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      Varicocele and male infertility

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      Nature Reviews Urology

      Springer Nature

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          Abstract

          Varicocele is the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention, and so the link between varicoceles and male infertility remains a matter of debate. Oxidative stress seems to be a central mechanism of testicular damage; however, no single theory to explain the differential effect of varicoceles on infertility has been suggested. In this Review, a panel of expert authors discuss the epidemiology and pathophysiology of varicocele-related infertility, and consider the optimal treatment for men with varicocele.

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          Most cited references 69

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          Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair.

          Varicocele is a common condition, found in many men who present for infertility evaluation. To assess the effect of varicocelectomy on male infertility. A literature search was performed using Embase and Medline. Literature reviewed included meta-analyses and randomized and nonrandomized prospective (controlled and noncontrolled) studies. In addition, a new meta-analysis was performed. Four randomized controlled trials reporting on pregnancy outcome after repair of clinical varicoceles in oligozoospermic men were identified. Using the random effect model, the combined odds ratio was 2.23 (95% confidence interval [CI], 0.86-5.78; p=0.091), indicating that varicocelectomy is moderately superior to observation, but the effect is not statistically significant. We identified 22, 17, and 5 prospective studies reporting on sperm concentration, total motility, and progressive motility, respectively, before and after repair of clinical varicocele. The random effect model combined improvement in sperm concentration was 12.32 million sperm per milliliter (95% CI, 9.45-15.19; p<0.0001). The random effect model combined improvement in sperm total and progressive motility were 10.86% (95% CI, 7.07-14.65; p<0.0001) and 9.69% (95% CI, 4.86-14.52; p=0.003), respectively. These results indicate that varicocelectomy is associated with a significant increase in sperm concentration as well as total and progressive motility. Prospective studies also show that varicocelectomy reduces seminal oxidative stress and sperm DNA damage as well as improving sperm ultramorphology. Studies indicate that a microsurgical approach to a varicocele repair results in less recurrence and fewer complications than other techniques. Although there is no conclusive evidence that a varicocele repair improves spontaneous pregnancy rates, varicocelectomy improves sperm parameters (count and total and progressive motility), reduces sperm DNA damage and seminal oxidative stress, and improves sperm ultramorphology. The various methods of repair are all viable options, but microsurgical repair seems to be associated with better outcomes. Copyright © 2011. Published by Elsevier B.V.
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            The clinical utility of sperm DNA integrity testing: a guideline.

            (2013)
            Sperm DNA damage is more common in infertile men and may contribute to poor reproductive performance. However, current methods for assessing sperm DNA integrity do not reliably predict treatment outcomes and cannot be recommended routinely for clinical use.
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              Insight into oxidative stress in varicocele-associated male infertility: part 1.

              Varicocele is recognized as the leading cause of male infertility because it can impair spermatogenesis through several distinct pathophysiological mechanisms. Current evidence supports oxidative stress as a key element in the pathophysiology of varicocele-related infertility, although these mechanisms have not yet been fully described. Measurement of the reactive oxygen species and other markers of oxidative stress, including the levels of the antioxidant enzymes catalase and superoxide dismutase, can provide valuable information on the extent of oxidative stress and might guide therapeutic management strategies. The testis can respond to varicocele-associated cell stressors, such as heat stress, ischaemia or production of vasodilators (for example, nitric oxide) at the expense of the generation of excessive reactive oxygen species. These responses have their own implications in exacerbating the underlying oxidative stress and on the subsequent infertility.
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                Author and article information

                Journal
                Nature Reviews Urology
                Nat Rev Urol
                Springer Nature
                1759-4812
                1759-4820
                July 4 2017
                July 4 2017
                :
                :
                Article
                10.1038/nrurol.2017.98
                1c1cc83a-ad4f-4713-abf2-83827e6eafee
                © 2017

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