Can Varicocelectomy Significantly Change The Way Couples Use Assisted Reproductive Technologies?

Çayan, Selahíttín; Erdemır, Fikret; Özbey, İsa; Turek, Paul J.; Kadıoğlu, Ateş; Tellaloğlu, S

doi:10.1016/s0022-5347(05)65192-0

Cited by 135 publications

(74 citation statements)

References 22 publications

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“…Varicocele repair should also be considered in adolescents with a large varicocele and evidence of testis hypotrophy, and in the presence of varicocele-induced orchialgia. It is important to ensure adequate maternal reproductive potential if varicocele correction is performed for male infertility, given that the mean time to natural pregnancy after varicocele surgery is 8 months (16). In general, it is not advisable to repair varicoceles in with known genetic infertility, as the chance of improving either semen quality or natural pregnancy rates is low (17).…”

Section: Varicocelementioning

confidence: 99%

“…Cost-benefit and decision modeling arguments have shown that varicocelectomy is more cost effective than ART procedures (11,12). More recently, it has been demonstrated in "shift of care" analyses that as many as 50% of couples who would only be candidates for ART procedures due to low semen quality can be "rescued" from such procedures and conceive naturally or with IUI after varicocelectomy (16).…”

Section: Varicocelementioning

confidence: 99%

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Definition and current evaluation of subfertile men

Shefi

Turek

2006

Int. braz j urol.

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Male infertility affects 10% of reproductive aged couples worldwide and is treatable in many cases. In addition to other well-described etiologies, genetic causes of male infertility are now more commonly diagnosed. Using principles of evidencebased medicine, this review outlines diagnostic and treatments options to inform clinical management. In order of importance, randomized controlled clinical trials, basic scientific studies, meta-analyses, case-controlled cohort studies, best-practice policy recommendations and reviews from peer-reviewed literature were incorporated that provide organized and timely guidelines to the current management of male infertility. The strength of evidence for treatment recommendations is also classified when appropriate.

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Section: Varicocelementioning

confidence: 99%

Section: Varicocelementioning

confidence: 99%

Definition and current evaluation of subfertile men

Shefi

Turek

2006

Int. braz j urol.

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“…Many articles report favourable outcomes, 9-11 and others do not. [12][13][14] Some authors noted an increase of total motile sperm count by more than 50% and spontaneous pregnancy rate of 37% achieved after varicocelectomy. 15 Many authors tried to define preoperative parameters as patient age, obesity, and semen parameters to help predict varicocelectomy outcome.…”

Section: Introductionmentioning

confidence: 99%

Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study

Shabana

Teleb

Dawod

et al. 2015

CUAJ

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Introduction: We aim to predict results of varicocelectomy on sperm density and progressive motility using preoperative clinical, laboratory and radiological data and to propose cut-off values for significant parameters. Methods: This prospective study was carried out between July 2011 and June 2014. We included 123 patients in our study. They were diagnosed with primary infertility with varicocele, were scheduled for varicocelectomy, and completed their follow-up. We excluded patients with azoospermia, total necrospermia, recurrent varicocele, and pituitary hormonal abnormalities. Varicocele was diagnosed and graded by physical examination and colour Doppler ultrasound. Semen analyses were completed preoperatively and 6 months postoperatively. Microscopic subinguinal varicocelectomy was done in all cases. Patient demographics, pre-and postoperative clinical data (varicocele grade and semen parameters) were statistically analyzed. Results: The mean ± standard deviation of age, body mass index, and subfertility duration was 28.3 ± 7.4 years, 29.1 ± 2.7 kg/m 2 , and 21.9 ± 7.1 months, respectively. About 53% of our patients (n = 66) had bilateral varicocele, and unilateral disease was found in the other 57 (46.3%) cases. Varicocele grade I was diagnosed in 42 (34.1%) patients, while the other 81 (65.9%) patients had grade II or III. Higher grades of varicocele, preoperative total testosterone level, sperm density, and progressive motility had a statistically significant impact on the outcome of varicocelectomy in univariate testing. Multivariate logistic analysis revealed that grade of preoperative varicocele (95% confidence interval [CI] 5.6-6.3, p = 0.007) and sperm density (95% CI 2.7-1.6, p = 0.0035), and progressive motility (95% CI 1.1-2.3, p = 0.0123) are independent predictors of semen parameters improvement after varicocelectomy. Conclusion:The grade of the varicocele, sperm density, and progressive motility are major predictors of outcome in varicocelectomy. Cut-off values of >8 million/mL and >18% for sperm density and progressive motility, respectively, in men with varicocele grade II or III, indicate a successful outcome. IntroductionVaricocele is an abnormal enlargement and tortuosity of the pampiniform plexus of veins in the spermatic cord. It is the most common identifiable cause of male subfertility, with an estimated prevalence of 15% in the general male population and up to 40% in subfertile men.1 One of the theories of the varicocele influence on spermatogenesis is the resultant venous blood stagnation in the testis that increases oxidative stress and hinders spermatogenesis through a thermal effect. 2Varicocelectomy is by far the most common procedure to treat male subfertility in patients with clinical varicocele. It reduces intratesticular temperature to the normal range. Hence, semen parameters not uncommonly show significant improvement following varicocele ligation. There are many approaches for varicocelectomy. [4][5][6] Initially open surgical approach was the standard, but now...

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“…Using DNA fragmentation for triage can reduce the cost of varicocele management by the use of less com-Advances in Reproductive Sciences plicated technique of ART. Some authors like Jallouli [30], Coccuza [31] or Daitch [32] showed that the improvement of semen quality after surgery helped to choose less expensive technique of ART or even avoid it [33] [34], with spontaneous pregnancies following the repair [7]. In our study, DNA fragmentation is significantly more important in patients with varicocele.…”

Section: Discussionmentioning

confidence: 49%

Varicocele and DNA Fragmentation in Senegalese Infertile Males—A Study of 95 Cases

Diallo¹,

Faye²,

Diallo³

et al. 2017

ARSci

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Varicocele is the first etiology of infertility in men worldwide and affects almost half of the men dealing with infertility in Senegal. Varicocele is associated with a high rate of sperm DNA fragmentation so this test is being more and more recommended especially when patients have to benefit from an ART (Assisted Reproductive Technology) procedure. The aim of our study was to assess if our patients with varicocele are concerned by higher DNA fragmentation rate in spermatozoon. Sperm samples were collected (95 cases of varicocele and 30 controls) and analyzed between January 2013 and June 2016 in a prospective study. Sperm DNA damage, characterized by the rate of DNA fragmentation was evaluated by TUNEL assay using fluorescence microscopy. There was a significant higher percentage of DNA fragmentation in patients with varicocele (p < 0.001), compared to controls. We plan to study a bigger cohort to assess this tendency and study the benefits of surgery in varicocele by evaluating DNA fragmentation after the procedure.

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Can Varicocelectomy Significantly Change The Way Couples Use Assisted Reproductive Technologies?

Abstract: Varicocelectomy has significant potential not only to obviate the need for assisted reproductive technology, but also to down stage or shift the level of assisted reproductive technology needed to bypass male factor infertility.

Cited by 135 publications

References 22 publications

Definition and current evaluation of subfertile men

Definition and current evaluation of subfertile men

Predictors of improvement in semen parameters after varicocelectomy for male subfertility: A prospective study

Varicocele and DNA Fragmentation in Senegalese Infertile Males—A Study of 95 Cases

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