Varicocele sclerotherapy improves serum inhibin B levels and seminal parameters

The usefulness of treating varicocele in order to improve fertility is still a matter of debate. The aim of this study was to evaluate variations in seminal parameters and inhibin B concentrations in a group of males affected by varicocele and treated by percutaneous retrograde sclerotherapy in comparison with a group of patients who did not undergo varicocele treatment. Thirty-eight patients with left varicocele underwent spermatic vein phlebography and percutaneous retrograde sclerotherapy with hydroxy-polyaethoxy-dodecanol. Serum inhibin B, follicle-stimulating hormone (FSH), testosterone levels and seminal parameters (sperm concentration, motility and morphology) were performed before and 6 months after sclerotherapy. Forty patients with left varicocele who did not undergo sclerotherapy were studied as controls. A significant increase (p < 0.01) in serum inhibin B levels and a significant decrease (p < 0.05) in FSH levels were observed 6 months after treatment. Semen analysis showed a significant improvement in sperm concentration (p < 0.05) and progressive motility (p < 0.01) after treatment. In control group no significant variations in hormonal and seminal parameters were observed 6 months after the basal examination. Six months after the basal evaluation, inhibin B levels were significantly higher in treated subjects than in controls (p < 0.05) whereas FSH levels were significantly lower (p < 0.05). Sperm concentration and progressive motility were significantly increased (p < 0.05 and p < 0.001, respectively) in treated subjects in comparison with controls. In conclusion, varicocele sclerotherapy improves inhibin B levels and seminal parameters, confirming the positive effect of this treatment on spermatogenesis and Sertoli cell function.     

Varicocele in adolescence induces left and right testicular volume loss

OBJECTIVE: To determine the effect of a palpable left-sided varicocele (which in adolescent patients can adversely affect left testicular volume) on right testicular volume with progressive Tanner development and increasing varicocele grade. PATIENTS AND METHODS: The right and left testicular volumes were measured with a standard orchidometer in 70 control patients (mean age 14.6 years, SD 2.2) with no palpable testicular abnormality and in 434 (mean age 14.3 years, SD 2.3) with a palpable left-sided varicocele. Patients with bilateral and right-sided varicoceles were excluded from the study. RESULTS: There was no significant difference between the left and right testicular volumes in the control patients. The testicular volumes of patients with a grade I varicocele were similar to those in control patients. Patients with a grade II varicocele had a significantly smaller left testis than the controls at Tanner stages 4 and 5 (P < or = 0.05). Patients with a grade III varicocele had a significantly smaller left testis than controls at each Tanner stage (P < or = 0.05) and significantly smaller right testis than controls at Tanner stages 4 and 5 (P < or = 0.05). CONCLUSION: The presence of a grade I varicocele in adolescence appears to have no effect on normal testicular growth. Some patients with a grade II varicocele are at risk of left testicular volume loss with time and should have their testicular volume measured annually. Patients with grade III varicocele are at risk of bilateral testicular volume loss; a careful evaluation and early surgical intervention are recommended in this group of patients.     

Sexual function and fertility after treatment of testicular cancer

As a result of the introduction of effective cisplatin-based chemotherapeutic regimens into the clinical routine, even patients with metastatic testicular cancer at initial diagnosis can be cured of their disease. Sexual dysfunction and infertility are common long-lasting sequelae in testicular cancer survivors, affecting approximately 20% of patients after the application of the different treatment modalities currently available for the treatment of early and advanced clinical stages, including retroperitoneal surgery and systemic chemotherapy. Accordingly, it has been demonstrated that fertility distress and sexual disturbances, the latter occurring in only a minority of patients after surgical or chemotherapeutic treatment of testicular germ cell tumours, substantially alter the patients' quality of life. It is even worse because testicular cancer mostly affects men in the prime of their physical, sexual and reproductive function. Although semen quality is frequently poor at initial diagnosis and further deteriorates after orchiectomy, probably because of structural abnormalities in the remaining contralateral testicle, the advent of intracytoplasmatic sperm injection promises a fertile future to most patients, even if only a few sperms are present in the ejaculate. Further long-term investigations should be initiated to clarify the impact of the different treatment modalities on fertility and sexual life. The main objective should be the identification of patients who are at increased risk of developing therapy-related physical and psychological problems.     

Predictors of improved seminal parameters and fertility after varicocele repair in young adults

The aim of our study was to determine hormonal or biochemical markers in patients with clinically palpable left varicocele but without a history of infertility, with especial emphasis on nitric oxide, related with improved seminal parameters after varicocelectomy. Semen samples were obtained from 202 patients with left varicocele grade II or III. Nitric oxide levels in seminal plasma were determined by the Griess technique. Testicular volume was determined ultrasonographically in both testes and hormonal profile was measured. The post-operative sperm concentration increased significantly in patients with normal sperm count or moderate oligozoospermia, but we did not find an increment in sperm count in patients with mild and severe oligozoospermia after surgery . The mean percentage of normal motility significantly increased after surgery, but we did not observe a significant increment in morphologically normal sperm count and testicular volume after varicocele repair. Moreover, we did not find any correlation between nitric oxide concentrations and severity of oligozoospermia, asthenozoospermia or abnormal sperm morphology in this population. It is concluded that in the general male population, varicocele repair is not associated with an improved semen profile in all cases. We did not observe a significant correlation between nitric oxide concentrations and semen profile.     

精浆胸苷激酶1与精液参数关系的初步分析

目的 探讨精浆胸苷激酶1(Thymidine kinase 1,TK1)的浓度与精子参数的关系.方法 利用增强化学发光法检测无精子症和少弱精子症及已生育健康人精浆TK1的浓度.同时利用计算机辅助精液分析系统分析各实验组精子密度及活力.各实验组精浆酸性磷酸酶、α-葡糖苷酶、精浆果糖和锌的浓度也一并检测.分析精浆TK1浓度变化和精子参数、精浆相关参数的相关性.结果 弱精于组(2.41±0.21)及无精子组(2.72±1.16)患者精浆TK1的浓度显著高于正常对照组(1.53±0.22)(P<0.01),少精子组(1.60±0.13)和少弱精子组(1.68±0.24)患者精浆TK1的浓度与对照组相比差异没有统计学意义(P>0.05).精浆TKl与精浆生化指标即精浆酸性磷酸酶、α-葡糖苷酶、果糖和锌的浓度都没有显著的相关性(P>0.05).结论 TKl可能与精子活动质量有一定相关性,高浓度的TKl是引起弱精子症的原因之一,与精子数量的变化关系不密切.TKI在无精子症患者中浓度偏高的原因有待进一步研究.     

Problems in evaluating male fertility: valuable factors in evaluating male fertility and normal values of seminal parameters

To determine the valuable factor for evaluating male fertility, a comparative study was done as to various seminal parameters between fertile and infertile groups. The fertile group consists of 57 proven fertile males and the infertile group consists of randomly chosen 67 infertile patients. Seminal parameters assessed were sperm concentration, motility, mean velocity, total sperm output, total motile sperm output, sperm morphology, acrosin activity and sperm penetration rate on zona-free hamster egg penetration assay (SPA). The infertile group was significantly different from the fertile group in every parameter except acrosin activity. However, the range of each parameter in the two groups overlapped each other. The diagnostic rate of each parameter, which is the percentage of an infertile male correctly diagnosed as infertile, was calculated by using 95% specificity threshold value of fertile males. The 95% specificity threshold values of sperm concentration, motility and % normal shaped sperm were 24.9 x 10(6)/ml, 34.9% and 55%, respectively, and they could be acceptable for the normal limit of seminal parameters. The diagnostic rate was highest in penetration rate (72.4%). In other words, penetration rate is the most valuable factor in various parameters for making a distinction between fertile and infertile males. Sperm motility and mean velocity showed the next highest diagnostic rate. On the other hand, sperm concentration showed a poor diagnostic rate (36.8%). In addition, there was no significant correlation between penetration rate and any other seminal parameters. These results suggest that the SPA will be an essential test for evaluating male fertility and penetration rate may be a marker of male fertility in the treatment of male infertility.     

精浆酸性磷酸酶活性与抗精子抗体

目的：探讨男性不育症精浆酸性磷酸酶（ＡＣＰ）与精子密度、精子成活率、血清和精浆抗精子抗体（ＡｓＡｂ）之间的关系。方法：检测不育男性精子密度、精子活率、血清和精浆ＡｓＡｂ及精浆ＡＣＰ活性。结果：精子成活率＞５０％、３０％～５０％、＜３０％组的精浆ＡＣＰ活性逐渐降低,分别为（１６２．１２±８５．７７）Ｕ／ｍｌ、（１２３．０１±５２．５５）Ｕ／ｍｌ和（１１１．２１±５４．４２）Ｕ／ｍｌ;与成活率＞５０％的精浆ＡＣＰ相比,活率在３０％～５０％和＜３０％组的ＡＣＰ活性降低,具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）;精子密度＞２０×１０９／Ｌ、（１０～１９）×１０９／Ｌ和＜１０×１０９／Ｌ组的精浆ＡＣＰ活性依次下降,分别为（１６５．９９±８８．６７）Ｕ／ｍｌ、（１３９．１９±７０．７８）Ｕ／ｍｌ和（１１５．２１±６０．５１）Ｕ／ｍｌ;与密度＞２０×１０９／Ｌ组的ＡＣＰ活性相比,密度在（１０～１９）×１０９／Ｌ和＜１０×１０９／Ｌ的精浆ＡＣＰ活性降低,具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）;血清、精浆ＡｓＡｂ阳性病人的ＡＣＰ活性明显低于二者均阴性的病人,且ＡＣＰ降低具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）。结论：?     

Assessment of fertility after testicular torsion: An experimental study

Summary The spermatic cord was ligated in Charles River adult rats producing viable reversible and non viable damaged testes. Weight of the rats, weight of the testes, weight of the epididymis, sperm motility, sperm concentration and fertility were the different parameters assessed. The results showed that there is a high percentage of subsequent atrophy in the ligated testes, and that there is a definite correlation between the length of the occlusion and the amount of testicular injury sustained. Leaving a ligated testis in situ for three months provoked a severe reduction in fertility and some lesser reduction in the sperm motility in the contralteral testis. This damage was not observed in the rats where the ligated testes were removed.     

Varicocele treatment in paediatric age: relationship between type of vein reflux,surgical technique used and outcomes

Varicocele is the first andrological disease in adolescent males. The aim of this study was to report our experience with different techniques. We retrospectively analysed patients treated between January 2005 and January 2011. Inclusion criteria for the study were created. Patients were treated with different techniques based on the type of spermatic vein reflux detected on Doppler velocimetry. The following rates were considered as study endpoints: hydrocele rate, rate of relapses, rate of persistence and rate of testicular atrophy. During the study period, 522 surgical varicocelectomies were performed. Patients were treated with videolaparoscopy, open inguinal technique, subinguinal technique and one‐trocar transumbilical technique. The laparoscopic and the subinguinal techniques showed a lower rate of hydrocele, and the laparoscopic technique had a lower rate of relapses. Choosing a technique based on the type of spermatic vein reflux can reduce the post‐operative complications. The laparoscopic techniques had a lower rate of relapses with respect to other techniques.     

Prepubertal testicular torsion: subsequent fertility

Eighteen patients were reviewed 7 to 23 years after prolonged unilateral testicular torsion. They had all undergone surgical untwisting with replacement of the nonviable testis in the scrotum during prepubertal period. Five patients were now married and had fathered one or more children. Thirteen patients were unmarried. There was absence of testis on the affected side in 14 of 18 patients. Four patients had severe testicular atrophy on the affected side (testicular volume less than 1 mL). The contralateral side showed either a normal testicular volume or a compensatory hypertrophy (testicular volume greater than 25 mL). Seminal analysis was done in 13 unmarried men and it was completely normal in 10 patients. Two patients had low sperm density but normal semen volume and motility. One patient had pathologic semen analysis. IgG and IgA specific mixed agglutination reaction (MAR) test did not show evidence of sperm autoantibodies in any patient. Our clinical experience shows that, after prepubertal torsion, the contralateral testis undergoes normal development. Furthermore, torsion in the prepubertal male does not cause autosensitization and diminished fertility in adult life.     

Seminal plasma transferrin concentration: relationship with seminal parameters and plasma hormone levels.

Seminal plasma transferrin concentrations were determined in 155 infertile male patients and in 15 pregnancy-proven fertile males (control group); then the relationship between these concentrations and seminal parameters and plasma hormone levels was investigated. The concentrations of seminal plasma transferrin in patients with a sperm concentration below 20 x 10(6)/ml were significantly lower than those in the control group (p < 0.01). There was no significant difference in seminal plasma transferrin concentration between patients with a sperm concentration of 40 x 10(6)/ml or more and the control patients. A positive correlation was observed between sperm concentration and seminal transferrin content (r = 0.56; p < 0.05). However, correlations between seminal transferrin concentration and sperm motility and between seminal plasma transferrin content and sperm morphology did not show any significance, nor did the seminal transferrin content correlate with plasma LH, FSH, prolactin or testosterone levels. It, therefore, seems that while transferrin is indicative of certain physiopathological conditions in the germ cells, this protein is not a distinctive marker of the fertility potential of an individual.     

肾移植对慢性肾功能不全尿毒症期患者睾丸体积及生育力指数的影响

目的 探讨肾移植对男性慢性肾功能不全尿毒症期患者睾丸体积及生育力指数的影响.方法 解放军第117医院肾移植中心30例慢性肾功能不全尿毒症期患者于肾移植术前以及术后1个月、3个月和1年应用彩超进行睾丸体积监测,并与20名正常男性的睾丸体积比较.另检测40例尿毒症期和40例肾移植受者的精液,并根据公式[精子密度(×106/mL)×精子活动力×精子正常形态率]计算出生育力指数.结果 慢性肾功能不全尿毒症期患者的睾丸体积术前左侧为(6.82±1.49)mL, 右侧为(7.46±1.89)mL;肾移植术后1个月、3个月和1年左侧分别为(8.25±1.67)mL、(9.31±1.56) mL和(9.80±1.51)mL,右侧分别为(9.18±1.76) mL、(10.41±1.43) mL和(11.09±1.45)mL,肾移植受者术后1个月、3个月和1年的睾丸体积均大于尿毒症期患者,差异有显著性意义(均P<0.01).正常对照组生育力指数为13.03(14.26),肾移植受者的生育力指数为7.19(10.18), 而尿毒症期患者的生育力指数仅为0.23(0.76).尿毒症期患者的生育力指数比肾移植受者和正常对照组均小,差异有显著性意义(均P<0.01). 结论 慢性肾功能不全尿毒症期患者睾丸体积缩小,生育力指数下降, 而成功的肾移植可以明显改善尿毒症期患者的睾丸体积及生育力指数.     

精液粘度与精液分析参数、解脲支原体感染和抗精子抗体关系分析

目的探讨精液粘度增高导致男性不育的机理。方法共4337例不育门诊就诊者,分为精液粘度增高和正常组,观察粘度与主要精液常规参数、UU感染率和AsAb阳性率关系。结果精液粘度增高率为65.02%。粘度增高组精子活动率、a,b级活力精子率显著低于粘度正常组(P<0.05,P<0.001);畸形精子率、液化时间均明显高于粘度正常组(P<0.001);两组精液量、精子密度和精液pH比较无显著性差异(P>0.05)。精液白细胞>5个/HP组粘度增高率明显高于白细胞<5个/HP组(P<0.001)。粘度增高组精浆AsAb阳性率和精液UU阳性率均明显高于粘度正常组(P<0.001)。结论精液粘度可影响精液参数,并与精液白细胞数、精浆AsAb和UU感染有关。     

Zinc and testicular hormone profiles before and after renal transplantation

Summary: Data on zinc status in Indian patients with chronic renal failure is lacking. There are conflicting data in the literature on plasma and erythrocyte zinc levels in renal failure patients and the effect of haemodialysis on zinc status. of the multiple factors believed to be involved in the pathogenesis of uraemic impotence, attention has been focused on the possible role of zinc depletion and hyperprolactinaemia. We report a longitudinal study on 27 patients with end-stage renal disease (ESRD). Plasma and erythrocyte zinc, serum prolactin and serum total testosterone were studied at diagnosis, 4 weeks after haemodialysis, and 3 and 6 months after successful renal transplantation. Zinc status and hyperprolactinaemia are both normalized within 6 months after renal transplantation. While there was a significant positive correlation between plasma zinc and serum testosterone, there was no correlation between serum prolactin and testosterone. This observation suggests that plasma zinc may be a more important determinant of normal gonadal function than prolactin in renal transplant recipients.     

Correlation between gamma seminoprotein in seminal plasma and ejaculate parameters

Gamma seminoprotein (G-SM) levels in seminal plasma were determinated in 62 ejaculates using an enzymimmunoassay. There was no statistical significant difference in G-SM between men with normozoospermia (n = 14), asthenozoospermia (n = 17), OAT-syndrome (n = 18) and azoospermia (n = 13). Also there was no correlation of G-SM levels in those samples with normal (n = 14) or pathological (n = 35) motility and normal (n = 17) or pathological (n = 32) swelling test. Ejaculates with high viscosity (n = 12) showed similar G-SM levels than those with normal (n = 50) viscosity. According to these results seminal G-SM levels does not appear to provide an useful marker for evaluation of male fertility.     

Right testicular volume is a dominant predictor of testicular function determined by sperm parameters and total testosterone

This study aims to evaluate the predictive value of left testicular volume (LTV) and right testicular volume (RTV) for testicular function respectively. Men who requested fertility testing for any reason were enrolled from December 2012 to November 2015. Subjects with primary scrotal diseases or a condition interfering reproductive system were excluded. Testicular volume (TV) was evaluated by scrotal ultrasound. Sex hormone and semen analysis including sperm concentration (SC) and sperm motility rate (SMR) were performed. Statistical analysis including comparison, stepwise linear regression and logistic regression was used. Two hundred and seventy‐four patients with oligoasthenozoospermia/low testosterone and 27 control subjects were enrolled. Both LTV and RTV positively correlated with testicular function, and no differences were found between bilateral TV. RTV is the best independent factor associated with testicular function determined by SC (β=.292, p < .001), SMR (β=.227, p < .001) and total testosterone (TT) (β=.245, p < .001). Using a RTV value of 15.47 ml, the highest discriminating sensitivity and specificity were 66.7% and 62.4% respectively. RTV (<15 ml) was the only positive predictor for low testicular function (odds ratio=2.79, 95% confidence interval: 1.18–6.66; p =.020). RTV rather than LTV is the independent factor of overall testicular function determined by semen quality and TT levels. Further studies are needed to support and elucidate the difference in volume‐function between bilateral testes.