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Pro: Should Varicocele Be Repaired in Azoospermic Infertile Men?

  • Sandro C. EstevesEmail author
Chapter

Abstract

The coexistence of palpable varicocele and nonobstructive azoospermia has led urologists to offer varicocele repair as a means to improve reproductive outcomes for men with spermatogenic failure seeking fertility. In this chapter, we critically discuss the existing evidence concerning the potential beneficial effect of varicocele repair on selected men with NOA and spermatogenic failure. We also examine the prognostic factors affecting postoperative outcomes to help clinicians best identify those candidates for varicocele repair. Providing care for infertile men with nonobstructive azoospermia, including those with varicocele, involves a coordinated multi-professional effort. Clinicians should judiciously examine the existing evidence and discuss with their patients with NOA and concomitant varicocele the possibility of improvement in reproductive outcomes by varicocele repair. Offering varicocele repair to selected men with NOA is valid and sound provided that the advantages and limitations of the intervention have been made clear to the patient.

Keywords

Varicocele Nonobstructive azoospermia Varicocele repair Male infertility Varicocelectomy Sperm retrieval Intracytoplasmic sperm injection Assisted reproductive technology Pregnancy Reproductive outcomes 

Notes

Conflict of Interest

The author has nothing to disclose.

References

  1. 1.
    Agarwal A, Hamada A, Esteves SC. Insight into oxidative stress in varicocele-associated male infertility: part 1. Nat Rev Urol. 2012;9(12):678–90.CrossRefGoogle Scholar
  2. 2.
    Agarwal A, Sharma R, Harlev A, Esteves SC. Effect of varicocele on semen characteristics according to the new 2010 World Health Organization criteria: a systematic review and meta-analysis. Asian J Androl. 2016;18(2):163–70.CrossRefGoogle Scholar
  3. 3.
    Benoff S, Gilbert BR. Varicocele and male infertility: part I. Preface. Hum Reprod Update. 2001;7:47–54.CrossRefGoogle Scholar
  4. 4.
    Cho CL, Esteves SC, Agarwal A. Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation. Asian J Androl. 2016;18(2):186–93.CrossRefGoogle Scholar
  5. 5.
    Czaplicki M, Bablok L, Janczewski Z. Varicocelectomy in patients with azoospermia. Arch Androl. 1979;3:51–5.CrossRefGoogle Scholar
  6. 6.
    Dai RL, Hou Y, Li FB, Yue JM, Xi Q, Liu RZ. Varicocele and male infertility in Northeast China: Y chromosome microdeletion as an underlying cause. Genet Mol Res. 2015;14(2):6583–90.CrossRefGoogle Scholar
  7. 7.
    de Sousa Filho EP, Christofolini DM, Barbosa CP, Glina S, Bianco B. Y chromosome microdeletions and varicocele as aetiological factors of male infertility: a cross-sectional study. Andrologia. 2018;50(3)Google Scholar
  8. 8.
    Esteves SC, Glina S. Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. Int Braz J Urol. 2005;31(6):541–8.CrossRefGoogle Scholar
  9. 9.
    Esteves SC, Oliveira FV, Bertolla RP. Clinical outcome of intracytoplasmic sperm injection in infertile men with treated and untreated clinical varicocele. J Urol. 2010;184(4):1442–6.CrossRefGoogle Scholar
  10. 10.
    Esteves SC, Miyaoka R, Agarwal A. Surgical treatment of male infertility in the era of intracytoplasmic sperm injection – new insights. Clinics (Sao Paulo). 2011;66(8):1463–78.CrossRefGoogle Scholar
  11. 11.
    Esteves SC, Varghese AC. Laboratory handling of epididymal and testicular spermatozoa: what can be done to improve sperm injections outcome. J Hum Reprod Sci. 2012;5:233–43.CrossRefGoogle Scholar
  12. 12.
    Esteves SC, Agarwal A. Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: case series and systematic review. Clinics (Sao Paulo). 2013;68(Suppl 1):141–50.CrossRefGoogle Scholar
  13. 13.
    Esteves SC, Agarwal A. Re: sperm retrieval rates and intracytoplasmic sperm injection outcomes for men with non-obstructive azoospermia and the health of resulting offspring. Asian J Androl. 2014;16(4):642.CrossRefGoogle Scholar
  14. 14.
    Esteves SC, Gosálvez J, López-Fernández C, Núñez-Calonge R, Caballero P, Agarwal A, Fernández JL. Diagnostic accuracy of sperm DNA degradation index (DDSi) as a potential noninvasive biomarker to identify men with varicocele-associated infertility. Int Urol Nephrol. 2015;47(9):1471–7.CrossRefGoogle Scholar
  15. 15.
    Esteves SC. Clinical management of infertile men with nonobstructive azoospermia. Asian J Androl. 2015;17(3):459–70.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Esteves SC, Miyaoka R, Roque M, Agarwal A. Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl. 2016;18(2):246–53.CrossRefGoogle Scholar
  17. 17.
    Fujisawa M, Yoshida S, Kojima K, Kamidono S. Biochemical changes in testicular varicocele. Arch Androl. 1989;22:149–59.CrossRefGoogle Scholar
  18. 18.
    Gao DJ, Li JS, Sun BG, Liu G, Zhu ZJ, Liu WG. Screening of Y chromosome microdeletions in infertile males with varicocele. Zhonghua Nan Ke Xue. 2012;18(11):973–7.PubMedGoogle Scholar
  19. 19.
    Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993;59(3):613–6.CrossRefGoogle Scholar
  20. 20.
    Hamada A, Esteves SC, Agarwal A. Insight into oxidative stress in varicocele-associated male infertility: part 2. Nat Rev Urol. 2013;10(1):26–37.CrossRefGoogle Scholar
  21. 21.
    Haydardedeoglu B, Turunc T, Kilicdag EB, Gul U, Bagis T. The effect of prior varicocelectomy in patients with nonobstructive azoospermia on intracytoplasmic sperm injection outcomes: a retrospective pilot study. Urology. 2010;75(1):83–6.CrossRefGoogle Scholar
  22. 22.
    Hwang K, Lamb DJ. Diagnostic testicular biopsy before varicocele repair plays a realistic and important role. Fertil Steril. 2011;95(2):488.CrossRefGoogle Scholar
  23. 23.
    Inci K, Hascicek M, Kara O, Dikmen AV, Gürgan T, Ergen A. Sperm retrieval and intracytoplasmic sperm injection in men with nonobstructive azoospermia, and treated and untreated varicocele. J Urol. 2009;182(4):1500–5.CrossRefGoogle Scholar
  24. 24.
    Kirby EW, Wiener LE, Rajanahally S, Crowell K, Coward RM. Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis. Fertil Steril. 2016;106(6):1338–43.CrossRefGoogle Scholar
  25. 25.
    Kohn TP, Kohn JR, Pastuszak AW. Varicocelectomy before assisted reproductive technology: are outcomes improved? Fertil Steril. 2017;108:385–91.CrossRefGoogle Scholar
  26. 26.
    Marmar JL. The evolution and refinements of varicocele surgery. Asian J Androl. 2016;18(2):171–8.CrossRefGoogle Scholar
  27. 27.
    Marte A. The history of varicocele: from antiquity to the modern ERA. Int Braz J Urol. 2018;44(3):563–76.CrossRefGoogle Scholar
  28. 28.
    Miyaoka R, Esteves SC. A critical appraisal on the role of varicocele in male infertility. Adv Urol. 2012;2012:597495.CrossRefGoogle Scholar
  29. 29.
    Moro E, Marin P, Rossi A, Garolla A, Ferlin A. Y chromosome microdeletions in infertile men with varicocele. Mol Cell Endocrinol. 2000;161(1–2):67–71.CrossRefGoogle Scholar
  30. 30.
    Robb WA. Operative treatment of varicocele. Br Med J. 1955;2:355–6.CrossRefGoogle Scholar
  31. 31.
    Samanta L, Agarwal A, Swain N, Sharma R, Gopalan B, Esteves SC, Durairajanayagam D, Sabanegh E. Proteomic signatures of sperm mitochondria in varicocele: clinical use as biomarkers of varicocele associated infertility. J Urol. 2018;200(2):414–22.CrossRefGoogle Scholar
  32. 32.
    Simşek F, Türkeri L, Cevik I, Bircan K, Akdaş A. Role of apoptosis in testicular tissue damage caused by varicocele. Arch Esp Urol. 1998;51(9):947–50.PubMedGoogle Scholar
  33. 33.
    Schlegel PN, Kaufmann J. Role of varicocelectomy in men with nonobstructive azoospermia. Fertil Steril. 2004;81(6):1585–8.CrossRefGoogle Scholar
  34. 34.
    Skandhan KP, Rajahariprasad A. The process of spermatogenesis liberates significant heat and the scrotum has a role in body thermoregulation. Med Hypotheses. 2007;68(2):303–7.CrossRefGoogle Scholar
  35. 35.
    Shiraishi K, Oka S, Matsuyama H. Predictive factors for sperm recovery after varicocelectomy in men with nonobstructive azoospermia. J Urol. 2017;197(2):485–90.CrossRefGoogle Scholar
  36. 36.
    Tulloch WS. A consideration of sterility factors in the light of subsequent pregnancies. II. Sub fertility in the male. Tr. Edinburgh Obst. Soc. session 104. Edinb Med J. 1951–1952;59:29–34.Google Scholar
  37. 37.
    Verza S Jr, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. Int Braz J Urol. 2008;34(1):49–56.CrossRefGoogle Scholar
  38. 38.
    Weedin JW, Khera M, Lipshultz LI. Varicocele repair in patients with nonobstructive azoospermia: a meta-analysis. J Urol. 2010;183(6):2309–15.CrossRefGoogle Scholar
  39. 39.
    Zhi EL, Liang GQ, Li P, Chen HX, Tian RH, Xu P, Li Z. Seminal plasma miR-192a: a biomarker predicting successful resolution of nonobstructive azoospermia following varicocele repair. Asian J Androl. 2018;20(4):396–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.ANDROFERTAndrology & Human Reproduction ClinicCampinasBrazil

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