Best Practice Policies for Male Infertility

Jarow, Jonathan P.; Sharlip, Ira D.; Belker, Arnold M.; Lipshultz, Larry I.; Sigman, Mark; Thomas, Anthony J.; Howards, Stuart S.; Nehra, Ajay; Damewood, Marian D.; Overstreet, James W.; Sadovsky, Richard

doi:10.1016/s0022-5347(05)65109-9

Cited by 227 publications

(122 citation statements)

References 33 publications

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“…A topic of considerable debate over the years has been as to whether varicocele size affects outcome of varicocele repair (1,2,6,12,17). This is of considerable importance since early reports have suggested that varicocele size had no impact upon subsequent pregnancy rates, leading to the conclusion that very small varicoceles, even subclinical ones, should be identified and treated (8,9,31).…”

Section: Discussionmentioning

confidence: 99%

“…Since in our series of patients no differences in the hormonal levels were found between patients with and those without right subclinical varicoceles when a clinical left grade II-III varicocele was present, we argue that a subclinical varicocele does not impaired hormonal levels. The accuracy of diagnosis must be taken into account when subclinical varicocele repair is addressed (1,16). It is well known that there is no "gold standard" for the diagnosis of varicoceles.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical studies and laboratory research have provided convincing evidence that varicoceles may have a detrimental effect on spermatogenesis (1,2). In fact, semen quality uniformly declines in animals with induced varicoceles, even when only a left varicocele is produced (3).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, even though recent progress in diagnostic methods has revealed a higher incidence of subclinical varicoceles, the clinical significance of this is controversial as regards male infertility (1,2,16).…”

Section: Introductionmentioning

confidence: 99%

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Is it worthwhile to operate on subclinical right varicocele in patients with grade II–III varicocele in the left testicle?

Pasqualotto

Lucon

Góes

et al. 2005

J Assist Reprod Genet

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Purpose : To determine whether repair of subclinical varicoceles in the right testicle results in significant seminal improvement in patients with clinical left varicocele. Methods : Patients were divided into two groups: Group I (unilateral varicocelectomy) and Group II (bilateral varicocelectomy-subclinical left varicocele). The mean sperm concentration before treatment was higher in Group I (21.01 ± 19.1) compared to Group II (5.7 ± 10.7) (p = 0.04). Results : An increase in volume was detected in the left testicle of patients in Group I (17 ± 7.9 vs. 22.81 ± 8.2; p = 0.04) and in the right testicle of patients in Group II (18.4 ± 6.2 vs. 22.3 ± 6.5; p = 0.04). Although the mean postoperative sperm concentration in Group I increased slightly (25.7 ± 22.8), the mean sperm concentration in Group II increased significantly (30.32 ± 9.8; p = 0.03). Pregnancy rate was higher in Group II (66.7%) compared to Group I (33.3%). Conclusions : Even a small, subclinical unrepaired varicocele continues to have a detrimental effect on bilateral testis function in a patient with grade II-III left varicocele.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is it worthwhile to operate on subclinical right varicocele in patients with grade II–III varicocele in the left testicle?

Pasqualotto

Lucon

Góes

et al. 2005

J Assist Reprod Genet

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“…43 Guidelines suggest that adolescent patients with a varicocele but normal ipsilateral testicular size should be monitored with yearly measurements of either tes ticular size or semen analyses (or both). 44,45 However, it is unknown whether this generic recommendation is adequate for all patients and guidance is lacking regard ing the recommended duration of followup. Criteria for better risk stratification are needed for these patients.…”

Section: Surgical Therapymentioning

confidence: 99%

The hemodynamic approach to evaluating adolescent varicocele

et al. 2012

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| During adolescence, the risk of developing a varicocele increases. Prevalence is less than 1% in boys aged younger than 10 years, but approaches that of the general adult population (about 15%) during puberty. For adolescent males with varicoceles, surgical risk factors have not yet been clearly delineated and clinical severity correlates poorly with prognosis. Fortunately, the widespread use of Doppler ultrasonography is transforming the diagnostic work-up for this demographic. A continuous reflux detected by color Doppler ultrasound (CDUS) is thought to have a negative prognostic value and evidence suggests that a peak retrograde flow above 38 cm per second is a powerful predictor of lack of spontaneous improvement in adolescent patients with ≥20% asymmetry between testes. CDUS also enables the detection of varicocele resulting from reflux in the deferential vein adjunctive to a refluxing internal spermatic vein; a causality that accounts for approximately 15% of cases. In addition to a diagnostic role, hemodynamic parameters can be used to predict the risk of persistence or worsening asymmetry. Although further studies are necessary to validate single parameters, it seems that the more severe the reflux, the greater the likelihood that the patient will develop testicular asymmetry.

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