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      Varicocele and testicular function

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          Abstract

          Testicular varicocele, a dilation of the veins of the pampiniform plexus thought to increase testicular temperature via venous congestion, is commonly associated with male infertility. Significant study has clarified the negative impact of varicocele on semen parameters and more recent work has shed light on its detrimental effects on the molecular and ultrastructural features of sperm and the testicular microenvironment, as well as more clearly defined the positive impacts of treatment on couples’ fertility. The relationship between varicocele and testicular endocrine function, while known for some time based on histologic evaluation, has become more apparent in the clinical setting with a growing link between varicocele and hypogonadism. Finally, in the pediatric setting, while future study will clarify the impact of varicocele on fertility and testicular function, recent work supports a parallel effect of varicocele in adolescents and adults, suggesting a re-evaluation of current treatment approaches in light of the progressive nature of the condition and potential increased risk of future disease.

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          Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis.

          Antonio Ciampi, J Boman, Armand Zini … (2008)
          Sperm DNA damage is common amongst infertile men and may adversely impact natural reproduction, IUI-assisted reproduction and to a lesser degree IVF pregnancy. The aim of this study was to examine the influence of sperm DNA damage on the risk of spontaneous pregnancy loss after IVF and ICSI. We conducted a systematic review and meta-analysis of studies on sperm DNA damage and pregnancy loss after an IVF and/or ICSI pregnancy. Two by two tables were constructed and odds ratios (ORs) were derived from 11 estimates of pregnancy loss (five IVF and six ICSI studies from seven reports). These 11 studies involved 1549 cycles of treatment (808 IVF and 741 ICSI cycles) with 640 pregnancies (345 IVF and 295 ICSI) and 122 pregnancy losses. The combined OR of 2.48 (95% CI 1.52, 4.04, P < 0.0001) indicates that sperm DNA damage is predictive of pregnancy loss after IVF and ICSI. In conclusion, sperm DNA damage is associated with a significantly increased risk of pregnancy loss after IVF and ICSI. These data provide a clinical indication for the evaluation of sperm DNA damage prior to IVF or ICSI and a rationale for further investigating the association between sperm DNA damage and pregnancy loss.
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            Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair.

            Antonio Ciampi, Abdulaziz Baazeem, Armand Zini … (2011)
            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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              Do sperm DNA integrity tests predict pregnancy with in vitro fertilization?

              John Collins, Kurt Barnhart, Peter Schlegel (2008)
              To evaluate the predictive value of sperm DNA integrity tests for pregnancy from in vitro fertilization treatment. Systematic review and meta-analysis. Studies from infertility centers. Infertile couples undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment. Sperm DNA integrity tests before IVF and ICSI cycles. Diagnostic test properties for sperm DNA integrity tests with reference to pregnancy after IVF or ICSI treatment. Among 22 relevant studies, 2 x 2 tables were constructed from 13 studies involving 18 estimates of the diagnostic test properties of sperm DNA integrity tests in 2162 cycles of treatment. The sum of sensitivity and specificity ranged from 0.83 to 1.59. In six of 18 estimates abnormal DNA integrity was associated with a higher than expected pregnancy rate. The summary diagnostic odds ratio was 1.44 (95% CI, 1.03, 2.03), but the summary likelihood ratios (LR) were not predictive of pregnancy outcome (LR+ = 1.23; 95% CI, 0.98, 1.54; LR- = 0.81; 95% CI, 0.67, 0.98). Neither sperm chromatin structure assay nor terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay tests were more predictive of pregnancy outcome after IVF/ICSI, and DNA integrity testing was not more predictive for IVF than ICSI. The small but statistically significant association between sperm DNA integrity test results and pregnancy in IVF and ICSI cycles is not strong enough to provide a clinical indication for routine use of these tests in infertility evaluation of men. It is possible that yet to be determined subgroups of infertile couples may benefit from sperm DNA integrity testing.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Asian J Androl
                Journal ID (iso-abbrev): Asian J. Androl
                Journal ID (publisher-id): AJA
                Title: Asian Journal of Andrology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1008-682X
                ISSN (Electronic): 1745-7262
                Publication date (Print): Jul-Aug 2015
                Publication date (Electronic): 24 April 2015
                Volume: 17
                Issue: 4
                Pages: 659-667
                Affiliations
                [1 ]Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
                [2 ]Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
                [3 ]Divisionof Urology, University of Texas Medical School at Houston, Houston, TX, USA
                [4 ]Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
                Author notes
                Correspondence: Dr. AW Pastuszak ( pastusza@ 123456bcm.edu )
                Article
                Publisher ID: AJA-17-659
                DOI: 10.4103/1008-682X.153539
                PMC ID: 4492060
                PubMed ID: 25926610
                SO-VID: c341a5da-8874-4279-a545-f7e27cc045f4
                Copyright © Copyright: © Asian Journal of Andrology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 December 2014
                Date revision received : 06 February 2015
                Date accepted : 28 February 2015
                Categories
                Subject: Invited Review

                Keywords: hypogonadism,leydig cell,male fertility,oxidative stress,sertoli cell,ultramorphology,varicocele
                Data availability:
                Keywords: hypogonadism, leydig cell, male fertility, oxidative stress, sertoli cell, ultramorphology, varicocele

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