Clinical and subclinical varicocele: a useful distinction?

Marsman, J. W. P.; Brand, Ronald; Schats, R.; Bernardus, Rob E.

doi:10.1016/0028-2243(95)02099-e

Cited by 14 publications

(11 citation statements)

References 24 publications

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“…6 In subsequent studies in which subclinical varicocelectomy was compared with clinical varicocelectomy, authors claimed that surgical treatment of subclinical varicocele was effective, even more effective on semen parameters and pregnancy rates when compared with that of clinical varicocele. 1,3,4,7 In contrast, Jarow et al found that the seminal improvement was statistically insignificant following subclinical varicocelectomy when compared with that following clinical varicocelectomy. 2 However, exact effects of subclinical varicocelectomy on fertility could be only found by comparing those of observation without treatment.…”

Section: Discussionmentioning

confidence: 96%

“…[1][2][3][4] However, decisive outcomes regarding subclinical varicocele and varicocelectomy could only be obtained by performing prospective and well-designed investigations with large series, as contradictory outcomes might have arisen from the small number of well-designed studies.…”

Section: Introductionmentioning

confidence: 99%

“…While some investigators stated that subclinical varicocele was of no significance with respect to effect on fertility potential, others suggested that it should be treated with particularly high ligation of the internal spermatic vein because management of subclinical varicocele improved seminal parameters and pregnancy rates. [1][2][3][4] However, decisive outcomes regarding subclinical varicocele and varicocelectomy could only be obtained by performing prospective and well-designed investigations with large series, as contradictory outcomes might have arisen from the small number of well-designed studies.…”

Section: Introductionmentioning

confidence: 99%

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Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: A prospective randomized study

et al. 2001

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Background: The purpose of the study was to compare the effect of varicocelectomy with that of clomiphene citrate on seminal improvement and pregnancy rates in patients with subclinical varicocele. Methods: A total of 42 infertile men with left subclinical varicocele were randomized to group I (21 patients, surgery) and group II (21 patients, medical therapy). The patients in group I were treated with varicocelectomy and those in group II with clomiphene citrate, 50 mg/day, orally. Sperm parameters (sperm density, motility and morphology) were recorded before and 6 months after beginning the treatment and pregnancy rates were estimated. In statistical analysis, paired and independent-samples t-tests, Kaplan-Meier and Log rank tests and Fisher's exact test were used. Results: Mean ± SD age of the series was 32.7 ± 6.1 years, that of group I was 32.2 ± 5.5 years and that of group II was 33.1 ± 6.7 years (P = 0.680). All seminal parameters increased after both surgical and medical treatment, but only increases in sperm density and motility following varicocelectomy were statistically significant. Changes in seminal parameters between groups I and II were statistically insignificant. Pregnancy was seen in two cases in group I and in one in group II (P = 0.500). The cumulative pregnancy rates were 12.5% in group I and 6.7% in group II (P = 0.589). Conclusions: Clomiphene citrate did not increase sperm density and motility as effectively as subclinical varicocelectomy, but there was no statistically significant difference between surgical and medical therapy methods in terms of seminal improvement and pregnancy rate.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: A prospective randomized study

et al. 2001

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“…These occasions make them equal to those patients with clinically present varicocele, regarding the criteria of our study. Besides that, there are studies that indicate the influence of subclinical varicocele on male infertility (8)(9)(10).…”

Section: Methodsmentioning

confidence: 99%

Comparison of Sperm Parameters in Patients with Infertility Induced by Genital Infection versus Varicocele

et al. 2015

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Background: Male infertility is a common and complex problem and, despite much research in this field, the major cause of infertility unfortunately remains unknown. Genital infection and varicocele are important causes of infertility. Aims: To compare the influence of genital infection and varicocele individually on male infertility based on semen analysis. Study Design: Cross-sectional study. Methods: The study included 120 infertile patients divided into two groups according to the presence of genital infection or varicocele. The first group included 60 examinees with proven genital infection, but without varicocele formation. The second included 60 patients with varicocele, regardless of the varicocele grade, but without genital infection. The fertile parameters were compared and an assessment was performed on the impact on quality of spermatogenesis due to infection and varicocele. Results: There is a statistically significant difference regarding abnormal forms of spermatozoids (45.94±9.79 vs. 25.27±6.54) and progressive motility (8.15±1.24 vs. 24.95±7.2), between two groups of patients. However, acidity of ejaculates, minimum sperm concentration, total spermatozoid motility and ejaculate volume showed no statistically significant difference. Conclusion:The study showed a stronger negative influence of genital infection on fertile parameters over varicocele. The significance of our study is the lack of contemporary researches comparing varicocele and genital infection influence on male infertility individually. Keywords: Genital infections, infertility, semen analysis, varicocele Infertility is related to the disability of a sexually active, couple not using contraception to become pregnant within one year. Male infertility is a complex, contemporary problem, which affects approximately every 20 th person. The etiology of infertility usually remains unknown, despite detailed and comprehensive research in this field (1-3).Genital infection and varicocele are the main causes of male infertility worldwide. Genital infection can impair the quality of spermatozoa and decrease the function of male accessory glands. Nevertheless, it is a correctable cause of male infertility (4). Contemporary studies claim that varicocele can be associated with significant and progressive testicular damage if started during adolescence, which can permanently decrease fertility. Nevertheless, only a small percentage of men with varicocele are infertile, although almost 30% of men with abnormal semen parameters have clinical varicocele (5,6). Initially, the diagnosis of infertility in males is established through the analysis of semen (7).Since there is no contemporary research with regards to the comparison between genital infection and varicocele influence on male infertility, the aim of our research is to compare genital infection and varicocele influence on male infertility, separately, based on semen analysis.

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“…There is disagreement as to the nature of the improvement in sperm quality following high ligation. Some studies have reported an improvement in all sperm quantity and quality parameters (Demas et al ., 1991; Marsman et al ., 1995; Parikh et al ., 1996), others observed an improvement only in sperm density (Schlesinger et al ., 1994) or in the motility index (Soffer et al ., 1984), whereas others claimed that the sperm does not exhibit any quantitative or qualitative improvement (MacLeod, 1969). The ambiguity of the reported results may be due to lack of uniformity in patient selection, follow‐up, treatment techniques, criteria for success and statistical methods (Comhaire et al ., 1984).…”

Section: Introductionmentioning

confidence: 99%

Sperm ultramorphology as a pathophysiological indicator of spermatogenesis in males suffering from varicocele

et al. 2000

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Varicocele of spermatic veins is considered to be one of the major causes of male infertility associated with reduction of sperm quality. The pathophysiology of this condition is not yet completely understood. The aim of this study was to shed light on the pathophysiology of varicocele by identifying semen parameters, especially sperm ultramorphology, which improve following high ligation of the spermatic vein. Seventy-five males with diagnosed varicocele were included in this study. Semen parameters were assessed prospectively using light microscopy, semen biochemistry and sperm quantitative ultramorphological analysis, before high ligation and 3-9 months after high ligation. The control group consisted of twenty-five untreated varicocele patients who underwent two semen examinations within 3-9 months. No statistical difference in any of the examined variables was found between the two examinations in the control group. The treated patients exhibited a significant improvement in sperm density, progressive motility, percentage of normally formed spermatozoa, agenesis of sperm acrosome, chromatin condensation and incidence of amorphous heads compared with the pretreatment condition (P < or = 0.01). In contradiction, no significant improvement was observed following treatment in any of the sperm tail subcellular organelles. It is concluded that varicocele may cause deleterious alterations in early spermatid head differentiation during spermiogenesis and that varicocele patients with a high incidence of sperm acrosome and nucleus malformations are appropriate candidates for varicocele correction.

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Clinical and subclinical varicocele: a useful distinction?

Cited by 14 publications

References 24 publications

Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: A prospective randomized study

Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: A prospective randomized study

Comparison of Sperm Parameters in Patients with Infertility Induced by Genital Infection versus Varicocele

Sperm ultramorphology as a pathophysiological indicator of spermatogenesis in males suffering from varicocele

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