Scrotal sonography in early management of subclinical varicocele and male infertility

Abstract

Background: Varicocele is the most common cause of male infertility. About 20-30% men with varicocele are infertile. The clinically obvious varicocele is identifiable and correctable cause of male infertility, but less is known about the subclinical varicocele and its relationship to infertility. However, subclinical varicocele seems to be an important cause of infertility and hence scrotal ultrasonography is increasingly used in the diagnosis of subclinical varicocele. This study was undertaken to reveal incidence of subclinical varicocele in patients with severely impaired fertility potential.Objectives: To find the prevalence of subclinical varicocele in subjects of severely impaired fertility potential. Materials and Methods:The semen samples were obtained from 31 male partners (age 25-40 years) of infertile couples (sperm count less than 1 million/ml) attending the OPD Smt. SCL Hospital, Ahmedabad. They were analyzed for routine seminogram parameters. In this study, we evaluated male subjects with severely impaired fertility potential using scrotal ultrasonography, follicle-stimulating hormone, luteinizing hormone, and free testosterone. Results:The subclinical varicocele was present in 12 of 31 infertile male subjects evaluated. Percentage prevalence of subclinical varicocele was observed to be 39%. Hormonal levels of all the subjects studied were within normal limit. There was no significant difference in testicular volume of affected side and contralateral side of infertile male subjects.Conclusion: Scrotal ultrasonography is an important technique to reveal the subclinical varicocele for early diagnosis and management of these infertile male subjects.

Significant predictive factors for subfertility in patients with subclinical varicocele

“…Prajapati, Jadeja, and Patel () reported that scrotal CDU might be an important technique for detecting SV, as well as for the early diagnosis and management of male infertility. Their study used the CDU and WHO guidelines () for diagnosing SV.…”

“…In addition, Prajapati et al. () reported no significant difference in testicular volume in infertile patients with SV, but whether subfertile patients with SV had smaller testis remained under debate. The present study is the first to demonstrated that SV patients with PRF >29 cm/s and total testicular volume <27 cc have higher chances of male subfertility.…”

Effect of Varicocelectomy on Serum Follicle-Stimulating Hormone and Testosterone; The Interrelationship Between Hormonal Variables

“…It has been validated to be secondary to assorted abuses, which include high scrotal temperature with loss of scrotal counter-cooling mechanism, gonadotropins or autoimmunity, oxidative stress, and reflux of adrenal metabolites. 2 Semen parameters are reported to be enhanced by varicocelectomy in almost 70% of the infertile male population as well as 40% of the population will accomplish pregnancy consequently. It is postulated that Sertoli cell dysfunction and low testosterone might be intertwined concerning the influence of testosterone on spermatogenesis.…”

“…On the other hand, testosterone is produced in the testis. 2 The alteration of spermatogenesis is associated with an increase in serum FSH and a decrease in testosterone levels. Different categories of sperm concentration in infertile men have been revealed from the FSH concentration, which includes oligozoospermia and azoospermia.…”