The influence of antisperm antibodies, intratesticular haemodynamics and the surgical approach to varicocelectomy on seminal variables

Abstract

ObjectiveTo evaluate the effect of antisperm antibodies (ASAs), hormonal levels, intratesticular haemodynamics and the surgical approach on the outcomes of varicocelectomy in infertile men, as assessed by seminal variables.Patients and methodsIn a prospective case-series study, 82 infertile men with varicocele (35 left and 47 bilateral) were evaluated. The preoperative assessment included a physical examination, semen analysis, assessment of ASAs in seminal plasma, hormonal levels (follicle-stimulating hormone (FSH), luteinising hormone and testosterone), and scrotal colour Doppler ultrasonography (CDUS) to measure the peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and pulsatility index. Patients were scheduled for varicocelectomy, with high ligation (Palomo) used in 40 patients (18, 45%, with left and 22, 55%, with bilateral varicocele), or an inguinal approach (Ivanissivich) with loupe magnification used in 42 (17, 40%, with left and 25, 60%, with bilateral varicocele). The men were reassessed at ⩾3 months after surgery and according to the improvement in seminal variables (expressed as a ⩾50% increase in total motile sperm count, TMSC), patients were further categorised into ‘improved’ or ‘unimproved’. Binary logistic regression analysis was used to investigate the predictors of improvement.ResultsBefore surgery the ASAs were positive in 17 men (21%). There was no significant difference between the right and left sides in intratesticular haemodynamics. The TMSC was improved in 52 (63%) patients who had a significant improvement in the haemodynamic variables. Intratesticular haemodynamics, serum FSH and testosterone levels differed significantly between the improved and unimproved patients. Positivity for ASAs, the surgical approach and laterality of the varicocele were not significantly different, although the ASA-positive cases were characterised by a significant decrease in motility. Logistic regression analysis showed that the EDV, PSV, FSH, testosterone level and bilateral testicular volume (BTV) were significant predictors of improvement.ConclusionPositivity for ASAs is not a predictor of the outcome after varicocelectomy but affects only the motile fraction in positive cases, despite the improvement in other seminal variables and testicular haemodynamics, and regardless of the surgical approach. The EDV, PSV, FSH, testosterone and BTV were significant predictors of a successful outcome.

The impact of coexisting sperm DNA fragmentation and seminal oxidative stress on the outcome of varicocelectomy in infertile patients: A prospective controlled study

“…A factor that could explain this may be the assumption that in the presence of high oxidative stress and denatured DNA spermatogenesis may be impaired. Other factors that may be essential for spermatogenesis and that were previously found to be significant predictors of success after repair are a good preoperative testicular blood supply and normal Sertoli cell and Leydig cell secretory function [17] . Whilst in another study, preoperative serum FSH and testosterone concentrations were predictors of improvement after varicocelectomy [53] .…”

“…Our present results are in agreement with many studies regarding the laterality of varicocelectomy and the response in different grades of varicocele. Many studies have reported a statistically non-significant difference between bilateral and unilateral repair with similar seminograms [16] , [17] , [50] . In addition, some authors found no clear correlation between ligated vein size (individual or cumulative) and improvements in seminal variables [51] ; whilst others have found a significant difference in favour of bilateral repair [49% (54/110) vs 36% (53/146), P < 0.05] [52] .…”

“…Currently, the sperm chromatin structure assay (SCSA) is a clinically applicable method for calculating the sperm DNA fragmentation index (DFI%, percentage of sperm with denatured nuclei) to determine the susceptibility of sperm DNA to denaturation [14] . There is no conclusive evidence that a varicocelectomy improves spontaneous pregnancy rates; however, its beneficial effect on various sperm variables [15] , improvement of sperm DNA damage [16] , and improvement of the testicular microcirculation has been evaluated [17] . Varicocele repair also has a beneficial effect in reducing seminal oxidative stress [18] .…”

Bilateral disease and intratesticular haemodynamics as markers of dyspermia in patients with subclinical varicocele: A prospective study

“…On the other hand, Ross et al [37] have observed that neither varicocele nor varicocelectomy alter testicular blood flow in men, whereas experimental data demonstrated that varicocele increased testicular blood flow, which might be the reason for testicular hyperthermia [38,39]. Used as markers, Ener et al [40] reported that both EDV and PSV were increased significantly after varicocelectomy, indicating a restoration of testicular microcirculation, whereas, in another study, elevation of EDV after varicocelectomy in the affected side was associated with a successful outcome [41]. In our present study, decreased EDV values of patients in Group B may correspond to clinically meaningful impedance of blood flow inside the testicular parenchyma.…”

Specialized sperm function tests in varicocele and the future of andrology laboratory

“… 17 Thus, the clinical utility of ASA testing remains questionable as the presence of ASA neither predict semen quality improvement after varicocele repair nor direct a different form of treatment. 20 …”