Varicocele is one of the most common diseases in the male reproductive system. More and more attention has been drawn to the influence of varicocele on male reproduction recently. Although many experiments and achievements have been made, the mechanism of infertility in varicocele patients has not yet been fully understood. The development of the disease might be related to many factors such as microcirculation of the testis, vasoactive substance, reactive oxygen species, nitric oxide, hypoxia, immunology and apoptosis. Mostly these changes are not confined to one testis. Thus, it is of great significance to investigate the mechanism of male infertility induced by varicocele. This article updates the studies on the mechanism of infertility in varicocele males.
Humans ; Infertility, Male ; etiology ; pathology ; Male ; Varicocele ; complications ; pathology

The incidence of varicocele in older adolescence varies from 12.4% to 17.8% with an average of 14.7%, similar to the incidence in adult males. Varicocele is associated with testicular growth arrest in adolescents. Varicocelectomy can reverse the testicular growth arrest. But without the testicular growth arrest, prophylactic surgery for every adolescent with varicocele is not advised. Surgery treatment should be offered to: 1. adolescents with testicular growth arrest more than 2 ml of difference between left and right testicle, 2. adolescents with abnormal semen analysis with high-grade varicocele, 3. adolescents with symptoms: pain, heaviness, swelling, 4. adolescents with bilateral varicoceles. Recurrence of the varicocele after surgery treatment can occur in 9% to 16% of adolescents. But rate of recurrence can be kept below 2% in adolescents treated by high retroperitoneal ligation with testicular artery ligation.
Adolescent ; Humans ; Incidence ; Male ; Recurrence ; Varicocele ; epidemiology ; pathology ; physiopathology ; surgery

OBJECTIVETo examine the semen quality and the sperm morphology in infertile men with varicocele.

METHODSSemen from 98 infertile men with varicocele were studied and those of 130 normal semen donors were taken as the control. Semen analysis was performed based on the methods described in the WHO manual and sperm morphology was evaluated by WHO criteria.

RESULTSA significantly reduced percentage of normal morphologic sperm and of forward progression were found in patients with varicocele comparing with those of the control (P <0.001). The head defects were observed as the predominant type of sperm malformation.

CONCLUSIONThe varicocele increases malformed sperm in ejaculates, which may result from impaired male fertility by varicocele. Sperm morphologic assessment with WHO criteria provides a sensitive and practical measurement of sperm damage in infertile men with varicocele.

Adult ; Humans ; Infertility, Male ; complications ; pathology ; Male ; Semen ; Spermatozoa ; abnormalities ; pathology ; Varicocele ; complications ; pathology

OBJECTIVETo explore the effects of experimental varicocele on the apoptosis of spermatogenic cells in rats.

METHODSThirty-two Sprague-Dawley(SD) male rats were randomly divided into four groups: pseudo-operation group, 45 d experimental group, 60 d experimental group and 90 d experimental group. Experimental varicocele was created by partial ligation of left renal vein. The apoptosis number of spermatogenic cells was measured by flow cytometry.

RESULTSNo marked apoptosis peak was observed in the control group, but it was observed in all the other groups, and the height of the peak increased with the duration of experiment.

CONCLUSIONSVaricocele can induce apoptosis of large numbers of spermatogenic cells, and the decrease of spermatogenic cells. This may be the mechanism of varicocele causing male sterility.

Animals ; Apoptosis ; Flow Cytometry ; Male ; Random Allocation ; Rats ; Spermatocytes ; cytology ; Testis ; pathology ; Varicocele ; pathology

OBJECTIVETo study the mechanism of male infertility caused by varicocele by evaluating the effects of hyperbaric oxygenation (HBO) therapy on the testicular tissue morphology and function of rabbit model with varicocele(VC).

METHODSTwenty-four mature male rabbits were randomly divided into three groups: pseudo-operation, VC model and VC model administered by HBO. Experimental varicocele was induced by partial ligation of the left "lumbotesticular" trunk vein in rabbits. HBO was administered to one of the two groups of VC model rabbits after the operation. Weight and volume of both testes, parameters of seminal fluid, histological changes of testicular tissues, MTDs, TFI, and Sertoli cell index (SI) of seminiferous tubules were studied.

RESULTSThe average weight and volume of the left testes significantly increased in the rabbits treated by HBO. The semen quality was improved, and MTDs increased significantly compared with VC group(P < 0.0001). The testicular tissue morphology became nearly normal in VC + HBO group.

CONCLUSIONS1. Both the structure and spermatogenetic function of testes can be damaged by the presence of varicocele; 2. Chronic ischemia, anoxia and microcircular dysfunction may be the key process and essential factor that make varicocele contributive to testicular damage and spermatogenetic dysfunction; 3. HBO can effectively alleviate, even eliminate, chronic ischemia, anoxia and microcircular dysfunction in testicular tissues with varicocele, and thus protect the structure and functions of testes.

Animals ; Hyperbaric Oxygenation ; Male ; Rabbits ; Testis ; blood supply ; pathology ; Varicocele ; pathology ; physiopathology ; therapy

BACKGROUNDCytogenetic and molecular studies of azoospermic and oligozoospermic males have suggested the presence of azoospermia factors (AZF) in the Y chromosome. Deletion in AZF regions has been reported to disrupt spermatogenesis and cause infertility. Several candidate genes responsible for spermatogenesis have been identified in this region and some of them are thought to be functional in human spermatogenesis. And we reported clinical and molecular studies of Y chromosome microdeletions in Chinese. This study aimed at assessing the frequency of microdeletions in Chinese men with idiopathic and nonidiopathic infertility problems and dicussing the clinical significance of the AZF region.

METHODSIn this study, we screened 143 infertile men (62 with idiopathic infertilitas and 81 with nonidiopathic infertilitas), in whom karyotype, sperm count, hormonal parameters and fine needle aspiration cytology were evaluated. Genomic DNA was extracted from the peripheral leukocytes. Molecular analysis was performed by two multiplex polymerase chain reactions (PCR) using a set of a sequence tagged sites (STS) from 3 different regions of the Y chromosome: AZFa (sY84, sY86), AZFb (sY127, sY134), AZFc (sY254, sY255).

RESULTSNineteen point four percent of idiopathic males (12/62, 19.4%) had microdeletions of either the AZFa, AZFb, AZFc or AZFb + c region. Significantly, a high frequency of microdeletions (9/81, 11.1%) was found in nonidiopathic patients with varicocele and cryptorchidism. No deletions were found in healthy fertile men. There were no significant differences in the localization and extent of deletions between idiopathic and nonidiopathic patients.

CONCLUSIONSThe knowledge of the presence of these deletions in idiopathic and nonidiopathic cases is important to understand the prognosis, better management and counsel these patients accordingly. Furthermore, a more extended screening for Y chromosome microdeletions in idiopathic and nonidiopathic men, particularly candidates for intracytoplasmic sperm injection, is recommended.

Chromosome Deletion ; Chromosomes, Human, Y ; Cryptorchidism ; genetics ; pathology ; Humans ; Infertility, Male ; genetics ; pathology ; Male ; Testis ; pathology ; Varicocele ; genetics ; pathology

PURPOSE: To assess the ability of scrotal Doppler ultrasonography to confirm the diagnosis of clinical varicoceles and detect subclinical varicoceles. MATERIALS AND METHOD: Sixty patients with clinically evident varicocele were examined by scrotal doppler ultrasonography(gray scale: 60 patients, spectral Doppler: 35 patients, color Doppler: 22 patients). A control group of 21 patients with no suspected scrotal pathology also were studied. The age range of the varicocele group was 12-49 years. The normal group consisted of 21 subjects aged 19-23 years. Ultrasonographic measurement of scrotal vein diameter of patients before and during Valsalva maneuver, and scrotal vein blood flow reversal with Valsalva maneuver was compared with the findings of varicocele by physical examination. RESULTS: Significant differences were found in scrotal vein diameter before and during Valsalva maneuver between normal and varicocele testicular units. Cut-off points were selected in an arbitrary fashion on the basis of scattergram. Using this cut-off points and blood flow reversal, we found that 12(23%) of 53 patients with a clinically palpable left unilateral varicocele had an ultrasonographically positive subclinical right varicocele. 8(38%) of 21 patients without a clinical varicocele had a positive scrotal ultrasound. CONCLUSIONS: We suggest that scrotal doppler ultrasonography is a reliable means of confirming the clinical varicocele and screening the subclinical varicoceles.
Diagnosis ; Humans ; Mass Screening ; Pathology ; Physical Examination ; Ultrasonography ; Ultrasonography, Doppler* ; Valsalva Maneuver ; Varicocele* ; Veins

Right-sided varicocele is a relatively rare disease, which could be caused by retroperitoneal pathology, situs Inversus or ananomalous termination of the right internal spermatic vein into the right renal vein or the left renal vein. Herein we report a rare case of right-sided varicocele in a 31-year-old fertile man with situs inversus.
Adult ; Humans ; Pathology ; Rare Diseases ; Renal Veins ; Situs Inversus* ; Varicocele* ; Veins

Some physiological and ethical problems make it difficult to obtain semen samples from adolescents with varicocele (VC) and to directly evaluate their fertility. Therefore we can only rely on indirect methods to assess the influence of VC on the future fertility of the adolescent patients. Most of the VC adolescents may have normal semen parameters in the adulthood. Thus whether and when to intervene in adolescent VC remain a controversy in andrology. Physical examination is the most common method for screening adolescent VC and ultrasonography is very effective for its diagnosis and evaluation. Other important diagnostic indicators include the widely accepted testicular atrophy index, recently proposed peak retrograde venous flow, total testis volume, and scrotal temperature. Based on the latest literature, this review offers some proposals for the evaluation and intervention of adolescent VC.
Adolescent ; Humans ; Infertility, Male ; diagnosis ; Male ; Semen ; Semen Analysis ; Testis ; pathology ; Varicocele ; diagnosis

OBJECTIVETo examine and analyze semen quality and sperm ultrastructural characteristics of infertile patients with varicocele.

METHODSThis study included 118 infertile patients with varicocele (the VC group) and 76 normal semen donors (the control group). We obtained routine semen parameters, seminal plasma biochemical markers and the levels of reproductive hormones in the subjects, and observed the changes in sperm structure under the scanning electron microscope and transmission electron microscope.

RESULTSCompared with the normal control, the VC patients showed significantly decreased sperm concentration, sperm progressive motility, sperm viability (P < 0.05), but no remarkable difference in semen volume and non-progressive motility (P > 0.05). The concentrations of zinc and alpha-glycoside enzyme in the seminal plasma were markedly reduced in the VC group in comparison with the controls (P < 0.05), but there was no significant difference in the level of fructose (P > 0.05), nor in such seminal plasma biochemical markers as FSH, LH, T and E2 between the two groups (P > 0.05). The percentage of morphologically normal sperm was dramatically lower in the VC than in the control group ([56.76 +/- 15.32]% vs [12.34 +/- 6.58]%, P < 0.05), and the sperm deformities were mostly in the head and neck, mainly tapering pin head accompanied by complex abnormal differentiation.

CONCLUSIONThis study demonstrated that VC may lead to oligo-astheno-terato zoospermia, and hence male infertility, which may be attributed to the changes of seminal plasma microenvironment and sperm ultrastructure.

Adult ; Case-Control Studies ; Humans ; Infertility, Male ; etiology ; pathology ; Male ; Semen Analysis ; Sperm Motility ; Spermatozoa ; ultrastructure ; Varicocele ; complications ; pathology