Significance of sperm characteristics in the evaluation of adolescents, adults and older men with varicocele.

Abstract: Study question Can a standardized assessment of abnormal human sperm morphology provide additional useful information by identifying men with more severe disturbances in different types of abnormalities? Summary answer Definition-based categorization of sperm head, midpiece and tail defects has shown how differently these abnormalities are distributed in fertile men and other groups of men, thus providing high and low thresholds, a starting point for diagnosis or research purposes. What is known already Several recent studies have reported indisputable genetic origins for various sperm defects. A few studies have also identified associations between environmental factors and low percentages of morphologically normal spermatozoa. Nevertheless, with the exception of rare situations in which the vast majority of spermatozoa have specific, easily characterized defects, such as 'globozoospermia', little attention has been paid to the description and precise quantification of human sperm abnormalities. The lack of standardization in the phenotyping of sperm morphological defects by conventional microscopy is a limiting factor for diagnosis and for intra- or inter-observer or centre consistency in studies investigating the causal factors and possible functional consequences of the abnormalities detected. There are currently no baseline data for abnormalities of sperm morphology based on a standardized classification, in the general population, among fertile or other groups of men. Study design, size, duration This study is based on detailed sperm abnormality datasets acquired by a standardized classification method, from several groups of men, over the same 5-year period. Participants/materials, setting, methods We studied cross-sectional data from fertile men (n = 926), male partners from infertile couples (n = 1747) and testicular cancer patients (n = 239). We used a standardized classification to analyse Shorr-stained slides, taking into account all the abnormalities encountered. Main results and the role of chance Most sperm defects were significantly more frequent in infertile than in fertile men, with 20-30% of infertile men having frequencies of abnormalities above the 95th percentile in fertile men for 9 out of the 15 categories of abnormalities. Interestingly, several head abnormalities were significantly more frequent in patients with testicular cancer than in infertile men, highlighting the particular impact of this condition on sperm morphogenesis. We used the 95th percentile in fertile men as the lower threshold and the 99th percentile in infertile men as an extreme upper threshold, for the classification of morphological abnormality frequencies into three levels: low, intermediate and high. The assessment of several semen samples, with or without a genetic background, for abnormal sperm morphology, based on the percentage of normal spermatozoa, a teratozoospermia index, and the detailed profile of abnormalities categorized according to the three levels proposed, has highlighted the value of detailed phenotyping for diagnosis and research purposes. Limitations, reasons for caution The thresholds proposed for the various categories of sperm abnormality should be considered relative rather than absolute, owing to the known sampling error related to the limited number of spermatozoa assessed per sample, or when studying the general population or populations from regions other than Western Europe. The standardized assessment of abnormal sperm morphology requires time and experience. We therefore suggest that this assessment is carried out during a first andrological check-up or for epidemiological or research studies, rather than in the routine management of infertile couples for assisted reproductive technologies. Wider implications of the findings The study design used for the fertile group of men was similar to that previously used for the WHO reference values, providing a rationale for considering the 95th percentile in fertile men as the level below which abnormalities may be considered to occur at a frequency representing random background variations of a normal spermiogenesis process. The crude frequencies obtained, and the three levels of abnormality frequency proposed for each standardized category of sperm defect, provide baseline data useful for diagnosis and a starting point for future studies aiming to identify associations with genetic or environmental factors. Study funding/competing interests Part of this study was supported by contract BMH4-CT96-0314 from the European Union. The authors have no competing interests to declare.

Abstract: Objective To compare proteomic profiles of seminal plasma from adolescents with varicocele and changes in semen quality with the plasma from adolescents with varicocele without seminal changes and from adolescents without varicocele. Design Observational study. Setting Patients in an academic research environment. Patient(s) Adolescents without varicocele (control group), adolescents with varicocele and normal semen quality (VNS group), adolescents with varicocele and abnormal semen quality (VAS group). Intervention(s) Two semen collections at 1-week interval. Protein separation by two-dimensional protein electrophoresis, analysis by gel densitometry, and identification by mass spectrometry. Main Outcome Measure(s) Overexpressed proteins in each group, observed by increased densitometric signal in gels, and exclusively identified proteins in each group. Result(s) No differences were observed among the three groups regarding clinical parameters. In semen analysis, the VAS group presented lower sperm concentration, motility, and morphology compared with the VNS and control groups. Forty-seven protein spots of interest were submitted to mass spectrometry identification. Apoptosis regulation proteins were overexpressed in the VAS group, whereas spermatogenesis proteins were overexpressed in the VNS group. Controls presented proteins related to homeostasis. Conclusion(s) Changes in the proteomic profile of adolescents with varicocele and normal semen parameters (VNS group) indicate that normal semen analysis may not reflect alterations in proteins in seminal plasma. Implementation of proteomics will help characterize proteins identified in seminal plasma and will facilitate detection of new proteins associated with spermatogenesis and sperm function.

Abstract: Testicular varicocele, a dilation of the veins of the pampiniform plexus thought to increase testicular temperature via venous congestion, is commonly associated with male infertility. Significant study has clarified the negative impact of varicocele on semen parameters and more recent work has shed light on its detrimental effects on the molecular and ultrastructural features of sperm and the testicular microenvironment, as well as more clearly defined the positive impacts of treatment on couples' fertility. The relationship between varicocele and testicular endocrine function, while known for some time based on histologic evaluation, has become more apparent in the clinical setting with a growing link between varicocele and hypogonadism. Finally, in the pediatric setting, while future study will clarify the impact of varicocele on fertility and testicular function, recent work supports a parallel effect of varicocele in adolescents and adults, suggesting a re-evaluation of current treatment approaches in light of the progressive nature of the condition and potential increased risk of future disease.

Abstract: Aim: To evaluate the effect of presence, grade and anatomical side of varicocele on semen parameters and to identify age-related modifications in semen quality in men with varicocel

Abstract: The aim of our study was to assess the impact of patient age on sperm characteristics, and hormonal levels following varicocelectomy. We retrospectively reviewed the clinical records of 96 patients with a mean age of 28.1 years (range 18–48), who underwent microsurgical subinguinal varicocelectomy because of infertility, palpable swelling, or scrotal pain. These groups of patients were categorized into three age groups: group I, 18–25 years old at the time of varicocelectomy (n = 35 [36.5%]); group II, 26–35 years old (n = 43 [44.8%]); and group III, older than 36 years (n = 18 [18.8%]). Of the 96 patients, 68 attended the initial postoperative visit at 1 month and 96 attended the 6 months follow-up visit. Before surgery, no significant differences were seen among the three groups in sperm concentration, sperm motility and hormonal levels. After ligation, the sperm concentration and motility rates increased in all groups, but no significant differences were seen among the three groups for those parameters (P = 0.235 and P = 0.729, respectively). However, no significant changes in follicle-stimulating hormone, LH, testosterone levels were observed between each group. At sixth month of follow-up, two patients in group II, and a patient in group III, had persistent scrotal pain, and a patient in group I had varicocele recurrence; but no patients had hydrocele formation, evidence of testicular loss or progressive hypotrophy. The results of our study have shown that age is not a significant factor for outcomes of surgery and subinguinal microsurgical varicocelectomy in all aged patients has a similar high success rates.

Abstract: The incidence of varicocele in an unselected material consisting of 1072 Danish school boys aged 6–19 years was investigated. No cases of varicocele were encountered in 188 boys, aged 6–9 years, while the incidence in the 837 examined boys, aged 10–19 years, was 16.2%. This showed a steadily increasing incidence from 5.7% in the 10-year-old group to 19.3% at the age of 14 years. The incidence of “genuine” clinical varicocele showed an increase from 1.9% in 10-year-olds to 10.6% in 14-year-olds. All of the varicoceles were found in the left half of the scrotum. The development of puberty was more advanced in the boys with varicocele than in the control material. The boys with varicocele were taller than those without. These two observations are presumed to be of significance for the development of varicocele. The figures for the incidence of varicocele from the literature, compared with the author's own findings, suggest that there is a difference in the incidence of varicocele in fertile and infertile mal...

Abstract: Objective To determine the distribution of sperm abnormalities in a population of suspected infertile men presenting for the initial investigation of male factor infertility. Study design Results obtained in the analysis of sperm viability, motility, conventional morphology (including 12 sperm anomalies), strict criteria sperm morphology analysis (SCSMA) and hypoosmotic swelling test (HOST) were compared in oligozoospermic ( 250.0 x 10(6)/mL) semen samples from 233 suspected infertile men. Results Percentage of sperm viability, category a and categories a plus b of sperm motility, oval-headed sperm, and normal-headed sperm according to SCSMA and HOST had a direct relationship with sperm counts (P 40.0 x 10(6)/mL (P = .003) and of neck/midpiece defects was lowest in semen with 250.0 x 10(6)/mL (viability and motility), > 100.0 x 10(6)/mL (conventional morphology) and > 40.0 x 10(6)/mL (SCSMA and HOST). Conclusion The incidence of defective spermatozoa is lowest in semen with the highest sperm count. However, sperm abnormalities that affect male fertility may be detected at any level of sperm density. The data indicate that an increase in any sperm abnormality should be regarded as a possible cause of decreased fertility.

Abstract: The interest for varicocele in the determination of male infertility has increased during the last decades. Most researchers consider varicocele as the primary cause of male infertility, but recently another group of authors give it a secondary role in the alteration of spermatogenesis. We think that the major part of the controversy depends on an absence of a systematic approach to the problem. We give a primary importance to an accurate epidemiological evaluation which consists in a transversal and longitudinal survey of male subjects in puberal age. Our data show that left varicocele is practically inexsistent before the onset of puberty; the percentage incidence of this alteration increases progressively with puberal maturity and the tends to decrease slightly when maturity is complete. By correlating this pathology with puberty we can obtain more precise informations than when it is correlated to the regestrated age. The young patients who result suffering from varicocele, must be controlled carefully and periodically for the evaluation of the period and the opportunity of a therapeutic treatment.