The role of reactive oxygen species and apoptosis in the pathogenesis of varicocele in a rat model and efficiency of vitamin E treatment

Dietary supplements in the management of varicocele-induced infertility: A review of potential mechanisms

Varicocele is a main cause of lower production of spermatozoon and infertility with multiple pathophysiological mechanisms. In the past decades, the use of dietary supplements has significantly increased due to both the modern lifestyle and the food shortages of the industrialised countries. The purpose of this review paper is to collect scientific evidences from basic and clinical studies which support the use of dietary supplements to define the clinical framework for patients with varicocele. In the present review, we used keywords such as dietary supplements, varicocele, male infertility, oxidative stress, DNA fragmentation, sperm parameters to find the proper articles. The standard search biomedical engines were used for seeking the papers. The use of dietary supplements such as minerals, vitamins and antioxidants has an essential role in the prevention and treatment of varicocele by increasing the levels of antioxidant enzymes (e.g. peroxidase, superoxide dismutase and catalase) and decreasing the levels of inflammatory markers (e.g. tumour necrosis factor-α, interleukin-6 and interleukin-1) in testis. According to the results, the dietary supplements may alleviate the spermatogenesis in varicocele patients through different mechanisms such as suppression of stress oxidative and inflammation in testicular tissue.

Increased Sperm DNA Fragmentation in Infertile Men with Varicocele: Relationship with Apoptosis, Seminal Oxidative Stress, and Spermatic Parameters

This study intends to determine the extent of nuclear sperm injury in patients with varicocele and to investigate its relationship with apoptosis and oxidative stress (OS). Ejaculated sperm samples from 51 patients diagnosed with varicocele and 29 fertile men were examined. According to the guidelines, the patient's sperm samples were classified into varicocele with normal semen parameters (n = 11) and varicocele with abnormal semen parameters (n = 40). Sperm DNA fragmentation was assessed using terminal deoxynucleotidyl transferase dUTP nick end labeling assay. The proportion of both viable and dead spermatozoa with externalized phosphatidylserine (PS) was detected by the bivariate annexin V/6-CFDA staining method. Seminal malondialdehyde (MDA) amounts and antioxidant enzymes activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were measured spectrophotometrically. Sperm DNA fragmentation, viable spermatozoa with externalized PS, and MDA levels were significantly higher in studied subgroups of patients with varicocele, either with normal or with abnormal semen parameters than controls. The seminal antioxidant enzymes activities were significantly reduced in both subgroups of patients with varicocele compared to the controls. The percentage of spermatozoa with fragmented DNA was positively correlated to the MDA level as well as the proportion of viable spermatozoa with externalized PS. However, the decreased seminal antioxidant status was negatively correlated with the increased proportion of sperm DNA fragmentation and apoptotic spermatozoa. Impaired seminal antioxidant profile and increased seminal level of lipid peroxidation may be involved in the pathophysiological mechanisms of cell death-mediated DNA breaks in patients with varicocele.

Superoxide Anion Production by the Spermatozoa of Men with Varicocele: Relationship with Varicocele Grade and Semen Parameters

Purpose

To investigate the pathophysiological role of superoxide anion and total reactive oxygen species (ROS) production by the spermatozoa of men with varicocele and its relationship with varicocele grade and semen parameters.

Materials and Methods

This prospective study included 34 men with grade II–III varicocele, regardless of their fertility status. The control group consisted of 13 healthy men. Semen characteristics were examined according to the 2010 World Health Organization criteria. The swim-up method was used for sperm preparation. Total ROS and superoxide anion production was assayed by luminol- and lucigenin-dependent chemiluminescence (CL), respectively.

Results

The men with varicocele had significantly higher total ROS and superoxide anion levels than the healthy control subjects (2.9±0.4 relative light unit (RLU) vs. 2.4±0.1 RLU, p=0.001 for luminol-dependent CL and 2.8±0.4 RLU vs. 2.3±0.2 RLU, p=0.002 for lucigenin-dependent CL). Cases of grade III varicocele had significantly higher superoxide anion and total ROS levels than grade II cases and control subjects (p<0.001). Superoxide anion and total ROS levels were negatively correlated with all semen parameters.

Conclusions

The superoxide anion levels produced by spermatozoa were significantly higher in varicocele patients than in control subjects. ROS production was related to increased varicocele grade, impaired semen concentration, and abnormal morphology in men with varicocele. Our findings suggest that superoxide anion overproduction may be an important step in the cascade of ROS-related damage to spermatozoa, resulting in impaired semen parameters in patients with varicocele.

JG. Semen parameters in men with varicocele: DNA fragmentation, chromatin packaging, mitochondrial membrane potential, and apoptosis

OBJECTIVE

To evaluate varicocele effects on conventional semen parameters: sperm DNA fragmentation, chromatin packaging, mitochondrial membrane potential (MMP) and sperm apoptosis.

METHODS

A cross-sectional study was carried out with semen samples from 2,399 men of couples who attended an infertility clinic. A total of 16.3% (391/2399) of the men were diagnosed with varicocele by a urologist.

RESULTS

A regression analysis revealed that the percentages of sperm with DNA fragmentation, abnormal chromatin packaging, and abnormal MMP were significantly increased in individuals with varicocele, when compared to men without varicocele. Apoptosis was not influenced by varicocele. Conventional semen parameters were significantly worse in individuals with the disease. On the other hand, in men with varicocele, Spearman's correlation demonstrated that early apoptosis and abnormal MMP showed a positive and significant correlation with sperm DNA fragmentation.

CONCLUSION

Men with varicocele had worse semen parameters, including increased levels of sperm DNA fragmentation, inactive mitochondria, and abnormal chromatin packaging. These changes are possible causes of infertility in individuals with varicocele.

Grape seed proanthocyanidin extract attenuates varicocele‑induced testicular oxidative injury in rats by activating the Nrf2‑antioxidant system

The present study investigated whether grape seed proanthocyanidin extract (GSPE) can attenuate varicocele‑induced testicular oxidative injury through the nuclear factor (erythroid‑derived 2)‑like 2 (Nrf2) antioxidant pathway. A varicocele model in rats was established by partial ligation of the left renal vein. Following 4 weeks of GSPE administration, the decreased sperm count and motility and other pathological changes caused by varicocele were significantly alleviated, as indicated by the results of computer‑assisted sperm analysis and hematoxylin and eosin staining. In addition, the decreased antioxidant enzyme (superoxide dismutase and glutathione peroxidase) activity and elevated oxidative stress level were partially reversed by administration of GSPE. Furthermore, the apoptotic level of the testis induced by varicocele was decreased by the GSPE treatment, according to terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Additionally, the expression of apoptosis‑related proteins, including B‑cell lymphoma 2 (Bcl‑2), Bcl‑2‑like protein 4 and cleaved caspase‑3, were also affected by GSPE. GSPE activated Nrf2, which is a key antioxidative transcription factor, with elevation of the downstream factor hemeoxygenase‑1. These findings suggest that GSPE can ameliorate abnormal spermatogenesis and testicular injury in varicocele rats, potentially due to its antioxidative activity and ability to activate the Nrf2 pathway.

Evaluation of sperm protamine deficiency and apoptosis in infertile men with idiopathic teratozoospermia

Objective

Sperm morphology plays an important role in infertility, especially in cases of defects in the heads of spermatozoa. Tapered-head or elongated-head spermatozoa are examples of morphological abnormalities. The aim of this study was to compare the semen parameters, levels of protamine deficiency, and frequency of apoptosis between patients with normozoospermia and those with teratozoospermia with tapered-head spermatozoa.

Methods

Fifty-two semen samples (27 patients with tapered-head sperm and 25 fertile men) were collected and semen analysis was performed according to the World Health Organization criteria for each sample. Protamine deficiency and the percentage of apoptotic spermatozoa were evaluated using chromomycin A3 (CMA3) staining and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) assays, respectively.

Results

Sperm concentration, motility, and normal morphology in the tapered-head spermatozoa (cases) were significantly lower than in the normozoospermic samples (controls). CMA3-reactive spermatozoa (CMA3+) in the case group were more common than in the controls. Apoptotic spermatozoa (TUNEL-positive) were significantly more common in the cases than in the controls.

Conclusion

This analysis showed that tapered-head spermatozoa contained abnormal chromatin packaging and exhibited a high rate of apoptosis, which can be considered to be an important reason for the impaired fertility potential in teratozoospermic patients with tapered-head spermatozoa.

Short-term effects of troxerutin (vitamin P4) on muscle fatigue and gene expression of Bcl-2 and Bax in the hepatic tissue of rats

In the current study, the effects of troxerutin (TRX) on muscle fatigue and gene expression of Bcl-2 and Bax in the hepatic tissue of rats was investigated. Forty male Wistar rats were randomly divided into 4 groups and designated as control and TRX treatment at 75 (TRX75), 150 (TRX150), and 300 mg/kg per day (TRX300). The treated groups and control group received TRX and water orally for 7 days. After an exhaustive swimming test on the 7th day, all animals were euthanized immediately and several biochemical parameters related to fatigue and gene expression of Bcl-2 and Bax in the hepatic tissue were measured. Our results showed that the exhaustion swimming time in the TRX300 groups significantly increased 1.2-fold compared with the control group (P < 0.001). TRX300 significantly reduced ALT (P < 0.05) activity and increased liver SOD activity compared with the control group (P < 0.01). Additionally, TRX significantly reduced the liver mRNA expressions of Bax (P < 0.001) and increased the Bcl-2/Bax ratio (P < 0.001) compared with the control group. Based on our data, TRX possesses anti-apoptotic and hepatoprotective action following exhaustive swimming exercise.

Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation

Varicocele has been associated with reduced male reproductive potential. With the advances in biomolecular techniques, it has been possible to better understand the mechanisms involved in testicular damage provoked by varicocele. Current evidence suggests the central role of reactive oxygen species (ROS) and the resultant oxidative stress (OS) in the pathogenesis of varicocele-associated male subfertility although the mechanisms have not yet been fully described and it is likely to be multifactorial. Excessive ROS is associated with sperm DNA fragmentation, which may mediate the clinical manifestation of poor sperm function and fertilization outcome related to varicocele. Testing of ROS/OS and DNA fragmentation has the potential to provide additional diagnostic and prognostic information compared to conventional semen analysis and may guide therapeutic management strategies in individual patient.

Outcome of Varicocelectomy with Different Degrees of Clinical Varicocele in Infertile Male

Aim. To evaluate the prevalence and effect of varicocele repair on sperm motility, sperm concentration, testicular volume, and pregnancy rate in different degrees of clinical varicocele. Material and Methods. The case records were retrospectively evaluated for 482 infertile patients with varicocele who underwent varicocelectomy from December 2008 to December 2013. Semen analysis of patient at preoperative and 3-, 6-, and 12-month postoperative period was done. Varicocele was graded as per the World Health Organization grading (WHO 1993) system and included in the study. Testicular volume was noted by ultrasonography in pre- and postoperative period in one-year follow-up. Pregnancy rate was calculated at 3, 6, and 12 months of follow-up. Results. Significant differences were seen in sperm motility and concentration of patients with Grade 3 varicocele as compared with Grade 1 and Grade 2 varicocele. Significant increase in testicular volume was present after one year in Grade 3 varicocele in the postoperative period. There was significant correlation between the testicular volume and the sperm concentration. Percentage of spontaneous pregnancy in 1 year after varicocele treatment was 32 to 41% of cases. Conclusion. Varicocelectomy significantly improved sperm motility, concentration, and testicular volume. There were 32 to 41% of infertile patients who achieved pregnancy spontaneously.

Tert-butylhydroquinone attenuates scrotal heat-induced damage by regulating Nrf2-antioxidant system in the mouse testis

Tert-butylhydroquinone (tBHQ), a widely used nuclear factor erythroid 2-related factor 2 (Nrf2) activator, was always employed to investigate the potential protective role of Nrf2 activation. In this study, to elucidate the effect of tBHQ on scrotal heat-induced damage and Nrf2-antioxidant system in mouse testes, eight-week-old mice were administrated with or without dietary tBHQ (1%w/w) for 1week and afterward subjected to a single scrotal heat treatment (42°C for 25min). Trunk blood and testes were collected 3h or 1, 2, or 7days later. Mice displayed less germ cell loss in testes, higher relative testis weight and lower testosterone concentration on day 2 in tBHQ treatment group. Before heat treatment, there were significant increases in malondialdehyde (MDA) concentration in tBHQ treatment group. After heat treatment, mice in tBHQ treatment group showed lower MDA concentration than those in non-tBHQ treatment group. In addition, both tBHQ pretreatment and scrotal heat treatment induced markedly increased Nrf2 protein expression in cytoplasm and nuclei of interstitial cells, accompanying with elevated mRNA expression of Nrf2 and Nrf2-regulated genes in mice testes. Our data indicated that pretreatment to tBHQ induced a mild oxidative stress, and further enhanced the cellular antioxidative ability to protect testicular cells against scrotal heat-induced damage via a mechanism that might involve the Nrf2-antioxidant system in mice testes.

Seminal BAX and BCL2 gene and protein expressions in infertile men with varicocele

OBJECTIVE

To assess seminal BAX and BCL2 gene and protein expressions in infertile men with varicocele (Vx).

MATERIALS AND METHODS

A total of 111 men were investigated and divided into the following groups: healthy fertile men (n = 20), fertile men with Vx (n = 16), infertile oligoasthenoteratozoospermic men without Vx (n = 29), and infertile oligoasthenoteratozoospermic men with Vx (n = 46). They were subjected to history taking, clinical examination, and semen analysis. In their seminal plasma, BAX and BCL2 gene and protein expressions were estimated.

RESULTS

The mean level of seminal BAX gene and protein was significantly decreased, and the mean level of seminal BCL2 gene and protein was significantly increased in fertile men compared with fertile men with Vx and in infertile men without Vx compared with infertile men with Vx. The mean level of seminal BAX gene and protein were significantly increased in men associated with bilateral Vx compared with men associated with unilateral Vx and in cases with Vx grade III compared with Vx grade I and II cases. Seminal BAX demonstrated significant negative correlation with sperm concentration, sperm motility, and sperm normal forms. Seminal BCL2 demonstrated significant positive correlation with sperm concentration, sperm motility, and sperm normal forms and significant negative correlation with seminal BAX.

CONCLUSION

Seminal BAX is significantly increased and seminal BCL2 is significantly decreased in men associated with Vx. Seminal BAX is significantly increased in men associated with bilateral Vx compared with unilateral Vx and in cases with Vx grade III compared with Vx grade I and II cases. Seminal BAX demonstrates significant negative correlation with sperm concentration, sperm motility, and sperm normal forms, whereas seminal BCL2 demonstrates significant reverse positive correlations.

The role of animal models in the study of varicocele

Varicocele is the most common correctible cause of male infertility and is present in 15% to 20% of the male population. Despite its prevalence, the pathophysiology of varicocele remains under investigation. One of the largest obstacles in studying varicocele is that it is almost exclusively found in humans. This has necessitated the creation of an animal model of varicocele. The most commonly used animal model involves the creation of a varicocele in a rodent by partially occluding the left renal vein. This model has provided a significant amount of data on varicocele, and a modification of this model utilizing microsurgery appears even more promising. Animal models have proven critical to investigating the pathophysiology of varicocele.

Impact of micronised purified flavonoid fraction on increased malondialdehyde and decreased metalloproteinase-2 and metalloproteinase-9 levels in varicocele: outcome of an experimentally induced varicocele

To analyse the levels of an indirect marker of ROS-induced lipid peroxidation [i.e. malondialdehyde (MDA)] in both testes and the levels of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and matrix metalloproteinase inhibitor-1 (TIMP-1) in the left testis after induction of varicocele and investigated the impact of micronised purified flavonoid fraction (MPFF) on these markers. Forty-nine adolescent (6-week-old) male Wistar rats were included in this study. The rats were divided into seven groups as follows:Group-1, control; Group-2, sham; Group-3, left varicocele-induced; Group-4, varicocele + varicocelectomy + MPFF-treated (for 4 weeks); Group-5, varicocele + MPFF-treated (for 8 weeks); Group-6, varicocele-induced and 4 weeks later, MPFF-treated (for 4 weeks); and Group-7, varicocele + varicocelectomy. MDA was measured in the tissues of both testes using the thiobarbituric acid reactivity method. The ELISA method was used for the quantification of MMP-2, MMP-9 and TIMP-1 in the left testicular tissue. The levels of MDA were significantly higher in the varicocele group than in the other groups. The MDA levels in the left testicular tissues of Group-7 were significantly higher than those of Group 4 (P = 0.03). In the varicocele group, the MMP-2 and MMP-9 levels decreased, whereas the levels of TIMP-1 increased. The tissue levels of MMP-2 in Groups 4, 5 and 7 were significantly higher than those in Group 1 (P < 0.05).

Insight into oxidative stress in varicocele-associated male infertility: part 2

Varicocele, the leading cause of male infertility, can impair spermatogenesis through several pathophysiological mechanisms. Of these, current evidence suggests that oxidative stress is the central element contributing to infertility in men with varicocele, to which the testis responds by way of heat stress, ischaemia or production of vasodilators, such as nitric oxide. Surgical varicocele repair (varicocelectomy) is beneficial not only for alleviating oxidative stress-associated infertility, but also for preventing and protecting against the progressive character of varicocele and its consequent upregulations of systemic oxidative stress. However, antioxidant therapy in infertile men with surgically treated and those with untreated varicocele is poorly studied, and well-designed trials are needed.

The effect of micronized purified flavonoid fraction on the prevention of testicular pathologies in adolescent rats with experimentally induced varicocele

PURPOSE

We investigated the effect of micronized purified flavonoid fraction on the prevention of testicular pathologies following varicocele induction.

MATERIALS AND METHODS

A total of 66 adolescent (6-week-old) male Wistar rats were included in study. Rats were divided into 7 groups, including group 1--control, group 2--sham operation, group 3--left varicocele induced, group 4--varicocele induced, varicocelectomy done 4 weeks later and micronized purified flavonoid fraction administered for 4 weeks, group 5--varicocele induced and micronized purified flavonoid fraction administered for 8 weeks, group 6--varicocele induced and beginning 4 weeks later micronized purified flavonoid fraction administered for 4 weeks, and group 7--varicocele induced and varicocelectomy done 4 weeks later. Before sacrifice bilateral real-time testicular microvascular perfusion of all rats was measured using the PeriFlux System 5000 PF 5010 LDPM Unit (Perimed, Järfälla, Sweden). All testes were graded according to the Johnsen scoring system. To assess apoptosis caspase-3 levels were measured.

RESULTS

Testicular weight in group 3 was markedly decreased and the extent of seminiferous tubular damage was significantly increased compared with the other groups. Bilateral testicular blood flow and the number of apoptotic germ cells were greater in group 3. Significantly higher Johnsen scores and a meaningful decrease in the apoptotic index were detected in groups 4 to 7 compared with group 3.

CONCLUSIONS

We observed favorable effects of micronized purified flavonoid fraction on the regression of testicular damage secondary to varicocele.

Effects of anthocyanin extracted from black soybean seed coat on spermatogenesis in a rat varicocele-induced model

Varicocele is the most common cause of primary male infertility and is associated with oxidative stress. The aim of the present study was to investigate the effects of anthocyanin on a rat model of varicocele. Twenty-four male rats were divided into four experimental groups: a normal control group, a varicocele-induced control group and two varicocele-induced groups treated with either 40 or 80mgkg(-1), p.o., anthocyanin for 4 weeks. Varicocele was induced by the partial obstruction of the left renal vein. After 8 weeks, the testes and epididymides from rats in all groups were removed, weighed and subjected to histological examination and semen analysis. Apoptosis in the testes was determined by terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labelling (TUNEL) and oxidative stress was assessed by measuring 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels. Although no significant differences in sperm counts were observed among the groups, anthocyanin treatment of the varicocele-induced groups resulted in significantly increased testes weight, sperm motility and spermatogenic cell density (P<0.05). Anthocyanin treatment also significantly decreased apoptotic body count and 8-OHdG concentrations (P<0.05). We suggest that the antioxidant effect of anthocyanin prevented the damage caused by varicocele-induced reactive oxygen species.

Sperm caspase-9 in oligoasthenoteratozoospermic men with and without varicocele

OBJECTIVE

To assess sperm caspase-9 activity in infertile oligoasthenoteratozoospermic (OAT) men with and without varicocele.

DESIGN

Prospective.

SETTING

Academic setting.

PATIENT(S)

Eighty men: healthy fertile control subjects (n = 20), OAT (n = 25), and OAT associated with left-side varicocele (n = 35).

INTERVENTION(S)

History taking, clinical examination, semen analysis,assessment of seminal caspase-9.

MAIN OUTCOME MEASURE(S)

Semen analysis, sperm caspase-9.

RESULT(S)

Sperm caspase-9 was significantly increased in infertile OAT men associated with varicocele compared with OAT men without varicocele and healthy fertile control subjects. Sperm casapse-9 activity demonstrated significant negative correlation with sperm count, sperm motility, sperm velocity, sperm linear velocity, sperm linearity index, and sperm normal morphology.

CONCLUSION(S)

Sperm caspase-9 is exaggerated in infertile OAT cases with varicocele compared with infertile OAT cases without varicocele or healthy fertile men. Sperm caspase-9 demonstrated significant negative correlation with semen variables.

Reactive oxygen species in the internal spermatic and brachial veins of patients with varicocele-induced infertility

Purpose

The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility.

Materials and Methods

Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared.

Results

The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels.

Conclusions

Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

Seminal reactive oxygen species-antioxidant relationship in fertile males with and without varicocele

The aim of this study was to assess seminal reactive oxygen species (ROS)-antioxidants relationship in fertile and infertile men with and without varicocele. One hundred and seventy six males were studied; fertile healthy volunteers (n = 45), fertile men with varicocele (n = 45), infertile oligoasthenozoospermia (OA, n = 44) without varicocele and infertile OA with varicocele (n = 42). In their seminal plasma, two ROS parameters (malondialdehyde, hydrogen peroxide) and five antioxidants (superoxide dismutase, catalase, glutathione peroxidase, vitaminE, vitaminC) were estimated. Compared with fertile healthy men, in all other studied groups, estimated seminal ROS were significantly higher and estimated antioxidants were significantly lower. Infertile men with varicocele showed the same relationship as infertile men without varicocele. Sperm concentration, total sperm motility as well as sperm normal forms were negatively correlated with seminal malondialdehyde and were positively correlated with vitaminC. It is concluded that varicocele has an oxidative stress (OS) in fertile normozoospermic bearing conditions. This may allow understanding that, within men with varicocele, there is a threshold value of OS over which male fertility may be impaired.

Programmed cell death in varicocele-bearing testes

Accelerated apoptosis is a significant factor in the pathophysiology of male infertility disorders associated with abnormal spermatogenesis. This study aimed to investigate apoptosis in varicocele-bearing testes. Sixty four men with varicocele (18 fertile and 46 infertile) were studied compared with eight men with obstructive azoospermic as controls. Apoptosis was assessed in testicular biopsy specimens using terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) method as well as electron microscopy. The results demonstrated that the occurrence of apoptotic changes comprised all types of germ cells but not affecting Sertoli cells. Mean tubular apoptotic indices of fertile or infertile men with varicocele were significantly higher than controls (mean +/- SD 4.55 +/- 1.03%, 6.29 +/- 1.82% versus 2.71 +/- 0.45%, P < 0.05). Mean Leydig cells apoptotic indices of infertile men with varicocele were significantly higher than those of fertile men without varicocele as well as controls (1.18 +/- 0.38%, 0.68 +/- 0.15%, 0.31 +/- 0.21%, P < 0.05). Apoptotic indices were nonsignificantly correlated with Johnsen score, testicular volume or varicocele grade. It is concluded that testicular apoptosis is increased in varicocele-associated men either fertile or infertile who may be implicated in associated spermatogenic dysfunction.

Effects of epidermal growth factor on sperm content and motility of rats with surgically induced varicoceles

AIM

To investigate the effect of epidermal growth factor (EGF) on the sperm content and motility of the varicocelized rats.

METHODS

Forty-eight male Wistar rats were randomly divided into five groups. Experimental varicocele was induced by partial ligation of the left renal vein in the varicocele, the varicocele repair, the varicocele with EGF and the varicocele repair with EGF groups, whereas the control group only received a sham induction of varicocele. Surgical repair of varicocele was performed 4 months later in the varicocele repair and varicocele repair with EGF groups. EGF administration was performed daily by s.c. injection in the varicocele with EGF and varicocele repair with EGF groups at the dose of 10 microg/(kg.day) from the next day of the second surgery. One month later, all animals were killed and bilateral cauda epididymal sperm counts and motility were evaluated.

RESULTS

The mean sperm count and percentage of motile spermatozoa were significantly higher bilaterally in the varicocele with EGF group than in the varicocele group (P < 0.05). They were also significantly higher bilaterally in the varicocele repair with EGF group than in the varicocele repair and the varicocele with EGF groups (P < 0.05).

CONCLUSION

EGF can improve bilateral epididymal sperm content and motility of the rat with surgically induced varicocele. The administration of EGF in combination with surgical repair is more effective than surgical repair or EGF administration alone. EGF might be useful for the treatment of infertility induced by varicocele.

Increased sperm DNA damage in patients with varicocele: relationship with seminal oxidative stress

BACKGROUND

The pathophysiology of the testicular damage in varicocele has not been completely understood. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility. The current study was designed to determine the extent of sperm nuclear DNA damage in patients with varicocele and to examine its relationship with oxidative stress.

METHODS

Semen samples from 55 patients with clinical varicocele and 25 normozoospermic donors were examined. Varicocele sperm samples were classified as normal or abnormal according to World Health Organization guidelines. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry and by the terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity were assessed by a chemiluminescence assay.

RESULTS

DNA fragmentation index (DFI) (percentage of sperm with denatured DNA) values and the percentage of TUNEL-positive cells were significantly greater in patients with varicocele, either with normal (DFI, 20.7 +/- 4.0; TUNEL positive, 26.1 +/- 3.2) or with abnormal (DFI, 35.5 +/- 9.0; TUNEL positive, 32.2 +/- 4.1) semen profile, compared with controls (DFI, 7.1 +/- 0.9; TUNEL positive, 14.2 +/- 1.2). Similarly, ROS levels were significantly higher (P < 0.01) in both groups of patients with varicocele.

CONCLUSIONS

The presence of a varicocele is associated with high levels of DNA-damage spermatozoa even in the presence of normal semen profile. The results also indicate that oxidative damage is associated with sperm DNA damage in these patients.