation, while no pregnancies occurred before surgery. In group II, four pregnancies (40%) were achieved after operation. Plasma testosterone (T) levels demonstrated a significant increase in 50% of the patients in both groups after surgery, resulting in a concurrent improved fertilization, cleavage, and pregnancy rates.