Clinical and laboratory profiles of a large cohort of patients with different grades of varicocele

The association between body mass index and varicocele: A meta-analysis

Objective:

Recently, several studies have found that obesity had a protective effect against varicocele, but no meta-analysis has confirmed this finding. Therefore, we conducted this meta-analysis to investigate the association between body mass index (BMI) and varicocele.

Material and Methods:

We searched for studies in PubMed, Science Direct and the Cochrane Library from inception until February 2018. The association between BMI and varicocele was assessed by pooling the odds ratios (ORs).

Results:

Eleven eligible studies with a total study population of 1.376.658 participants were included in our analysis. According to BMI, the subjects were defined as belonging to the obese, overweight and underweight groups. Our results showed that the obese group had a lower risk of varicocele when compared with the normal weight group (odds ratio [OR] 0.46, 95% confidence intervals [CIs] 0.37-0.58). Additionally, an overweight BMI had a protective effect against varicocele (OR 0.70, 95% CIs, 0.56-0.86). However, underweight patients had a more than 30% higher risk of varicocele (OR 1.31, 95% CI, 1.04-1.64). Furthermore, there was no publication bias in any of the analyses.

Conclusions:

Our study demonstrates that BMI is negatively associated with the presence of varicocele.

Lack of trusted diagnostic tools for undetermined male infertility

Semen analysis is the cornerstone of evaluating male infertility, but it is imperfect and insufficient to diagnose male infertility. As a result, about 20% of infertile males have undetermined infertility, a term encompassing male infertility with an unknown underlying cause. Undetermined male infertility includes two categories: (i) idiopathic male infertility-infertile males with abnormal semen analyses with an unknown cause for that abnormality and (ii) unexplained male infertility-males with "normal" semen analyses who are unable to impregnate due to unknown causes. The treatment of males with undetermined infertility is limited due to a lack of understanding the frequency of general sperm defects (e.g., number, motility, shape, viability). Furthermore, there is a lack of trusted, quantitative, and predictive diagnostic tests that look inside the sperm to quantify defects such as DNA damage, RNA abnormalities, centriole dysfunction, or reactive oxygen species to discover the underlying cause. To better treat undetermined male infertility, further research is needed on the frequency of sperm defects and reliable diagnostic tools that assess intracellular sperm components must be developed. The purpose of this review is to uniquely create a paradigm of thought regarding categories of male infertility based on intracellular and extracellular features of semen and sperm, explore the prevalence of the various categories of male factor infertility, call attention to the lack of standardization and universal application of advanced sperm testing techniques beyond semen analysis, and clarify the limitations of standard semen analysis. We also call attention to the variability in definitions and consider the benefits towards undetermined male infertility if these gaps in research are filled.

Differential DNA methylation pattern and sperm quality in men with varicocele

OBJECTIVE

To study the global DNA methylation pattern in spermatozoa of patients with varicocele as well as investigate their semen quality.

DESIGN

Prospective observational case-control study.

SETTING

University-affiliated hospital.

PATIENT(S)

A total of 26 men with varicocele and 26 fertile men without the disorder.

INTERVENTIONS

Analysis of semen quality and sperm DNA methylation patterns.

MAIN OUTCOME MEASURE(S)

Semen quality evaluated by semen analysis, and sperm DNA methylation patterns investigated using the Infinium MethylationEPIC BeadChip platform.

RESULT(S)

Men with varicocele displayed decreased semen quality. The sperm DNA methylation analysis showed that men with varicocele exhibit global hypomethylation in comparison with the control group. A total of 59 differentially methylated CpG sites were identified, most of them hypomethylated in the varicocele group. In regional analyses, 1,695 DNA regions were differentially methylated in men with varicocele. These regions show associations with gamete generation, meiotic and meiosis cell cycle, and semen quality based on gene ontology analysis.

CONCLUSION(S)

Gene ontology results suggest that changes in methylation may be associated with the low semen quality phenotype observed in some varicocele patients because the observed differentially methylated regions in varicocele patients are related to male reproductive pathways. Additionally, the varicocele grade may influence the magnitude of global sperm DNA methylation change. To our knowledge, this is the first report analyzing changes at a regional or CpG-specific level in men with varicocele.

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.

Chronic epididymitis and Grade III varicocele and their associations with semen characteristics in men consulting for couple infertility

Chronic epididymitis and varicocele are frequently observed genital disorders in men consulting for couple infertility, but their impact on semen characteristics at the time of infertility consultation is still a matter of debate. We investigated 652 male partners of couples who had their first infertility consultation between 1999 and 2015 in Argentina. Men with chronic epididymitis (n = 253), Grade III varicocele (n = 106), and both conditions (n = 125) were compared with a control group (n = 168) composed of men without these disorders or any other recognized causes of male infertility. We showed that men who presented isolated chronic epididymitis were more likely to have high percentages of low sperm motility and abnormal sperm morphology as well as a high number of white blood cells. Men with isolated Grade III varicocele had low sperm production and motility and an increased percentage of abnormal sperm morphology. Finally, men who simultaneously presented chronic epididymitis with Grade III varicocele had a low sperm motility and increased percentage of abnormal sperm morphology as well as a high number of white blood cells. Physical examination of the genital organs may identify common disorders, potentially involved as causal factors of patient's infertility. These disorders are associated with specific seminal profiles that should help in identifying the best treatment from the available therapeutic options, effectiveness, safety, and allowing as much as possible natural conception.

Does varicocele grade predict the postoperative changes of semen parameters following left inguinal micro-varicocelectomy?

Objective

To evaluate the relationship between preoperative grade and postoperative changes of semen parameters following left inguinal varicocelectomy.

Methods

This study included 44 patients undergoing left microsurgical inguinal varicocelectomy. Internal spermatic veins were classified as large (4 mm or more in diameter), medium (2-4 mm), or small (2 mm or less). Changes in sperm activity, morphology and count were estimated perioperatively. The introperative findings and semen parameters were compared between varicocele groups of grades 2 and 3.

Results

Both sperm motility and count improved significantly postoperatively (from (31.9 ± 16.3)% to (47.3  ± 15.5)%, from (28.1 ± 28.1) × 10⁶/mL to (52.1 ± 74.2) × 10⁶/mL). In varicoceles with grade 2 and 3, significant differences were found in the number of large veins (0.4 ± 0.6 vs. 1.2 ± 0.7, p < 0.001) and ultrasonographic maximum diameters of spermatic vein in supine and standing positions (2.3 ± 0.4 cm vs. 2.8 ± 0.6 cm, 3.1 ± 0.7 cm vs. 3.9 ± 0.7 cm, p = 0.001 and 0.001 respectively). However no difference of changes in sperm motility and count was detected ((16.3  ±  13.5)% vs. (14.4  ±  12.6)%, (30.5 ± 84.4) × 10⁶/mL vs. (12.9 ± 20.6) × 10⁶/mL respectively, p = 0.65 and 0.40 respectively).

Conclusion

Preoperative varicocele grade might not predict postoperative semen changes regardless of possible existence of anatomic and ultrasonographic associations.