Surgical techniques for the management of male infertility

Lopushnyan, Natalya; Walsh, Thomas J.

doi:10.1038/aja.2011.62

Cited by 19 publications

(25 citation statements)

References 127 publications

(126 reference statements)

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“…Controversy still remains regarding the benefit of varicocele repair to improve male fertility Evers et al, 2009;Nieschlag et al, 2010;Jungwirth et al, 2013). Evidence exists both in favour and against it, but as of now, most of specialty societies recognize that varicocele is detrimental to male reproductive health and its treatment may improve sperm function and chances of conceiving Baazeem et al, 2011;Ficarra et al, 2012;Kroese et al, 2012;Lopushnyan & Walsh, 2012;Miyaoka & Esteves, 2012;Kim et al, 2013). Despite the several different theories that aim to explain the impact of varicocele on testicular function, none can fully clarify the variable effect of varicocele on human spermatogenesis and male fertility.…”

Section: Introductionmentioning

confidence: 99%

The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy

et al. 2014

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SUMMARYAntisperm antibodies (ASA) are a cause of male infertility. ASA are often found in varicocele patients. The study objective was to assess the ASA role in fertility recovery after varicocelectomy. The longitudinal study involved 99 patients with varicocele. Patients were examined according to the WHO recommendations; ASA level was measured using the direct method of Sperm MAR test: 66 patients were ASA-negative, 33 had MAR-IgG ≥ 10%. All patients underwent microsurgical varicocelectomy. Student's t-test, Wilcoxon test, Chi-squared test and signed rank test were used for data analysis. The retrospective analysis of all operated patients data showed that the patients without spermiogram improvement after varicocelectomy had higher ASA levels. 3 months after the surgery, the initially ASA-negative varicocele patients demonstrated 2.5 times increase in number of progressive motile spermatozoa in the ejaculate (p < 0.001), accompanied by 6% decrease in abnormal sperm count (p < 0.05); the spermiogram parameters improved in 77% of cases (p < 0.01). After the surgery, ASA developed in 16% of cases (Max -MAR-IgG = 12%). The patients who were initially ASA-positive demonstrated ASA decrease only in half of the cases (16 of 33; p > 0.05). The main outcome in this group was a favourable response to the surgery (ASA level decrease) vs. no reduction in autoimmune process. The improvement in the ASA-positive group was demonstrated in the patients with higher varicocele grade (median -2 vs. 1; p < 0.05) and lower ASA level (MARIgG = 48% vs. 92%; p < 0.01). The pregnancy rate within a year after surgery was 2.8 times more frequent in couples with ASA-negative men: 39% (25 of 65) in the ASA-negative group compared to 14% (4 of 28) in the ASA-positive group (p < 0.05). Thus, antisperm immune response decreases the varicocelectomy efficacy for reproductive function recovery: the higher percentage of ASA and lower grade of varicocele are associated with an unfavourable prognosis.

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Section: Introductionmentioning

confidence: 99%

The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy

et al. 2014

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“…The higher frequency of varicocele appearances in men with infertility has drawn attention and resulted in increased research at the molecular level towards treatments. 3,9 The present study was performed to investigate the role of TRAIL and its receptors in the pathogenesis of varicocele-induced testicular dysfunction. We chose a well-established, experimental varicocele rat model that mimics the varicocele in humans.…”

Section: Discussionmentioning

confidence: 99%

“…However, the exact mechanism that causes this abnormality remains to be determined. 3 Several theories have been suggested to explain the mechanism by which varicoceles impair male fertility. These theories include increased apoptosis, increased DNA damage in sperm, oxidative stress, tissue hypoxia, degenerative changes in the seminiferous tubule and immunological infertility caused by the increased apoptosis of germ cells.…”

Section: Introductionmentioning

confidence: 99%

Role of TNF-related apoptosis-inducing ligand (TRAIL) in the pathogenesis of varicocele-induced testicular dysfunction

Çelik¹,

Kutlu²,

Tekcan³

et al. 2012

Asian J Androl

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The higher frequency of varicocele in men with infertility has drawn attention and resulted in increased research at the molecular level towards treatments. The aim of this study was to investigate the role of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) and its receptors in varicocele-induced testicular dysfunction in an experimental rat model. The rats were divided into three groups: control, sham and varicocele. Varicoceles in rats were induced by partial ligation of the left renal vein and left testes. The rats were analyzed 13 weeks after surgery. The degree of DNA fragmentation within cells in the testis was determined using terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) assay. Tubule degeneration was evaluated using the Johnsen score. The expression of TRAIL and its receptors was detected by immunohistochemical and Western blotting techniques. The apoptotic index, Johnsen score and the expression of TRAIL and TRAIL receptors were examined. The data are presented as the mean6s.d. and were analyzed using computer software. The Kruskal-Wallis and Dunn's multiple comparison tests were used in the statistical analyses. The germ cell apoptotic index was increased in rats with varicoceles when compared with the sham and control groups (P50.0031). The Johnsen score was significantly decreased in the varicocele group when compared with the sham and control groups (P,0.0001). Immunohistochemical and Western blotting analyses showed that after varicocele induction, the expression of TRAIL-R1 and TRAIL-R4 in germ cells was increased and the expression of TRAIL-R2 was decreased. There are no significant differences among the groups in terms of TRAIL and TRAIL-R3 receptor expression. The results of this study indicate that TRAIL and its receptors may have a potential role in the pathogenesis of varicocele-induced testicular dysfunction.

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“…12,13 The pregnancy rate decreases with increasing time between obstruction of the reproductive tract and its surgical reversal, suggesting that sequelae to the male reproductive tract increases with time after surgical reversal. [14][15][16] This study tried to demonstrate the expression change of epididymal proteins after obstruction and its surgical reversal. Image analysis of 2-D autoradiograms demonstrated that the total integrated intensity and total spot area of autoradiograms showed a consistent downward trend after reproductive tract obstruction, and this trend remained after patency.…”

Section: Discussionmentioning

confidence: 99%

Influence of reproductive tract obstruction on expression of epididymal proteins and their restoration after patency

Wang²,

Liu³

et al. 2012

Asian J Androl

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Vasectomy is a simple and reliable method of male contraception. A growing number of men after vasectomy request vasectomy reversal due to various reasons. The pregnancy rate is lower than the patency rate after vasovasostomy and the pregnancy rate is time dependent. In this study, we evaluated the influence of reproductive tract obstruction on expression of epididymal proteins and their restoration after patency. Adult male Wistar rats were studied 30, 60 and 120 days after vasectomy, 30 days after vasovasostomy or after sham operations. Two-dimensional gel electrophoresis, mass-spectrometric technique, multidatabase search, Western blotting and real-time PCR were used to analyze the expression regulation of epididymal proteins. Total integrated intensity and total spot area of autoradiograms showed a consistent downward trend with time after obstruction, and this trend remained after patency. The intensity of the autoradiographic spots in three patency groups showed three trends: a downward trend, similar intensity and an upward trend compared with the correspondent obstruction group, respectively. Further verified experiments on human epididymis 2 (HE2), fertilization antigen-1 (FA-1), clusterin and PH20 demonstrated that compared with the correspondent obstruction group, the translation levels of HE2 and the mRNA transcription levels of HE2 showed an upward trend in patency groups, especially in the groups of obstruction for 60 days where the expression levels of HE2 were significantly upregulated after patency (P,0.05). Reproductive tract obstruction provokes a disregulation of gene expression in the epididymis and this disregulation remained after patency. Successful reversal may recover some proteins and the recovery is time dependent. Obstruction differentially alters mRNA transcription of different proteins and the content of proteins seemed to be easier to be influenced than the gene transcription. Vasovasostomy by modern microsurgical techniques remains the standard technique for vasectomy reversal with which all other methods of vasectomy reversal are compared. If success is defined that sperm can be detected in ejaculate following reversal, patency is over 80% in most microsurgical series, with patency approaching 100% in some reports. 1 However, pregnancies are obtained without assisted reproduction in 30%-75% of couples. 2 In other words, about 25% of couples are affected. Male factors account for about 50% of couples with infertility. 3 Approximately 10%-15% of infertile men suffer from azoospermia-complete absence of sperms in the ejaculate. Among these azoospermic patients, approximately 40% have complete obstruction in the ductal system and hence suffer from obstructive azoospermia. 4 Vasoepididymostomy is performed for congenital, infectious, postvasectomy or idiopathic epididymal obstruction. Following this type of microsurgery, 20%-40% of couples achieve pregnancy through intercourse without the assistance of reproductive techniques. 2 Similar to vasectomy reversal, the pregnancy rate is mu...

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Surgical techniques for the management of male infertility

Cited by 19 publications

References 127 publications

The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy

The role of the antisperm antibodies in male infertility assessment after microsurgical varicocelectomy

Role of TNF-related apoptosis-inducing ligand (TRAIL) in the pathogenesis of varicocele-induced testicular dysfunction

Influence of reproductive tract obstruction on expression of epididymal proteins and their restoration after patency

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