Surgery or embolisation for varicoceles in subfertile men

Evers, Johannes L.H.; Collins, John A.; Clarke, Jane

doi:10.1002/14651858.cd000479.pub3

Cited by 65 publications

(55 citation statements)

References 32 publications

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“…The European Urological Association guidelines on male infertility conclude that treatment of varicocele to achieve pregnancies is still inconclusive [Dohle et al 2005]. The 2009 Cochrane review suggested that treatment of varicocele did not improve the pregnancy rate in the subfertile couples where men with varicocele is the only abnormal finding [Evers et al 2009]. Therefore, the aim of the present study was to assess sperm DNA integrity, measured by the sperm chromatin structure assay (SCSA), before and after the surgical treatment in patients with clinical varicocele.…”

Section: Introductionmentioning

confidence: 93%

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Li¹,

Yamaguchi²,

Okada³

et al. 2012

Systems Biology in Reproductive Medicine

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Varicocele is currently the most common irregularity identified in males that is associated with impaired spermatogenesis. It primarily presents in the form of decreased sperm count and motility, abnormal morphology, and significantly increased sperm DNA fragmentation. Several studies have shown that surgical repair improves semen parameters and increases the odds of spontaneous pregnancy. However the exact effect of surgical repair treatment remains controversial. Therefore, the aim of our study was to evaluate the effectiveness of microsurgical repair by comparing common semen parameters and sperm DNA fragmentation index (DFI). We evaluated infertile men (n = 19) who underwent microsurgical subinguinal varicocelectomy for treatment of clinical varicocele before and 3 months after surgery. Normozoospermic men (n = 19) were considered as the normal control group. Semen parameters improved significantly after surgery when compared with that before surgery, but still significant differences with the normal control group were observed. In comparison, sperm DNA integrity improved significantly after surgery (percentage DFI decreased from 28.4 ± 15.6% before surgery to 22.4 ± 12.9%, at 3 months post surgery) to similar levels as the normal control group. These results suggest that microsurgical repair may be considered as a treatment option in infertile men with palpable varicocele.

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Section: Introductionmentioning

confidence: 93%

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Li¹,

Yamaguchi²,

Okada³

et al. 2012

Systems Biology in Reproductive Medicine

View full text Add to dashboard Cite

show abstract

“…There is no evidence that early treatment increases the odds of conception in adult men with varicocoeles according to a Cochrane review conducted by Evers et al (2008). The recommended indications for varicocoele repair in children and adolescents are (Kogan, 2011): • Varicocoele associated with a significantly small ipsilateral testis.…”

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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“…Controversy still remains regarding the benefit of varicocele repair to improve male fertility Evers et al, 2009;Nieschlag et al, 2010;Jungwirth et al, 2013). Evidence exists both in favour and against it, but as of now, most of specialty societies recognize that varicocele is detrimental to male reproductive health and its treatment may improve sperm function and chances of conceiving Baazeem et al, 2011;Ficarra et al, 2012;Kroese et al, 2012;Lopushnyan & Walsh, 2012;Miyaoka & Esteves, 2012;Kim et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy

et al. 2014

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SUMMARYAntisperm antibodies (ASA) are a cause of male infertility. ASA are often found in varicocele patients. The study objective was to assess the ASA role in fertility recovery after varicocelectomy. The longitudinal study involved 99 patients with varicocele. Patients were examined according to the WHO recommendations; ASA level was measured using the direct method of Sperm MAR test: 66 patients were ASA-negative, 33 had MAR-IgG ≥ 10%. All patients underwent microsurgical varicocelectomy. Student's t-test, Wilcoxon test, Chi-squared test and signed rank test were used for data analysis. The retrospective analysis of all operated patients data showed that the patients without spermiogram improvement after varicocelectomy had higher ASA levels. 3 months after the surgery, the initially ASA-negative varicocele patients demonstrated 2.5 times increase in number of progressive motile spermatozoa in the ejaculate (p < 0.001), accompanied by 6% decrease in abnormal sperm count (p < 0.05); the spermiogram parameters improved in 77% of cases (p < 0.01). After the surgery, ASA developed in 16% of cases (Max -MAR-IgG = 12%). The patients who were initially ASA-positive demonstrated ASA decrease only in half of the cases (16 of 33; p > 0.05). The main outcome in this group was a favourable response to the surgery (ASA level decrease) vs. no reduction in autoimmune process. The improvement in the ASA-positive group was demonstrated in the patients with higher varicocele grade (median -2 vs. 1; p < 0.05) and lower ASA level (MARIgG = 48% vs. 92%; p < 0.01). The pregnancy rate within a year after surgery was 2.8 times more frequent in couples with ASA-negative men: 39% (25 of 65) in the ASA-negative group compared to 14% (4 of 28) in the ASA-positive group (p < 0.05). Thus, antisperm immune response decreases the varicocelectomy efficacy for reproductive function recovery: the higher percentage of ASA and lower grade of varicocele are associated with an unfavourable prognosis.

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Surgery or embolisation for varicoceles in subfertile men

Cited by 65 publications

References 32 publications

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Adolescent varicocoele management controversies

The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy

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