| INTRODUC TI ONVaricocele is among the causes of male factor infertility and is one of the most controversial issues concerning to whom varicocelectomy should be beneficial. Varicocele is found in about 40% of men complaining of primary infertility and 80% of men presented with secondary infertility, though it occurs in 12% of normzoospermic men (Brannigan, 2017;Hassanin, Ahmed, & Kaddah, 2018). Several theories were raised to explain how varicocele affects male infertility. It includes hypoxia, hyperthermia; impaired arterial perfusion, retrograde flow of adrenal/renal metabolites and increased seminal ROS Oxidative stress (OS) results from the disproportion between reactive oxygen species (ROS) and antioxidants. Lately, seminal OS gets impotence being responsible about sperm DNA damage, sperm membrane changes with decreased fertilising ability. Several studies showed high seminal OS generally in infertile men and particularly Abstract This work assessed seminal SIRT1-oxidative stress (OS) relationship in infertile oligoasthenoteratozoospermic (OAT) men after varicocele repair. Overall, thirty OAT men with varicocele were investigated. Inclusion criteria were infertile males (males who were unable to initiate a pregnancy within 1 year of regular unprotected intercourse), confirmed OAT and normal female factor. These cases were subjected to history taking, clinical checkup and semen analysis. In their semen, seminal SIRT1, malondialdehyde (MDA) and glutathione peroxidase (GPx) levels were assessed.These men were subjected to varicocele surgical repair and were followed up for 3 months. Post-operatively, the mean seminal SIRT1, GPx levels showed significant increases and the mean MDA level showed significant decrease compared to the pre-operative levels linked to improved sperm parameters. The mean seminal SIRT1, GPx, MDA levels showed more significant improvement in grade III varicocele cases compared to grade II cases after surgical repair. Seminal SIRT1 levels showed significant positive correlations with sperm concentration, sperm motility, sperm normal morphology, seminal GPx levels and a significant negative correlation with seminal MDA levels. It could be concluded that seminal SIRT1 is significantly decreased in infertile OAT men with varicocele after its surgical repair linked to improved sperm parameters as well as seminal OS. K E Y W O R D Smale infertility, oxidative stress, semen, SIRT1, varicocele

Background: Many harmful effects have been reported for the abuse of testosterone with supraphysiologic doses on the male genital system. Objective: To study the possible protective effect of silymarin in testosterone induced testicular changes. Materials and Methods: Eighty adult male albino rats were randomly divided into four groups; untreated rats (controls), rats treated with silymarin, rats treated with testosterone and rats treated with testosterone and silymarin. Relative testicular weight, serum testosterone and FSH were estimated in addition to histological, histochemical and immunohistochemical assessment. Results: Serum testosterone was significantly higher in testosterone treated rats compared with the controls and rats treated with testosterone plus silymarin. Serum FSH was significantly lower in testosterone treated rats as well as rats treated with silymarin plus testosterone compared with controls. There was a significant increase in caspase-3 expression between testosterone treated rats and the other studied groups (P<0.001). There was a significant increase in P53 expression between the testosterone treated rats and the control groups (P<0.001 for each), and also between the testosterone treated rats and rats treated with testosterone and silymarin (P=0.004). P53 expression was also significantly different between rats treated with testosterone plus silymarin and the control groups (P=0.012 for each). Conclusion: Oral concomitant treatment with silymarin was effective in attenuating testosterone-induced testicular damage in adult male albino rats.

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Background: Few studies have investigated the relationship of seminal L-Carnitine (LC) with male infertility associated with varicocele. The purpose of this prospective cross-sectional study was to assess seminal plasma LC levels in infertile oligoathenoteratozoospermic (OAT) men with varicocele. Methods: Overall, 86 men were investigated. They were divided into infertile OAT men with varicocele (n=45), infertile OAT men without varicocele (n=21), and fertile men (n=20) as a control group. According to WHO guidelines, these men were subjected to history taking, clinical examination, and semen analysis. Seminal LC levels were evaluated by the colorimetric method. Statistical comparisons were done using Kruskal-Wallis and Mann-Whitney U tests and correlations were verified by the Pearson test. P-value<0.05 was set to be statistically significant. Results: The mean seminal plasma LC levels were significantly lower in infertile OAT men with varicocele (216.3±57.1 ng/ml) compared to infertile OAT men without varicocele (252.9±62.9 ng/ml, p=0.01), or fertile men (382.8±63.6 ng/ml, p= 0.001). Besides, the mean seminal plasma LC level exhibited statistically significant decreases in infertile OAT men of varicocele grade III compared to varicocele grade II cases, and in infertile OAT men with bilateral varicocele compared with unilateral varicocele cases. Collectively, there was a statistically significant positive correlation between seminal LC levels with sperm concentration, motility, and normal morphology. Conclusion: Seminal LC levels are expressively reduced in infertile OAT men with varicocele and are influenced by an increase in varicocele grade and laterality.

Background Phosphodiesterase type 5 inhibitors (PDE5Is), due to their efficacy and tolerable profile for more than 2 decades,are considered a good addition to the available treatments in patients with erectile dysfunction (ED). Aim We sought to assess the possible influence of oral PDE5Is on male human reproduction. Methods A literature review was performed in several databases, including the PubMed/Medline database, Scopus, Cochrane Library, EMBASE, Academic Search Complete, and Egyptian Knowledge Bank databases. The keywords/search terms were “PDE5Is,” “sildenafil,” “vardenafil,” “tadalafil,” or “avanafil,” combining and crossing them with “male infertility,” “semen,” “reproductive hormones,” or “sperm.” Results Overall, 101 articles were selected. After removal of duplicates and animal studies, 75 articles were finally subjected to review covering the different items related to male human reproduction, including effects of PDE5Is on different parameters of semen or reproductive hormones, as uses of PDE5Is in cases related to distinctive male factor infertility, such as ED, temporary ED, or ejaculatory failure alongside assisted reproduction (AR) procedures, and ejaculatory dysfunction in spinal cord lesions. We found 26 articles that addressed the direct effects of PDE5Is on semen and reproductive hormonal profiles, 16 in vivo studies and 10 in vitro studies. Oral PDE5Is have in general a stimulatory effect on sperm motility, while other semen parameters and reproductive hormonal profiles showed varied outcomes. Such effects are more pronounced with a long-term daily regimen than with an on-demand regimen. However, it seems that the best-controlled studies suggested no change in the sperm quality of male reproductive potential. Conclusion Oral PDE5Is have in general stimulatory effects on sperm motility, while other semen parameters and hormone profiles showed varied results. In addition, oral PDE5Is have played a useful role in conditions related to distinctive male factor infertility, such as ED, temporary ED, ejaculatory failure alongside AR, and ejaculatory dysfunction in spinal cord lesions.