Varicocele and reproductive function: epidemiology and infertility risk (the eamination of 3632 patients)


Citar

Texto integral

Acesso aberto Acesso aberto
Acesso é fechado Acesso está concedido
Acesso é fechado Acesso é pago ou somente para assinantes

Resumo

Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. The study objective: to evaluate the quantitative correlation between varicocele and reproductive function with a large sample. Design: a cross-sectional and case control study. Materials and methods: 3632 patients from infertile couples and 276 fertile males. The ejaculate was tested following WHO recommendations (2010), DNA fragmentation was evaluated with chromatin dispersion in agarose gel. Results: we found weak correlation between varicocele degree (VD) and the spermogram parameters: -0.11 for concentration (р<0.001), -0.08 for progressively motile sperm count (PMSC) in the ejaculate (р<0.001), 0.11 for DNA fragmentation (р<0.01), correlation with other parameters was insignificant (p>0.05). The clinical varicocele (V) prevalence in the fertile (F) and the infertile (I) males was the same: 27.2% (75/276) in the F, 31.4% (101/322) in the I1 with oligoasthenotertozoospermia (OAT) syndrome, 34.4% (43/125) in the I2 with OAT (p>0.05). In the general sample of the males from infertile couples V was found insignificantly more frequently in the I2 than in the I1 31.6% (426/1348) and 28.1% (641/2284), respectively (OR=1.13; p<0.05), because of degree 1 varicocele: 23.5% и 20.2%, respectively (OR=1.16; p<0.05). Compared to the males without varicocele, median concentration is 8 mln/ml less in degree I,17mln/ ml in degree II and 24 mln/ml in degree III (p<0.001); we found parallel increase in oligozoospermia rate: from 14% without varicocele to 27 and 26% in degree II and III (p<0.05-0.01). The PMSC in degree I varicocele is 10 mln less (-16% of the group without varicocele),in degree II 27 mln less (-44%), in degree III 23 mln less (-38%) (р<0.001); the difference between the groups with degrees II and III is insignificant (p>0.05). The DNA fragmentation was significantly lower only in degree III (p<0.05). We found no difference in the sperm motility and morphology among the groups (p>0.05). Conclusion. In varicocele, the sperm count decreases but in ¾ of cases, concentration is within reference values; there is no difference between degree II and III. The sperm motility and morphology do not depend upon varicocele. The DNA fragmentation is increased in degree III varicocele. The relative risk of infertility in varicocele is low (OR is ≤1.13).

Texto integral

Acesso é fechado

Sobre autores

V. Bozhedomov

Lomonosov Moscow State University; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology; Polyclinic №3, Presidential Administration

Email: vbojedomov@mail.ru
Ph.D., MD, professor at the Department of Urology and Andrology, Faculty of Fundamental Medicine; Head of the “Men's Health” Clinic

A. Shomarufov

Lomonosov Moscow State University

Email: doctor.shomarufov@gmail.com
urologist, Ph.D. student at the Department of Urology and Andrology

G. Bozhedomova

Lomonosov Moscow State University; Polyclinic №3, Presidential Administration

Email: bozhiedomova@bk.ru
medical technologist at of the “Men's Health” Clinic

D. Okhobotov

Lomonosov Moscow State University

Email: 14072003m@gmail.com
urologist at the Medical Research and Educational Center, senior tutor at the Department of Urology and Andrology, Faculty of Fundamental Medicine

D. Kamalov

Lomonosov Moscow State University

Email: davidffm@mail.ru
Ph.D., urologist

A. Kamalov

Lomonosov Moscow State University

Email: priemnaya@mc.msu.ru
Academician of the RAS, Ph.D., MD, professor, Director of the "University Hospital" and Head of the Department of Urology and Andrology

Bibliografia

  1. EAU Guidelines. Sexual and Reproductive Health / A. Salonia (Chair), C. Bettocchi, J. Carvalho, et al. Edn. presented at the EAU Annual Congress Amsterdam 2020. ISBN 978-94-92671-07-3.
  2. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization. Fertil Steril 1992; 57: 1289-1293.
  3. WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple. 2000, Cambridge University Press: Cambridge.
  4. Jensen C.F.S., 0stergren P., Dupree J.M. et al. Varicocele and male infertility. Nat Rev Urol. 2017 Sep;14(9):523-533.
  5. Bozhedomov V.A., Gromenko D.S., Ushakova I.V. et al. Sperm oxidative stress in the pathogenesis of male infertility. Urology, 2009, No. 2, p. 51-56. Божедомов В.А., Громенко Д.С., Ушакова И.В. и соавт. Оксидативный стресс сперматозоидов в патогенезе мужского бесплодия. Урология, 2009, № 2, с. 51-56.
  6. Agarwal A., Majzoub A., Parekh N. et al. A. Schematic Overview of the Current Status of Male Infertility Practice. World J Mens Health. 2019 Jul 12. doi: 10.5534/wjmh.190068. [Epub ahead of print] Review
  7. Zini A., Dohle G. Are varicoceles associated with increased deoxyribonucleic acid fragmentation? Fertil Steril. 2011 Dec;96(6):1283-1287.
  8. Moazza A., Sharma R. & Agarwal A. Relationship of spermatozoal DNA fragmentation with semen quality in varicocele-positive men. Andrologia 2015, 47, 935-944.
  9. Damsgaard J., Joensen U.N., Carlsen E. et al. Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels: A Study of 7035 Healthy Young Men from Six European Countries. Eur Urol. 2016 Dec;70(6):1019-1029.
  10. Pallotti F., Paoli D., Carlini T. et al. Varicocele and semen quality: a retrospective case-control study of 4230 patients from a single centre. J. Endocrinol Invest, 2018. 41:185.
  11. Saypol D.C. Varicocele. J. Androl, 1981;2:61-71.
  12. Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic revive. Lancet. 2003;361:1849-1852.
  13. Esteves S.C. Varicocele // Male infertility / S.J.Parekattil, A.Agarwal (Ed.), 2012, Springer: 247-259.
  14. Akhvlediani N.D., Reva I.A., Chernushenko A.S., Bernikov A.N., Pushkar D.Yu. Varicocele: role in the development of male infertility and surgical techniques. Urology, 2020, 4: 111-118. Ахвледиани Н.Д., Рева И.А., Чернушенко А.С., Берников А.Н., Пушкарь Д.Ю. Варикоцеле: роль в развитии мужского бесплодия и методики хирургического лечения. Урология, 2020,4:111-118.
  15. Сизонов В.В., Сичинава З.А., Кравцов А.Ю., Коган М.И. Частота отцовства у мужчин, не оперированных по поводу варикоцеле в детском и подростковом возрасте. Урология. 2019,5:94-97
  16. Nieschlag E., Hertle L., Fischedick A., et al. Update on treatment of varicocele: counseling as affective as occlusion of the vena spermatica. Hum Reprod. 1998;13:13:2147-2150.
  17. Redmon JB, Carey P., Prior JL et al. Varicocele - the most common cause of male factor infertility? Hum Reprod Update. 2002;8:53-58.
  18. Comhaire F. Clinical andrology: from evidence to ethics. The “E” quintet in clinical andrology. Hum Reprod. 2000; 15(10):2067-2071.
  19. Bozhedomov V., Alexandrova M., Sukhikh G. et al. The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy. Andrology. 2014 Nov;2(6):847-855.
  20. Wang Y.J., Zhang R.Q., Lin Y.J. et al. Relationship between varicocele and sperm DNA damage and the effect of varicocele repair: a metaanalysis. Reprod Biomed Online. 2012 Sep;25(3):307-314.
  21. WHO laboratory manual for the examination and processing of human semen. Fifth ed., WHO, 2010; 271.
  22. Barratt C.L.R., Bjorndahl L., De Jonge C.J. et al. The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities. Hum Reprod Update. 2017;23(6):660-680.
  23. Genetics of human infertility /Ed. P.H. Vogt. Karger: Basel, Freiburg, Paris, London, New York, Tokyo. 2017, 177 p.
  24. Gosalvez J., Lopez-Fernandez C., Fernandez J.L. Sperm chromatin dispersion test: technical aspects and clinical applications. In: Zini, A., Agarwal A. (Eds.), Sperm Chromatin. Biological and Clinical Applications in Male Infertility and Assisted Reproduction. 2011. Springer: 151-170.
  25. Redmon, J., Drobnis E.Z., Sparks A.,et al. Semen and reproductive hormone parameters in fertile men with and without varicocele. Andrologia. 2019;00: e13407.
  26. Bitkin A., A Ozbalci M. Aydin. Effects of varicocele on testicles: Value of strain elastography:A prospective controlled study. Andrologia. 2018; e13161.
  27. Bozhedomov V.A., Lipatova N.A., Sukhikh G.T. et al. Male fertility and varicocele: role of immune factors. Andrology. 2014 Jan;2(1):51-58.
  28. Besiroglu H., Otunctemur A., Dursun M. et al. The prevalence and severity of varicocele in adult population over the age of forty years old: a crosssectional study. Aging Male. 2019 Sep;22(3):207-213.
  29. Alsaikhan B., Alrabeeah K., Delouya Ga., Zini A. Epidemiology of varicocele. Asian Journal of Andrology (2016)18,179-181.
  30. Gorelick J.I., Goldstein M. Loss of fertility in men with varicocele. Fertil Steril 1993;59:613-616.
  31. Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology 1993;42:541-543.
  32. Levinger U., Gornish M., Gat Y. et al. Is varicocele prevalence increasing with age? Andrologia 2007;39:77-80.
  33. Walsh T.J., Wu A.K., Croughan M.S., Turek P.J. Differences in the clinical characteristics of primarily and secondarily infertile men with varicocele. Fertil Steril 2009;91:826-830.
  34. Marmar J.L. The pathophysiology of varicoceles in the light of current molecular and genetic information. Hum Reprod Update. 2001;7,461-472.
  35. Panner Selvam M.K., Agarwal A. Sperm and Seminal Plasma Proteomics: Molecular Changes Associated with Varicocele-Mediated Male Infertility. World J. Mens Health. 2019 Jul 26. doi: 10.5534/wjmh.190018. [Epub ahead of print].
  36. Chertman W., Arora H.1., Griswold A.J., et al. Whole Exome Sequencing Identifies a Rare Nonsense Mutation in FAM47C as a Possible Cause of Severe Oligospermia in Brothers With Varicocele. Urology. 2019 Jul; 129:71-73.

Arquivos suplementares

Arquivos suplementares
Ação
1. JATS XML
Baixar

Declaração de direitos autorais © Bionika Media, 2021