Effect of varicocele on fertility potential: comparison between impregnating and nonimpregnating groups

Conventional semen analysis and advanced sperm function tests in diagnosis and management of varicocele

Clinical varicoceles are a common cause of male infertility and affect sperm parameters as measured in a conventional semen analysis. Varicocelectomy has been shown in prospective studies to improve semen parameters in men with a clinical varicocele. Clinical varicoceles are also a well-known source of oxidative stress which may affect the quality of spermatozoa. Spermatozoa are particularly susceptible to oxidative stress due to a limited capacity for DNA repair. The susceptibility of spermatozoa to oxidative stress is modulated by a balance between ROS and antioxidants, which can be quantified by various laboratory assays. Varicocelectomy has been consistently shown to reduce both ROS and sperm DNA fragmentation, and various assays should be utilised in the diagnosis and treatment of infertile men with a clinical varicocele.

Specialized sperm function tests in varicocele and the future of andrology laboratory

Varicocele is a common medical condition entangled with many controversies. Though it is highly prevalent in men with infertility, still it marks its presence in males who do have normal fertility. Determining which patients are negatively affected by varicocele would enable clinicians to better select those men who benefitted the most from surgery. Since conventional semen analysis has been limited in its ability to evaluate the negative effects of varicocele on fertility, a multitude of specialized laboratory tests have emerged. In this review, we examine the role and significance of specialized sperm function tests with regards to varicocele. Among the various tests, analysis of sperm DNA fragmentation and measurements of oxidative stress markers provide an independent measure of fertility in men with varicocele. These diagnostic modalities have both diagnostic and prognostic information complementary to, but distinct from conventional sperm parameters. Test results can guide management and aid in monitoring intervention outcomes. Proteomics, metabolomics, and genomics are areas; though still developing, holding promise to revolutionize our understanding of reproductive physiology, including varicocele.

The effect of varicocele on sperm morphology and DNA maturity: does acridine orange staining facilitate diagnosis?

OBJECTIVE

The aim of this study was to determine whether Acridine Orange (AO) can be used as a routine procedure in a physician's office to detect sperm deoxyribonucleic acid (DNA) fragmentation in patients with varicoceles.

MATERIAL AND METHODS

Forty-five patients with a mean age of 30.4 years, who had been diagnosed with varicoceles by physical examination and 30 healthy males with a mean age of 28.3 years and without any signs of varicoceles were included in this study. Doppler Ultrasonography was performed to each individual in addition to physical examination. Semen analyses were performed by the same biologist. Sperm morphology was evaluated according to the World Health Organization (WHO) criteria and Kruger's strict criteria. After routine semen analysis, the samples were fixed separately for further examination with AO staining.

RESULTS

In routine semen analyses, total sperm count, total motile sperm count, and fast direct forward motile and direct forward motile sperm counts were significantly lower in patients with varicoceles, and the immotile sperm count was significantly higher in patients with varicoceles compared to the control group. Kruger's examination revealed a lower sperm count with normal morphology in patients with varicoceles. After AO staining, the ratio of spermatozoa demonstrating red and green coloration were 6.5±11.0% and 93.5±11.0%, respectively in the varicocele group and 1.0±1.0% and 99.0±1.0%, respectively in the control group (p<0.001).

CONCLUSION

Semen analysis using AO staining can be performed under a clinician's office conditions with a fluorescent microscope without any additional equipment. Further studies are needed to validate the AO staining with more extensively used and well-known methods. Therefore, AO staining can be used as a simple and reliable method that can be performed daily in a physician's office in infertility and andrology clinics.

Are sperm motion parameters influenced by varicocele ligation?

OBJECTIVE

To document objectively, improvements in sperm motion parameters in subfertile men after varicocele ligation with the use of computer-aided sperm analysis.

DESIGN

Retrospective chart review.

SETTING

An academic clinical environment.

PATIENT(S)

Thirty-four men with varicocele as the primary cause of infertility who underwent a physical examination, hormonal profile, and Doppler ultrasound evaluation.

INTERVENTION(S)

Computer-aided sperm analysis was performed before and after either subinguinal or laparoscopic varicocele ligation.

MAIN OUTCOME MEASURE(S)

Patients were followed up for 3-18 months after operation, and average computer-aided sperm analysis values were obtained before and after operation. Computer-aided sperm analysis values were analyzed by paired Student's t-test, with special reference to motility and sperm motion parameters.

RESULT(S)

After varicocele ligation, patients demonstrated increases in mean sperm density and in the overall distribution of sperm with rapid velocity, although the increases were not statistically significant. Mean measures of straightness, linearity, and track speed also were increased after operation, but only progressive sperm velocity was increased to a statistically significant level.

CONCLUSION(S)

Because progressive velocity has been a primary computer-aided sperm analysis parameter predictive of male fertility and the success of assisted reproductive techniques, we conclude that varicocele ligation results in improvements in semen parameters, especially the key parameter of progressive sperm velocity.