Varicocele repair for infertility

Ficarra, Vincenzo; Crestani, Alessandro; Novara, Giacomo; Mirone, Vincenzo

doi:10.1097/mou.0b013e328358e115

Cited by 50 publications

(28 citation statements)

References 21 publications

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“…Varicocele is traditionally considered a potentially correctable cause of male infertility Baazeem et al, 2011;Ficarra et al, 2012;Kroese et al, 2012;Lopushnyan & Walsh, 2012;Miyaoka & Esteves, 2012;Kim et al, 2013). The prevalent opinion is that microsurgical inguinal or subinguinal varicocelectomy is safest and most efficient in the terms of clinical complications and recurrence (Cayan et is why in this study we used microsurgical sublingual ligation to correct varicocele in the male subjects from infertile couples.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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“…Moreover, current evidences also suggest that varicocele repair in men who have a clinically palpable varicocele with documented infertility significantly improves the male fertile capacity [50,107]. Surgical options for varicocele repair include the traditional high retroperitoneal (Palomo) and inguinal (Ivanissevich) approach, laparoscopic high ligation, and microsurgical low ligation via an inguinal or subinguinal incision.…”

Section: Varicocele Repairmentioning

confidence: 99%

Reactive Oxygen Species and Sperm Cells

Takeshima¹,

Kuroda²,

Yumura³

2018

Reactive Oxygen Species (ROS) in Living Cells

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Many cases of male factor infertility are idiopathic, but 30-40% of cases may have excessive levels of reactive oxygen species (ROS) in their semen. The origins of endogenous ROS are leukocytes and immature spermatozoa, and external causes are various. On the contrary, seminal plasma contains various antioxidants. Low levels of ROS are essential for the fertilization process, but excessive levels of ROS lead to oxidative stress and can have harmful effects such as lipid peroxidation of a membrane, sperm deoxyribonucleic acid fragmentation, and apoptosis on the fertile capacity. In order to evaluate oxidative stress appropriately, ROS is measured by the chemiluminescence method with neat semen and quantification of 8-OH-2′-deoxyguanosine and malondialdehyde in seminal plasma. Antioxidant potential is often measured using total antioxidant capacity (TAC) assay. The oxidation-reduction potential measured by a MiOXSYS analyzer is a novel, easier, quicker, and less expensive technology to measure oxidative stress. In order to minimize oxidative stress and improve clinical outcomes, sperm-sorting methods, lifestyle modifications, shortening the ejaculatory abstinence, and treatments such as oral antioxidants, varicocelectomy, and testicular sperm extraction are taken into account. As a future prospect, proteomics, metabolomics, and genomics are still developing areas that have the potential to discover new findings and highly sensitive biomarkers.

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“…15,[18][19][20] The various strategies include NMV, MV and PE ( Table 1). The treatment strategies were organized with decision arms progressing from primary to secondary treatment approaches over time (Fig.…”

Section: Model Designmentioning

confidence: 99%

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Kovac

Fantus

Lipshultz

et al. 2014

CUAJ

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Introduction: Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility. Methods: A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes. Results: Primary treatment with MV was the most cost-effective strategy at $5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about $7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >$4100 CAD/pregnancy. Conclusions: MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

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Varicocele repair for infertility

Cited by 50 publications

References 21 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

Reactive Oxygen Species and Sperm Cells

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

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