The Effect of Varicocelectomy on Serum Testosterone Levels in Infertile Men with Varicoceles

Su, Li‐Ming; Goldstein, Marc

doi:10.1097/00005392-199511000-00047

Cited by 44 publications

(64 citation statements)

References 11 publications

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“…Deleterious effects of altered Leydig cell function and seminiferous tubule damage in varicocele patients can disrupt the endocrine pathway affecting follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone [Pasqualotto et al 2005;Weiss et al 1978]. On one hand a study has indicated that varicocelectomy improved Sertoli cell and Leydig cell function increasing serum testosterone, and resulted in improvement in sperm concentration and motility [Su et al 1995]. On the other hand other groups have shown that there was no statistically significant change after the operation in levels in the semen of FSH, LH, and testosterone [Fujisawa et al 1994;Segenreich et al 1986].…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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show abstract

“…Such cases usually father a child 5-6 months after surgery. [1,3,6,9,10] O'Brien et al [4] reported that adult varicocelectomy resulted in signiÞ cant improvement in semen quality and pregnancy outcome. Following surgery, majority of varicocele cases show improvement in semen parameters, DNA integrity, testosterone levels and testicular volume.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Increased venous and adrenal reflux affects testicular microvasculature by down-regulating the arterial inflow, and precapillary vasoconstriction affects nutrient supply to testis and also adversely affects mitochondrial oxidative phosphorylation. [10] Varicocele adversely affects Leydig cell function, leading to decreased testosterone production and increased estrogen levels. [8,9,11] T e s t o s t e r o n e i s r e q u i r e d f o r o p t i m a l spermatogenesis, and reduced levels may lead to hypospermatogenesis.…”

mentioning

confidence: 99%

Azoospermia factor deletions in varicocele cases with severe oligozoospermia

Dada¹,

Shamsi²,

Sidhu³

et al. 2007

Indian J Med Sci

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“…30 A varicocele is associated with bilateral spermatogenic abnormalities and Leydig cell dysfunction. [31][32][33][34][35] The testicular histology in infertile men with varicocele is variable, but most studies report reduced spermatogenesis (hypospermatogenesis). The observed increase in germ cell apoptosis is thought to occur as a result of hyperthermia and low testosterone levels in the testicle.…”

Section: Pathophysiology Of Varicocelementioning

confidence: 99%

Varicocelectomy: microsurgical subinguinal versus inguinal technique

Zini

Binsaleh²,

Lo³

2012

CUAJ

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273POINT / COUNTERPOINT I t is reported that 35% to 40% of infertile men have a palpable varicocele (dilated testicular veins), whereas the prevalence of a varicocele in the general male population is about 15%.1-3 Although varicoceles have been associated with impaired male fertility potential, it is also clear that a significant proportion of men with a varicocele (about 75%) are fertile. 2,4,5 As such, a cause and effect relationship between varicocele and male infertility has not been conclusively established. 6 The effect of varicocelectomy on male fertility is also controversial.6-10 Uncontrolled studies have generally shown improved semen quality and pregnancy outcome after surgery.11 On the other hand, the results of randomized controlled studies of varicocelectomy for clinical varicocele (only a few such studies are published) are equivocal. [12][13][14][15] Despite the absence of clear evidence for a positive effect of varicocelectomy, many clinicians consider the data sufficient to support the practice of this surgery, and varicocele is the most commonly treated condition in men with infertility in North America. 8 The benefit of varicocele repair must be balanced by the risk associated with the procedure itself. As such, it is important to select the procedure with the highest success and lowest complication rate. Also, it is important to consider assisted reproductive technologies (ARTs) as an alternative to varicocelectomy in infertile couples. 16 Etiology of varicoceleThe etiology of varicocele is multifactorial. The anatomic differences between the left and right internal spermatic vein (accounting for the predominance of left-sided varicocele), the incompetence of venous valves resulting in reflux of venous blood and increased hydrostatic pressure are the most popular theories. 17,18 Increased intraabdominal pressure during childhood and early adolescence may be a predisposing factor in the development of a varicocele. 19 Mechanisms of varicocele-induced pathologyScrotal and intratesticular temperatures are elevated in humans and in experimental animal models with varicocele, and varicocelectomy may reduce testicular temperature. [20][21][22][23][24] Scrotal hyperthermia likely represents the primary factor by which a varicocele affects endocrine function and spermatogenesis, both sensitive to temperature elevation (testicular proteins exhibit a reduced thermal stability compared with proteins from other organs). [25][26][27] The detrimental effect of hyperthermia may also be exerted on the epididymis. 28 Experimental elevations in epididymal temperature reduce the storage capacity of this organ, resulting in decreased sperm count and quality in the ejaculate. 28Increased hydrostatic pressure in the internal spermatic vein from renal vein reflux may also be responsible for varicocele-induced pathology. Pathophysiology of varicoceleThe adverse effect of varicocele on male fertility is most clearly manifested by the testicular atrophy generally associated with this condition. 4 Using scrota...

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The Effect of Varicocelectomy on Serum Testosterone Levels in Infertile Men with Varicoceles

Abstract: Varicocelectomy can increase serum testosterone for infertile men with varicoceles. Although improvement in serum testosterone does not necessarily cause a direct improvement in semen quality, varicocelectomy may improve hormonal and spermatogenic function.

Cited by 44 publications

References 11 publications

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Azoospermia factor deletions in varicocele cases with severe oligozoospermia

Varicocelectomy: microsurgical subinguinal versus inguinal technique

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