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Kavoussi PK, Gupta C, Shah R. Varicocele and nonobstructive azoospermia. Asian J Androl 2024:00129336-990000000-00216. [PMID: 39104262 DOI: 10.4103/aja202444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/18/2024] [Indexed: 08/07/2024] Open
Abstract
Approximately 15% of men in the general population have varicoceles, and varicoceles are diagnosed in 40% of men presenting for fertility evaluations. One percent of men in the general population are azoospermic, and 15% of men presenting for fertility evaluations are diagnosed with azoospermia. This article aims to review the impact of varicoceles on testicular function in men with azoospermia, the impact of varicocele repair on the semen parameters of azoospermic men, and the impact of varicocele repair on sperm retrieval and pregnancy outcomes when the male partner remains azoospermic after varicocele repair.
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Affiliation(s)
- Parviz K Kavoussi
- Department of Reproductive Urology, Austin Fertility and Reproductive Medicine/Westlake IVF, Austin, TX 78746, USA
| | - Chirag Gupta
- Department of Urology, Matratva Fertility and Andrology Clinic, Jaipur National University, Jaipur, Rajasthan 302017, India
| | - Rupin Shah
- Department of Urology/Andrology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra 400050, India
- Department of Urology/Andrology, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra 400004, India
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Ramon R, Warli SM, Siregar GP, Prapiska FF, Kadar DD, Tala MRZ. Varicocele repair in improving spermatozoa, follicle-stimulating hormone, and luteinizing hormone parameters in infertile males with azoospermia: a systematic review and meta-analysis. Asian J Androl 2024:00129336-990000000-00199. [PMID: 38877692 DOI: 10.4103/aja202426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/11/2024] [Indexed: 06/16/2024] Open
Abstract
ABSTRACT Patients with azoospermia show a prevalence of varicocele of 10.9% and a 14.8% contribution to male infertility. Patients with azoospermia are thought to produce high-quality semen following varicocele treatment. Advising varicocelectomy prior to sperm retrieval in a reproductive program is still debated. This study reviewed the impact of varicocele repair on male infertility using several factors. A literature search was conducted using Scopus, PubMed, Embase, the Wiley Online Library, and Cochrane databases. Sperm concentration, sperm progression, overall sperm motility, sperm morphology, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were also compared. Outcomes were compared between those who received treatment for varicocele and those who did not. The data from the pooled analysis were presented as standardized mean difference (SMD) along with a 95% confidence interval (CI). Heterogeneity was evaluated using I2. Additionally, we conducted analyses for publication bias, sensitivity, and subgroup analysis as appropriate. Nine studies were included after screening relevant literature. Statistical analysis revealed a significant improvement in sperm concentration (SMD: 1.81, 95% CI: 0.84-2.77, P < 0.001), progressive sperm motility (SMD: 4.28, 95% CI: 2.34-6.22, P < 0.001), and sperm morphology (SMD: 3.59, 95% CI: 2.27-4.92, P < 0.001). Total sperm motility showed no significant difference following varicocele repair (SMD: 0.81, 95% CI: -0.61-2.22, P = 0.26). No significant differences were seen in serum FSH (SMD: 0.01, 95% CI: -0.16-0.19, P = 0.87) and LH (SMD: 0.19, 95% CI: -0.01-0.40, P = 0.07) levels as well. This study supports varicocele repair in infertile men with clinical varicocele, as reflected by the improvement in sperm parameters after varicocelectomy compared with no treatment. There were no significant improvements in serum FSH and LH levels.
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Affiliation(s)
- Ryan Ramon
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Medan 20136, Indonesia
| | - Syah Mirsya Warli
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan 20136, Indonesia
- Department of Urology, Universitas Sumatera Utara Hospital - Universitas Sumatera Utara, Medan 20154, Indonesia
| | - Ginanda Putra Siregar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan 20136, Indonesia
| | - Fauriski Febrian Prapiska
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan 20136, Indonesia
| | - Dhirajaya Dharma Kadar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan 20136, Indonesia
| | - Mohd Rhiza Z Tala
- Department of Obstetric and Gynaecology, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital, Medan 20136, Indonesia
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El-Shimi BI, Mohareb RM, Ahmed HH, Abohashem RS, Mahmoud KF, Hanna DH. Mechanistic Insights into Bisphenol A-Mediated Male Infertility: Potential Role of Panax Ginseng Extract. Chem Biodivers 2024:e202400480. [PMID: 38818674 DOI: 10.1002/cbdv.202400480] [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: 02/27/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/01/2024]
Abstract
Male infertility is identified by the inability of a man to successfully impregnate his fertile female partner, even following a year of regular unprotected sexual intercourse. About half of all infertility cases are attributed to what is known as "male factor" infertility. The escalating prevalence of male infertility in the contemporary era across the globe can be largely attributed to environmental pollution, which is the common etiological factor due to the ubiquitous presence of the environmental contaminants. Bisphenol A is recognized as an endocrine-disrupting chemical that has adverse effects on both male and female reproductive systems. On the other hand, numerous studies have demonstrated that Panax ginseng possessed the potential to improve male infertility parameters; promote spermatogenesis, recover the quality and motility of sperm and enhance testicular functions as it acted as a natural androgen supplement. The objective of this review is to offer a summary of the findings obtained from the current research data on the insult of bisphenol A (BPA) on male infertility and its supposed mode of action, as well as shed light on the potent ameliorative role of Panax ginseng extract, with a special focus on the mechanism behind its action. This review delivers a clear understanding of BPA mechanism of action on male infertility and the presumed risks deriving from its exposure. Also, this review provides evidence for the functional role of Panax ginseng extract in restoring male fertility.
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Affiliation(s)
- Basma I El-Shimi
- Chemistry Department, Faculty of Sciences, Cairo University, Giza, Egypt
| | - Rafat M Mohareb
- Chemistry Department, Faculty of Sciences, Cairo University, Giza, Egypt
| | - Hanaa H Ahmed
- Hormones Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
- Stem Cell Lab., Centre of Excellence for Advanced Science, National Research Centre, Dokki, Giza, Egypt
| | - Rehab S Abohashem
- Hormones Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
- Stem Cell Lab., Centre of Excellence for Advanced Science, National Research Centre, Dokki, Giza, Egypt
| | - Khaled F Mahmoud
- Food Technology Department, National Research Centre, Dokki, Giza, Egypt
| | - Demiana H Hanna
- Chemistry Department, Faculty of Sciences, Cairo University, Giza, Egypt
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Alkhayal A, Aljumaiah S, Alyami A, Abumelha S, Alrabeeah K. Varicocelectomy outcomes among patients with azoospermia and severe oligasthenoteratozoospermia. Urol Ann 2024; 16:60-63. [PMID: 38415238 PMCID: PMC10896319 DOI: 10.4103/ua.ua_24_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/28/2023] [Indexed: 02/29/2024] Open
Abstract
Background Varicocele is a reversible cause of male infertility. However, there are conflicting data available concerning the benefit of varicocele repair for patients with nonobstructive azoospermia (NOA) and severe oligoasthenoteratozoospermia (OAT). Objective To address the benefit of varicocelectomy in patients with severe OAT and NOA with regard to their semen parameters and surgical sperm retrieval rate in those who underwent testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). Materials and Methods This retrospective cohort study was conducted on a sample of 13 patients diagnosed with NOA and severe OAT who underwent varicocelectomy for infertility treatment with no prespecified exclusion criteria. Results Thirteen patients were enrolled. Five patients were diagnosed with NOA; eight were diagnosed with severe OAT. For improvements in the semen parameters postoperatively, the semen concentration of all patients was significantly increased compared to the preoperative concentration (3.59 ± 10.0.8 vs. 0.25 ± 0.31, P = 0.02) and the remaining parameters were unchanged. Regarding sperm retrieval, three patients underwent TESE and two patients underwent TESA, in which all had positive results. Conclusion Varicocele repair was found to improve the semen parameters in patients with NOA and severe OAT and produced a successful surgical sperm retrieval rate in all patients who underwent TESA or TESE.
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Affiliation(s)
- Abdullah Alkhayal
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sahar Aljumaiah
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali Alyami
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saad Abumelha
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khalid Alrabeeah
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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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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Adamczewska D, Słowikowska-Hilczer J, Walczak-Jędrzejowska R. The Fate of Leydig Cells in Men with Spermatogenic Failure. Life (Basel) 2022; 12:570. [PMID: 35455061 PMCID: PMC9028943 DOI: 10.3390/life12040570] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/25/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
The steroidogenic cells in the testicle, Leydig cells, located in the interstitial compartment, play a vital role in male reproductive tract development, maintenance of proper spermatogenesis, and overall male reproductive function. Therefore, their dysfunction can lead to all sorts of testicular pathologies. Spermatogenesis failure, manifested as azoospermia, is often associated with defective Leydig cell activity. Spermatogenic failure is the most severe form of male infertility, caused by disorders of the testicular parenchyma or testicular hormone imbalance. This review covers current progress in knowledge on Leydig cells origin, structure, and function, and focuses on recent advances in understanding how Leydig cells contribute to the impairment of spermatogenesis.
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Affiliation(s)
| | | | - Renata Walczak-Jędrzejowska
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, 92-213 Lodz, Poland; (D.A.); (J.S.-H.)
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Kaltsas A, Markou E, Zachariou A, Dimitriadis F, Mamoulakis C, Andreadakis S, Giannakis I, Tsounapi P, Takenaka A, Sofikitis N. Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:811487. [PMID: 36303681 PMCID: PMC9580802 DOI: 10.3389/frph.2022.811487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
The knowledge on male reproduction is constantly expanding, especially in treating infertility due to non-obstructive azoospermia (NOA). Varicocele is occasionally diagnosed in a subpopulation of males with NOA. Varicocele repair in NOA-men may contribute to the reappearance of spermatozoa in semen. However, spontaneous pregnancies are observed in only a small percentage of NOA-men post-varicocelectomy. Additionally, it has been reported that the repair of varicocele in NOA-men (before the performance of sperm retrieval techniques) may increase the testicular sperm recovery rate. In addition, it increases the pregnancy rate in intracytoplasmic sperm injection (ICSI) programs in NOA-men without spermatozoa in the semen post-varicocelectomy. In addition, to the improvement in Sertoli cellular secretory function, varicocelectomy may increase the secretory function of Leydig cells, which subsequently results in improved androgen production, raising the probability to negate the need for testosterone replacement therapy in cases of late-onset hypogonadism. On the other hand, the benefit of varicocelectomy in patients with NOA is still debatable. The current review study aims to provide a critical and extensive review of varicocele repair in males with NOA. This study additionally focuses on the impact of varicocele repair on sperm retrieval rates and its influence on the ICSI outcomes for those couples who remain negative for spermatozoa in their semen samples post-varicocelectomy.
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Affiliation(s)
- Aris Kaltsas
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
- *Correspondence: Aris Kaltsas
| | - Eleftheria Markou
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Athanasios Zachariou
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Fotios Dimitriadis
- Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Sotirios Andreadakis
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Giannakis
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Panagiota Tsounapi
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - Atsushi Takenaka
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - Nikolaos Sofikitis
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Shaeer O, Fawzy Ghaly M, Ibrahim ER, Abdelmotaleb ME, AbdelRahman IFS, Shaeer K. Effect of vas ligation on testicular sperm extraction results in nonobstructive azoospermic rats: Shaeer's lock-in technique. Andrologia 2021; 53:e14170. [PMID: 34196417 DOI: 10.1111/and.14170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022] Open
Abstract
This study evaluates the efficacy of vas ligation in enhancing sperm retrieval in nonobstructive azoospermia cases, by accumulating intratesticular spermatozoa. Fifty-six mature male rats with equally sized testes were included in this study. Forty-six were in the study group, and 10 were in the control group. Bilateral testicular fine needle aspiration was performed for all, to confirm presence of spermatozoa in all testes. Nonobstructive azoospermia was induced in all 56 rats, using Dienogest (40 mg/kg) + Testosterone Undecanoate (25 mg/kg) every month for three months. Monthly aspirations confirmed nonobstructive azoospermia from all rats, within the three months treatment. This was followed by unilateral vas ligation and was performed for 46 rats of the study group, with no ligation performed in the control group. After a further period of 90 days (2 spermatogenic cycles) with the same medical treatment maintained, bilateral testicular sperm extraction was performed. Sperm retrieval was evaluated, comparing the outcome of vas-ligated testicles to the nonligated. Upon evaluation, spermatozoa were found in 14/46 of the vas-ligated testes (30.4%), compared to none of the nonligated (0/66), p = .0005. Ligation of the vas deferens in rats with nonobstructive azoospermia may enhance the results of sperm retrieval via sperm accumulation.
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Affiliation(s)
- Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Fawzy Ghaly
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ehab Refat Ibrahim
- Department of Histology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Islam Fathy Soliman AbdelRahman
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt.,Armed Forces College of Medicine, Cairo, Egypt
| | - Kamal Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
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Obstructive oligospermia: the role of interventional radiology in its diagnosis and treatment. Pol J Radiol 2021; 86:e204-e207. [PMID: 34093916 PMCID: PMC8147715 DOI: 10.5114/pjr.2021.105590] [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] [Received: 08/25/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose According to the latest World Health Organization guidelines (2010), oligo-sperm it is due to a sperm concentration of less than 15 million/ml of seminal fluid. The cause can be obstructive and non-obstructive. Interventional radiology allows diagnosis and, in some cases, minimally invasive treatment. Case presentation A 28-year-old man with oligospermia (7 million/ml of seminal fluid), surgically treated 2 years ago for clinical grade III bilateral varicocele (according to Dubin’s classification), was admitted to the Urology Department for suspected accidental surgical ligation of the left vas deferens. The patient underwent several diagnostic tests including phlebography of the left pampiniform plexus, bilateral vesico-deferentography. The steno-occlusion of the ejaculatory ducts was diagnosed, which was resolved through an innovative interventional radiology treatment. Conclusions Interventional radiology has played a decisive role in the diagnosis and treatment of the causes of male infertility. In our experience, it has considerable potential in the minimally invasive treatment of steno-obstructive pathologies of the vesico-deferential system.
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Phan HT, Nguyen TX, Nguyen DV, Vu HA, Le DA, Pham NH. Efficacy of scroto-inguinal microsurgical varicocelectomy in treating male infertility. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundVaricocele presents as the most frequent cause of infertility in men. Most reports showed that varicocelectomy has a significant impact on male fertility and reproductive outcome. This study aims to evaluate the safety and effectiveness of scrotal–inguinal microsurgical varicocelectomy in treating male infertility.MethodsWe prospectively studied preoperatively and postoperatively (at 3 and 6 months) 86 consecutive patients diagnosed with varicocele, abnormal semen parameters, and infertility, undergoing scrotal–inguinal microsurgical varicocelectomy. Semen test was performed before surgery and at 3 months and 6 months after surgery. The reproductive events were short-term followed up.ResultsThe median age of the patient was 32.9 ± 5.1 (20–43). Two cases (2.7%) had a minor infection of the scrotum incision, who were well treated by appropriate antibiotics. After operation, total sperm count and the percentage of motile sperms at 3 months and 6 months were significantly higher than those pre-varicocelectomy, respectively. In total, 26.7% (23/86) of all couples achieved a spontaneous pregnancy. Late complications such as testicular atrophy, hydroceles, and recurrent varicocele have not occurred.ConclusionsScrotal–inguinal microsurgical varicocelectomy is an acceptable method in treating male infertility due to high rate of reproductive outcomes and very low rate of complications.
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11
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Caradonti M. Effect of varicocelectomy on fertility. Indications, techniques and results. Actas Urol Esp 2020; 44:276-280. [PMID: 32224093 DOI: 10.1016/j.acuro.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022]
Abstract
We define varicocele as the dilation of the veins that make up the pampiniform plexus, which is made up of three branches, the internal spermatic, deferential and external spermatic. The World Health Organization (WHO) has determined that varicocele is an important cause of male infertility. This has been acknowledged by several studies that have shown this cause-effect relationship. Varicocele does not always generate infertility. In fact, many patients with varicocele are fertile, decreasing their percentage in the progression of the pathology and the association with other factors such as tobacco, marijuana or endocrine disorders (diabetes or hypothyroidism). Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (WHO). SURGICAL THERAPEUTICS: Surgery is indicated in cases of grade 3 varicocele (when seen through the scrotal skin and palpable as a 'bag of worms' without Valsalva maneuver), cases of atrophy or growth arrest with volume differences of more than 2cm3 between testes, when accompanied by pain and alterations in the spermiogram in young patients. CONCLUSION: The presence of varicocele determines the performance of varicocelectomy, with the inguinal approach in its three branches being the approach of preference. The laparoscopic approach will be used in specific cases.
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Gondokusumo JC, Butaney M, Balasubramanian A, Beilan JA, Tatem AJ, Thirumavalavan N, Pastuszak AW, Lipshultz LI. The use of scrotal ultrasound in the evaluation of varicoceles: A survey study of reproductive specialists. Can Urol Assoc J 2020; 14:E358-E362. [PMID: 32209215 DOI: 10.5489/cuaj.6147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urologists use ultrasound in the male infertility workup to evaluate scrotal contents and objectively identify varicoceles if their presence is questionable on physical examination. We assessed practice patterns and diagnostic criteria of male reproductive urologists using ultrasound to evaluate varicoceles. METHODS An anonymous online survey was sent to the Society for Male Reproduction and Urology (SMRU) members. We queried respondents about ultrasonographic criteria and ultrasound techniques employed in varicocele evaluation. Chi-squared was used to determine association between categorical variables. RESULTS In total, 110/320 (34.4%) SMRU members responded. Sixty percent of respondents (66/110) reported performing scrotal ultrasound; 92.4 % (61/66) were attending urologists and 87.9% (58/66) completed an andrology fellowship. A total of 37.9% (25/66) performed their own ultrasound, while the remainder had ultrasound performed by an alternate practitioner. Among those performing their own ultrasound, 95.5% (21/22) measured varicocele venous diameter compared to 76% (29/38) when another practitioner performed the ultrasound. Venous diameter used to define a varicocele ranged from 2-4 mm. Although 80% (49/61) of respondents assessed retrograde flow during ultrasound, only 52.5% reported that retrograde flow was required for varicocele diagnosis. Almost all (60/61) indicated they would fix palpable varicoceles in patients with abnormal semen parameters. Fewer (42.6%, 26/61) respondents stated they would repair varicoceles found exclusively on ultrasound. CONCLUSIONS Ultrasound is commonly employed by male reproductive urologists to diagnose varicoceles. We identified that practitioners use various ultrasonographic criteria and techniques for varicocele diagnosis. Study limitations include recall bias and high degree of specialization among respondents.
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Affiliation(s)
- Jabez C Gondokusumo
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Mohit Butaney
- Department of Urology, Mayo Clinic, Rochester, MN, United States
| | | | - Jonathan A Beilan
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Alexander J Tatem
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
| | - Nannan Thirumavalavan
- University Hospitals Urology Institute Case Western Reserve University, Cleveland, OH, United States
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States
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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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14
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Soni KK, Zhang LT, Choi BR, Karna KK, You JH, Shin YS, Lee SW, Kim CY, Zhao C, Chae HJ, Kim HK, Park JK. Protective effect of MOTILIPERM in varicocele-induced oxidative injury in rat testis by activating phosphorylated inositol requiring kinase 1α (p-IRE1α) and phosphorylated c-Jun N-terminal kinase (p-JNK) pathways. PHARMACEUTICAL BIOLOGY 2018; 56:94-103. [PMID: 29316840 PMCID: PMC6130442 DOI: 10.1080/13880209.2017.1421672] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
CONTEXT MOTILIPERM was prepared as a mixture of extracts of three medicinal herbs [roots of Morinda officinalis How (Rubiaceae), outer scales of Allium cepa L. (Liliaceae) and seeds of Cuscuta chinensis Lamark (Convolvulaceae)]. OBJECTIVE To investigate the role of reactive oxygen species (ROS)-based endoplasmic reticulum (ER) stress in a rat model of varicocele and the therapeutic efficacy of MOTILIPERM in this model. MATERIALS AND METHODS Sixty male rats were divided into five experimental groups: a normal control group (CTR + vehicle), a control group administered MOTILIPERM 200 mg/kg (CTR + M 200), a varicocele-induced control group (VC + vehicle) and two varicocele-induced groups administered MOTILIPERM 100 (VC + M 100) or 200 (VC + M 200) mg/kg for 4 weeks. Testis weights were recorded and serums were assayed for hormone concentrations. Tissues were subjected to semen analysis, histopathology, analyses of ER response protein expression levels and oxidative stress were assessed by measuring ROS, reactive nitrogen species (RNS), malondialdehyde (MDA) level and ratios of total glutathione (GSH)/oxidized GSH (GSSG). RESULTS MOTILIPERM treatment of varicocele-induced groups significantly increased left testis weight, testosterone level, sperm motility, count and spermatogenic cell density. ER-response protein expression levels were dose-dependently decreased in VC + M 200 group compared with VC + vehicle group. MOTILIPERM treatment also decreased MDA and ROS/RNS level but increased GSH/GSSG ratio. DISCUSSION AND CONCLUSIONS This study suggests that ROS-related ER stress may play a major role in varicocele-induced infertility and MOTILIPERM, a novel compound targeting ROS-based ER stress, may be therapeutically useful in treatment of varicocele, or as a supplement for the treatment of infertility.
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Affiliation(s)
- Kiran Kumar Soni
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Li Tao Zhang
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Bo Ram Choi
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Keshab Kumar Karna
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Jae Hyung You
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Yu Seob Shin
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Sung Won Lee
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul Young Kim
- College of Pharmacy, Hanyang University, Ansan, Republic of Korea
| | - Chen Zhao
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and Shanghai Institute of Andrology, Shanghai, China
| | - Han-Jung Chae
- Department of Pharmacology, Chonbuk University of Medical School, Jeonju, Republic of Korea
| | - Hye Kyung Kim
- College of Pharmacy, Kyungsung University, Busan, Republic of Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
- CONTACT Jong Kwan ParkDepartment of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju54909, Republic of Korea
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15
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The Effects of Acupuncture Treatment in Infertile Patients with Clinical Varicocele. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.65451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Naz M, Kamal M. Classification, causes, diagnosis and treatment of male infertility: a review. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s13596-017-0269-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Santana VP, Miranda-Furtado CL, de Oliveira-Gennaro FG, Dos Reis RM. Genetics and epigenetics of varicocele pathophysiology: an overview. J Assist Reprod Genet 2017; 34:839-847. [PMID: 28523408 DOI: 10.1007/s10815-017-0931-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/19/2017] [Indexed: 11/26/2022] Open
Abstract
Varicocele is found in approximately 20% of adults and adolescents and in 19-41% of men seeking treatment for infertility. It is associated with a decrease in sperm count as well as sperm motility and morphology. The currently accepted description of the pathophysiology of varicocele does not explain all its clinical manifestations; therefore, other factors such as genetic and epigenetic changes, associated with the environment, might be involved in causing infertility and decrease in sperm quality. It has been reported that the varicocele-induced deterioration of testicular function is progressive and interferes with fertility; hence, early and efficient assessment of the genetic manifestations in patients would be important for developing future medical interventions. Chromosomal disorders, mutations, polymorphisms, changes in gene expression, and epigenetic changes have all been reported to be associated with varicocele. Several studies are underway to unravel the genetic basis of this disease, as it is important to understand the origin and the aggravating factors to ensure appropriate guidance and intervention. Here, we review the available literature regarding the genetic and epigenetic changes associated with varicocele, and how these alterations are related to the different clinical manifestations of the disease.
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Affiliation(s)
- Viviane Paiva Santana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Cristiana Libardi Miranda-Furtado
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
- Oswaldo Cruz Foundation (FIOCRUZ), Ceará, Fortaleza, Brazil
| | - Flavia Gaona de Oliveira-Gennaro
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil.
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Chiles KA, Schlegel PN. Cost-effectiveness of varicocele surgery in the era of assisted reproductive technology. Asian J Androl 2016; 18:259-61. [PMID: 26732113 PMCID: PMC4770496 DOI: 10.4103/1008-682x.172644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when. Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy of varicocele repair as well as cost-effectiveness of repair compared to immediate microTESE in azoospermic men and assisted reproductive technology in men with suboptimal semen parameters will be reviewed.
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Affiliation(s)
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medical College, New York, USA
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19
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Smith RP, Lipshultz LI, Kovac JR. Is varicocele repair necessary, given the advanced state of assisted reproductive technologies? Asian J Androl 2016; 18:349. [PMID: 27056348 PMCID: PMC4854077 DOI: 10.4103/1008-682x.179245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | - Jason R Kovac
- Men's Health Center, 8240 Naab Road, Suite 220, Indianapolis, Indiana 46260, USA
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20
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Anyadike CC, Ekeke ON, Eke N. Effect of varicocoelectomy on seminal fluid parameters. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2016; 6:123-137. [PMID: 28856128 PMCID: PMC5555725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Infertility can be a source of anxiety and marital disharmony to a couple. The male factor traditionally contributes 40%. Varicocoeles are a significant cause of male infertility. AIM To assess the effect of varicocoelectomy on seminal fluid analysis parameters in sub-fertile males. METHODOLOGY This was a prospective study of fifty four patients who presented with infertility to the urology clinic of University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria between January 2015. and January 2016 . Those who had clinically palpable varicocoeles as the only suspected cause of their infertility were enrolled. The varicocoeles were classified into right, left or bilateral and graded into grades 1, 2 and 3 using Dubins criteria. Each patient had two semen analyses done two weeks apart and underwent a bilateral varicocoelectomy via the inguinal approach. Seminal fluid analyses were done post operatively at four and six months. RESULTS Of the 54 patients that underwent varicocoelectomy, 11 (20.4%) had azoospermia, 28 (51.9%) had oligospermia and 15 (27.8%) had counts greater than 20 million but less than 40 million. Following varicocoelectomy there was a statistically significant increase in overall motility (p=0.000), morphology (p=0.000), density (p=0.000) and semen volume (p=0.004). Assessing only oligospermic patients there was no significant improvement in morphology (p=0.160). Azoospermic patients showed statistically significant improvement in all parameters though the values were well below those accepted for spontaneous conception. CONCLUSION Varicocoelectomy improves semen parameters in patients with varicocoele induced semen anomalies; it may provide an option for retrieving viable semen for patients with varicocoele induced azoospermia.
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Affiliation(s)
- C C Anyadike
- Department of Surgery, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Nigeria
| | - O N Ekeke
- Department of Surgery, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Nigeria
| | - N Eke
- Department of Surgery, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Nigeria
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21
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The development of surgical sperm extraction and new challenges to improve the outcome. Reprod Med Biol 2015; 15:137-144. [PMID: 29259430 DOI: 10.1007/s12522-015-0228-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022] Open
Abstract
Surgical sperm extraction with intracytoplasmic sperm injection has become widespread worldwide and is regarded as the sole option for patients with azoospermia. However, the sperm retrieval rate remains unsatisfactorily low, particularly for men with non-obstructive azoospermia (NOA). Therefore, the technical challenges associated with improving the sperm retrieval rate for men with NOA are being addressed. The most successful method developed to date is microdissection testicular sperm extraction (micro-TESE), which is rapidly becoming recognized as a useful technique due to its relatively high sperm retrieval rate and low complication rate. However, even with micro-TESE, the sperm retrieval rate for men with NOA remains at 30-60 %, with an even lower birth rate. The technical challenges associated with improving the outcomes of surgical sperm extraction are being approached through the use of ultrasound and optimal surgical devices such as narrow band imaging, multiphoton microscopy, and optical coherent tomography. In addition to the difficulties related to searching for sperm, medical treatments that induce spermatogenesis remain controversial. For example, varicocele repair prior to surgical sperm extraction and hormonal therapy before and after TESE have been extensively examined. We herein briefly summarized the development process in surgical sperm extraction up to the present and technical challenges to improve the outcomes of surgical sperm extraction.
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22
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D'Andrea S, Giordano AV, Carducci S, Sacchetti L, Necozione S, Costanzo M, De Gregorio A, Micillo A, Francavilla F, Francavilla S, Barbonetti A. Embolization of left spermatic vein in non-obstructive azoospermic men with varicocele: role of FSH to predict the appearance of ejaculated spermatozoa after treatment. J Endocrinol Invest 2015; 38:785-90. [PMID: 25740066 DOI: 10.1007/s40618-015-0259-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Varicocele repair in non-obstructive azoospermia (NOA) was occasionally associated to ejaculated spermatozoa independently from clinical and laboratory measures. We performed a prospective study in infertile men affected by NOA and left side varicocele to find whether or not the appearance of ejaculated spermatozoa after varicocele repair is predicted by baseline measures. METHODS Patients with NOA and grade II, or grade III left side varicocele were submitted to hormone analysis and to scrotal color Doppler ultrasound (CDU). Azoospermia was confirmed in 23 patients aged 25-47 years who were than submitted to varicocele repair through a retrograde internal spermatic vein embolization. Patients were re-evaluated after 6 months. RESULTS Six months after varicocele repair 12 patients (52.2 %) were still azoospermic (Group 1) while 11 patients (47.8 %) reported ejaculated spermatozoa (Group 2) [sperm count: 1.3 × 10(6)/mL; 0.5 × 10(6)/mL-1.6 × 10(6)/mL (median 25th-75th centiles)]. Serum baseline FSH was lower in Group 2 compared to Group 1 (p = 0.012), while no differences between groups were revealed for all other clinical and laboratory parameters. ROC analysis indicated that baseline FSH level predicted the appearance of ejaculated spermatozoa after treatment [AUC = 0.811; 95 % Confidence Interval (CI) 0.6-0.9; p = 0.0029]. A cut-off level of FSH <10.06 mIU/mL identified 82.0 % of cases with ejaculated spermatozoa with a specificity of 81.8 % and a sensitivity of 83.3 %. CONCLUSION Selected patients with NOA may show ejaculated spermatozoa after a non-invasive repair of a left side varicocele, therefore avoiding testicular sperm extraction. Baseline serum FSH was a valuable predictor for ejaculated spermatozoa after treatment.
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Affiliation(s)
- S D'Andrea
- Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - A V Giordano
- Interventional Radiology Unit, University Hospital San Salvatore, L'Aquila, Italy
| | - S Carducci
- Interventional Radiology Unit, University Hospital San Salvatore, L'Aquila, Italy
| | - L Sacchetti
- Interventional Radiology Unit, University Hospital San Salvatore, L'Aquila, Italy
| | - S Necozione
- Department of Epidemiology, University of L'Aquila, L'Aquila, Italy
| | - M Costanzo
- Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - A De Gregorio
- Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - A Micillo
- Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - F Francavilla
- Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
| | - S Francavilla
- Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
| | - A Barbonetti
- Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy
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Cavallini G, Beretta G, Biagiotti G, Mallus R, Maretti C, Pescatori E, Paulis G. Subsequent impaired fertility (with or without sperm worsening) in men who had fathered children after a left varicocelectomy: A novel population? Urol Ann 2015; 7:79-85. [PMID: 25657551 PMCID: PMC4310124 DOI: 10.4103/0974-7796.148625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/18/2014] [Indexed: 11/28/2022] Open
Abstract
Objectives: The objective of this paper was to assess whether the beneficial effects of a varicocelectomy on fertility are transitory or definitive after a first fathering. Materials and Methods: This was a retrospective study which involved seven andrological centers. The files of 2223 patients who underwent subinguinal ligation of a high grade left varicocele for (oligo)±(astheno)±(terato)-spermia and infertility between January 1st, 2002 and January 1st 2013 were reviewed. Inclusion criteria for the patients were the following: Sperm count improvement and fathering a child after an uneventful left varicocelectomy; 745 patients were considered. Patients who had undergone three assessments for (in-) fertility: Before surgery, before the first fathering and after the first fathering were included in the study. Each assessment included: Clinical history, physical examination, two sperm analyses, bilateral scrotal Duplex scans, blood hormonal levels [follicle stimulating hormone (FSH), luteinising hormone (LH), testosterone (T) and prolactin (PRL)]. Results: Forty patients were finally studied; they all had an improved sperm count and had fathered once after surgery. Fifteen had fathered twice and still had their sperm count increased after the second fathering. Twenty-five patients could not father twice; 13 patients had their sperm count decreased after the first fathering and 12 did not. A decrease in testicular volume and an increase in FSH paralleled the worsening of sperm concentration, motility and morphology after fathering. No other differences could be observed between the groups. Conclusions: Our data indicated that the beneficial effects of a varicocelectomy might be transitory in some cases.
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Affiliation(s)
- Giorgio Cavallini
- Department of Andrology, Gynepro-Medical Group, Via Tranquillo Cremona 8, 40137 Bologna, Italy
| | - Giovanni Beretta
- Department of Andrology, Centro Italiano Fertilita e Sessualita, Via Della Fortezza 6, 50129 Firenze, Italy
| | - Giulio Biagiotti
- Department of Andrology, Andros-Italia, Outpatient Clinic of Perugia, Via Somaglia 10, 29121 Piacenza, Italy
| | - Roberto Mallus
- Department of Urology, Clinica San Marco, Via XXI Aprile 7, 04100 Latina, Italy
| | - Carlo Maretti
- Department of Andrology, Centro Medico Cirm, Outpatient Clinic of Piacenza, Via Somaglia 10, 29121 Piacenza, Italy
| | - Edoardo Pescatori
- Department of Andrology, Andrological Section, Hesperia Hospital, Via Arquà 80/1, 41125 Modena, Italy
| | - Gianni Paulis
- Department of Andrology, Complex Operative Unit of Urology, Regina Apostolorum Hospital, 00041 Albano Laziale, Rome, Italy
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Coban S, Keles I, Biyik İ, Guzelsoy M, Turkoglu AR, Ocak N. Does varicocele correction lead to normalization of preoperatively elevated mean platelet volume levels? Can Urol Assoc J 2015; 9:E5-9. [PMID: 25624970 DOI: 10.5489/cuaj.2113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are several studies on the relationship between increased mean platelet volume (MPV) and varicocele. We investigated the relationship between preoperative and 6-month postoperative MPV values in patients whose varicocele was corrected with surgery. METHODS A total of 282 patients underwent surgery at our urology clinic between December 2011 and December 2013 for primary varicocele. We retrospectively examined the records of 61 patients who came to the 6-month postoperative follow-up. The preoperative varicocele diagnosis was made with physical examination findings and supported with colour Doppler ultrasonography. RESULTS The varicocele was grade I in 12 patients, grade II in 34 patients and grade III in 11 patients. When the preoperative and 6-month postoperative haemoglobin (Hb), MPV, mean corpuscular volume, platelet, and platelet distribution width (PDW) values were compared, there was a significant decrease in MPV (p = 0.019), and a significant increase in Hb (p < 0.001). A noticeable increase was also present in PDW, but it was not statistically significant (p = 0.058). CONCLUSION We found that MPV increased in patients with varicocele and tended to decrease again after the varicocele was surgically corrected. However, we feel larger prospective series are needed.
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Affiliation(s)
- Soner Coban
- Department of Urology, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Ibrahim Keles
- Department of Urology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - İsmail Biyik
- Department of Obstetrics and Gynecology, Karacabey State Hospital, Bursa, Turkey
| | - Muhammet Guzelsoy
- Department of Urology, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Ali Rıza Turkoglu
- Department of Urology, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Nihal Ocak
- Department of Biochemistry, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
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Naderi G, Mohseni Rad H, Tabassomi F, Latif A. Seminal insulin-like growth factor-I may be involved in the pathophysiology of infertility among patients with clinical varicocele. HUM FERTIL 2014; 18:92-5. [DOI: 10.3109/14647273.2014.965759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
This special issue is fully dedicated to the topic of azoospermia and contains the seminal work of renowned scientists and clinicians from seven countries on three continents. In seventeen chapters, a comprehensive review of the epidemiology, genetics, physiopathology, diagnosis, and management of azoospermia addresses our current knowledge on the topic. The clinical results of assisted reproductive techniques applied to this category of male infertility and the health of offspring originating from such fathers are critically analyzed. In addition, the challenges and the future biotechnological perspectives for the treatment of azoospermic males seeking fertility are discussed.
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