Adolescent varicocele: improved sperm function after varicocelectomy

Lacerda, José Iran Medeiros; Giudice, P.T. Del; Silva, Barbara Ferreira da; Nichi, Marcílio; Fariello, R.M.; Fraietta, Renato; Restelli, Adriana Ester; Blumer, Camile Garcia; Bertolla, Ricardo Pimenta; Cedenho, A.P.

doi:10.1016/j.fertnstert.2010.10.031

Cited by 80 publications

(35 citation statements)

References 30 publications

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“…Therefore, alteration of apoptosis regulation may be a possible mechanism by which varicocele leads to increased DNA fragmentation in adolescents, as observed in other studies in adolescents [13,14,19]. This is important because it suggests a testicular (and not a post-testicular) origin to alterations to sperm DNA quality in these patients, which in turn renders an immediate surgical approach more important, in order to revert initial testicular damage.…”

Section: Discussionmentioning

confidence: 70%

“…We have previously shown, for example, that sperm functional alterations may be present even in the absence of semen analysis alterations [13]. Moreover, we have also observed that a number of sperm functional alterations [14,19] and alterations to seminal plasma protein expression are associated to the adolescent varicocele [19][20][21]. We need, however, to better understand which molecular mechanisms are associated with the adolescent varicocele, especially to one that will determine infertility in the future [31].…”

Section: Discussionmentioning

confidence: 99%

“…However, previous reports have demonstrated that varicocele may lead to alterations not usually detected in conventional semen analysis, such as increased sperm DNA fragmentation [13] and decreased sperm mitochondrial activity [14]. Moreover, treatment of varicoceles through a microsurgical approach (microsurgical varicocelectomy) has been shown to improve semen quality [12,14,15], testicular volume [16,17], and sperm DNA integrity and mitochondrial activity [14], but this is not the case for all treated adolescents [18]. Therefore, there is a need to indicate, with improved sensitivity, which adolescents should be treated for varicoceles, so that they do not become infertile men in the future [11].…”

Section: Introductionmentioning

confidence: 95%

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Alterations in the proliferative/apoptotic equilibrium in semen of adolescents with varicocele

Belardin

Giudice

Camargo

et al. 2016

J Assist Reprod Genet

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Purpose To verify if the presence of varicocele (grades II and III) with and without seminal alterations, using the 5 th centile cutoff values in table A1.1 of the World Health Organization (WHO, 2010) manual, alters the seminal plasma levels of proteins DNASE1 (deoxyribonuclease-1) and IGFBP7 (Insulin-like growth factor-binding protein 7), which are related to apoptosis regulation and cell proliferation, respectively, demonstrating that these proteins are important for correct spermatogenesis. Methods This cross sectional study was performed at the Sao Paulo Federal University Paulo between May 2014 and April 2016. A total of 61 male adolescents were included in this study, of which 20 controls without varicocele (C), 22 with varicocele and normal semen analysis (VNS) and 19 with varicocele and altered semen analysis (VAS). Seminal plasma from each patient was used for Western blotting analysis of individual protein levels. Values of each protein were normalized to a testicular housekeeping protein (PARK7-protein deglycase DJ-1). Results Levels of IGFBP7 protein are increased in varicocele. Levels of DNASE1 are progressively decreased in varicocele (lower in varicocele and normal semen analysis, lowest in varicocele and altered semen analysis) when compared to adolescents without varicocele. DNASE1 levels are positively correlated with sperm concentration and morphology (correlation values of 0.400 and 0.404, respectively; p values of 0.001 and 0.001, respectively). Conclusion In conclusion, in adolescents, seminal plasma levels of IGFBP7, responsible for proliferative activity, are increased in varicocele grades II and III, and DNASE1, responsible for apoptosis regulation, are lower in varicocele, lowest in varicocele and low semen quality. These proteins demonstrate molecular alterations brought upon by varicocele. Moreover, DNASE1 is capable of discriminating a varicocele that causes alterations to semen quality from one that does not. We propose that the initial response of varicocele is to increase proliferative activity which, if followed by regulation of apoptosis, may lead to the ejaculation of a population of sperm that are in accordance with WHO cutoff values but, in the presence of dysregulated apoptosis, leads to lower sperm concentration and morphology.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

See 1 more Smart Citation

Alterations in the proliferative/apoptotic equilibrium in semen of adolescents with varicocele

Belardin

Giudice

Camargo

et al. 2016

J Assist Reprod Genet

Self Cite

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“…A 100% success rate was recorded for post-varicocoelectomy patients fathering a child (Salzhauer et al, 2004). Another recent study demonstrated that adolescent varicocoelectomy is associated with improved specialized functional sperm parameters (sperm DNA integrity and mitochondrial activity) and improved sperm morphology (Lacerda et al, 2011). Zampieri et al showed that following the guidelines for varicocoele management in the adolescent age group (operative treatment of only patients with symptoms or ipsilateral testicular hypotrophy and a 'wait and watch policy' for all others) does not guarantee preservation of fertility.…”

Section: To Treat or Not?mentioning

confidence: 99%

Adolescent varicocoele management controversies

2012

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SUMMARYVaricocoele is defined as excessive dilatation of the pampiniform venous plexus of the spermatic cord. Varicocoele frequently appears during early puberty and is recognized to be the most common surgically correctable cause of male infertility. However, the actual incidence in adolescents, pathophysiology and the association with male factor infertility all remain somewhat controversial. The most accurate diagnostic technique for identifying young men who will benefit from surgical treatment has yet to be established. Observations of testicular asymmetry and deteriorating semen quality helped establish current guidelines and recommendations for surgical treatment. Further studies, comparing observation with surgical intervention, are needed to refine the current indications for varicocoele repair in the adolescent male.

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“…It is widely believed that clinical varicocele in adult men should be surgically corrected when changes in the results of semen analysis or functional tests are confirmed [3,4]. Although varicocele repair is widely used as a treatment for male infertility, its efficacy has been a subject of intense debate for nearly 50 years.…”

Section: Introductionmentioning

confidence: 99%

Study of the effect of varicocelectomy on sperm proteins expression in patients with varicocele and poor sperm quality by using two-dimensional gel electrophoresis

Hosseinifar

Sabbaghian

Nasrabadi

et al. 2014

J Assist Reprod Genet

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Purpose To compare proteomic profiles of spermatozoa from patients with varicocele and poor sperm quality before and after varicocelectomy. Methods This work was designed as a prospective and observational study. The study was based on 20 men with varicocele grade 3 and poor sperm quality undergoing varicocelectomy at the Fertility Unit of Royan institute in 2009. Two semen samples were collected, one before varicocelectomy and the other after surgery. Protein separation was done by two-dimensional protein electrophoresis, and analyzed by gel densitometry and mass spectrometry. Differential sperm protein expression levels were measured by gel densitometry. Results Comparison of the sperm parameters showed that sperm motility and concentration were increased after varicocelectomy. At the level of protein, a total of 3 protein spots were identified whose expression was significantly lower in sperm samples before varicocelectomy compared with after surgery including heat shock protein A5 (HSPA5), superoxide dismutase 1 (SOD1) and δ-subunit of the catalytic core of mitochondrial adenosine triphosphate synthase (ATP5D). Conclusions High grade varicocoele affects sperm protein expression presumably because of increasing testicular temperature. These proteins play essential roles in sperm production, DNA integrity protection, and sperm motility. This novel study demonstrates that varicocelectomy can improve both sperm quality and proteins expression.

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Adolescent varicocele: improved sperm function after varicocelectomy

Cited by 80 publications

References 30 publications

Alterations in the proliferative/apoptotic equilibrium in semen of adolescents with varicocele

Alterations in the proliferative/apoptotic equilibrium in semen of adolescents with varicocele

Adolescent varicocoele management controversies

Study of the effect of varicocelectomy on sperm proteins expression in patients with varicocele and poor sperm quality by using two-dimensional gel electrophoresis

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