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Query: UMLS:C0021359 (infertility)
 26,075 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The mechanism by which varicocele caused infertility is not yet clear. Endocrine factors have been suggested to explain impaired spermatogenesis in patients with varicocele. We conducted a prospective study on testosterone and gonadotropin levels and their response to the luteinizing hormone-releasing hormone test to determine the possible role of a hormonal defect in subfertility. Luteinizing hormone-releasing hormone tests were performed on 11 subfertile men with varicocele preoperatively and 3 months postoperatively. The differences in the luteinizing hormone response were statistically significant. The maximal luteinizing hormone levels also were significantly lower in patients whose spermiogram changed postoperatively. No significant changes were noted in testosterone and other gonadotropin levels postoperatively. A prognostic correlation between the change in response of luteinizing hormone to luteinizing hormone-releasing hormone (preoperatively and postoperatively) and improvement in fertility (pregnancy success) was found. We suggest that the luteinizing hormone-releasing hormone test should be considered to estimate the hormonal derangement and also the prognosis of an operation in subfertile men with varicocele.
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PMID:Factors predicting the outcome of varicocele repair for subfertility: the value of the luteinizing hormone-releasing hormone test. 250 33

The study was aimed at the understanding of pathophysiological mechanisms of the impairment of spermatogenesis in varicocele patients. The crucial role of tension increase in the venous plexus of the spermatic cord in spermatogenesis damage in the testis on the varicocele side and absence of any effect of haemodynamic abnormalities on spermatogenesis in the complementary testis has been determined. Retrograde blood flow through the central vein of the left adrenal gland in varicocele has been evidenced by X-ray examination. The role of this phenomenon in the changes of functional activity of the adrenal gland is discussed. Results of the study of functional status of adrenal glands revealed their tendency to provide hyperactivity in synthesis of mineraloglucocorticoids. Correlation between cortisol level in peripheral blood and percentage of abnormal sperm in ejaculate was shown. This fact supported the idea about the existence of a causal interrelationship between abnormalities in the functional status of adrenal glands and development of infertility in varicocele patients.
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PMID:The role of impairment of adrenal mineraloglucocorticoid function in the development of infertility in varicocele patients. 255 48

Sperm chromatin heterogeneity has been evaluated in infertile males affected by different testicular diseases: 37 subjects had undergone orchidopexy in childhood (ex-cryptorchid), 50 were affected by idiopathic varicocele, 18 had a history of bilateral post-parotitis orchitis and 23 were "idiopathic infertiles". All subjects, except post-parotitis orchitic patients, exhibited significantly higher sperm chromatin heterogeneity than controls, with the highest incidence in ex-cryptorchid and in idiopathic infertiles. Ex-cryptorchid subjects also presented a significant positive linear correlation (p less than 0.001) between degree of sperm chromatin abnormality and percentage of morphological sperm alterations. Four monolateral ex-cryptorchid subjects showed a higher percentage of chromatin heterogeneity even when the cryptorchid testis had been removed during orchidopexy. In patients affected by varicocele, we also observed a significant correlation between chronological age and percentage of chromatin alterations. The results are discussed in relation to the pathogenesis of the disease concerned. Since sperm chromatin heterogeneity appears to be strongly involved in the development of infertility, we would suggest that it should be evaluated in routine diagnostic procedures of male infertility.
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PMID:Sperm nuclear chromatin heterogeneity in infertile subjects. 257 13

The precise mechanism of the hypospermatogenesis associated with varicocele has remained uncertain, although there have been a number of speculations on the etiology of the associated infertility. The altered spermatogenesis has been attributed to the reflux of toxic metabolites from either adrenal or renal origin, disturbed hormone status, spermatic venous hypertension, testicular hypoxia secondary to stasis, and abnormal temperature regulation. However, the biochemical changes of the testicular tissue with varicocele have been only partially explored. This overview includes the available information on the biochemical change in the testes associated with varicocele as well as the introduction of basic biochemical aspects on the testes, which may give new insights into the possible pathophysiological mechanism of male infertility.
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PMID:Biochemical changes in testicular varicocele. 266 80

Oligo/azoospermia contributes significantly to infertility in male Nigerians, being responsible for most of the problem. By definition, it would appear that the criteria for the diagnosis of this problem in Nigerians should be sperm density below 10 million/ml, total sperm ejaculate below 25 million, motility below 40%, and normal forms below 40% in agreement with more recent findings in other parts of the world. This reinforces the already generally accepted that the WHO may need to review its criteria for diagnosing oligo/azoospermia. Preventable causes of oligo/azoospermia in Nigeria include poorly treated infections such as venereal diseases, delayed treatment of torsion of the testis and of undescended testis, and repair of inguinal hernia by inexperienced native doctor [3, 4]. In addition, better approaches to the diagnosis of causes of infertility, such as a careful search for and rational treatment of varicocele, may improve the chances of infertile couples. Hormonal disorders are important factors to consider in oligo/azoospermic Nigerians, as with their counterparts elsewhere. Wide-spread availability of hormonal assays will therefore be a great help in separating the untreatable (primary testicular disease) from the treatable (hypothalamic/pituitary) diseases and planning rational treatment. With improvement of clinical care, many more patients with sickle-cell disease are reaching reproductive age. Oligo/azoospermia is quite common in patients with sickle-cell disease, and sickle-cell disease will eventually contribute more proportionately to the etiology of oligo/azoospermia in Nigerians. Extensive investigations have been conducted on the nature, etiology, and diagnosis of oligo/azoospermia [2-11, 25, 30-56].(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Oligo/azoospermia in Nigeria. 266 85

Varicoceles, which may produce oligo-astherospermia are a curable cause of subfertility in the male. Doppler velocimetry of the anterior spermatic venous plexus or pampiniform plexus allows the diagnosis of clinical and infraclinical varicoceles to be confirmed. It can also assess and quantify the spontaneous increase in flow due to venous distension and Valsalva reflux related to valvular incompetence. 50 patients investigated for conjugal infertility and suffering of oligo-astherospermia were included in this study. All underwent clinical examination by an andrologist, spermatic venography and Doppler examination before and after embolization. Doppler examination was performed with patients in the dorsal decubitus position using an 8 MHz transducer. Varicocele was confirmed in 84% of patients suffering of oligo-astherospermia. --Comparison with the results on clinical examination demonstrated a specificity of 100% but a sensitivity of only 66%. --Compared with venography taken as a reference, Doppler had a sensitivity and specificity of 94% and 100% for the examinations carried out after embolization. In the hands of a suitably trained doctor, Doppler examination is today the most rapid, simplest, least costly and most reliable non invasive method for diagnosis of varicoceles. In recent months Doppler hemodynamic data have been complemented by ultrasonographic images obtained using a high resolution apparatus emitting at 7.5 MHz. In the presence of varicocele, the pampiniform plexus has an alveolar appearance and the diameter of the principal draining vein is greater than 3 mm. These dates should be compared with those obtained on venography.
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PMID:[Diagnosis of varicocele by Doppler effect]. 268 61

Benign mass lesions of the scrotum include spermatocele, hydrocele, varicocele, sperm granuloma after vasectomy, tuberculous masses, and epididymitis. A careful history and physical examination are paramount in making the diagnosis of a scrotal mass. Referral to a urologist is indicated for masses that do not transilluminate, are solid or fixed to the testicle, or for epididymitis that does not respond to antibiotics. Hydroceles associated with significant symptoms or with hernia and varicoceles with symptoms or associated infertility are also reasons for referral. After a sexual history is obtained, lesions of the anogenital area should be carefully inspected. Male partners of women with cervical dysplasia should be examined for evidence of human papillomavirus infection. Treatment of anogenital lesions resulting from a sexually transmitted disease involves both partners.
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PMID:Benign conditions of the external genitalia. 269 49

Incompetence of the testicular vein appears to be the basic pathology of testicular dysfunction in varicocele. Doppler recording is a very sensitive method for detecting this reflux even when varicocele is not evident clinically. One hundred and seventy-eight men with infertility were studied. The presence of reflux in the pampiniform plexus as demonstrated by Doppler recording was compared with clinical varicocele. Reflux patterns were recorded on graph paper and various grades of reflux were observed. The three grades of reflux identified varied between a momentary reflux during vigorous Valsalva manoeuvre to significant reflux on minimal increase in intra-abdominal pressure brought about by normal respiration and deep breathing. Ninety-four per cent of the patients with clinical signs of varicocele had refluxes of grade 2 and 3 on Doppler study. Forty per cent of the patients without clinical evidence of varicocele were found to have reflux of grade 1 and 2 in the testicular veins.
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PMID:Patterns of Doppler recordings and its relationship to varicocele in infertile men. 269 30

During the clinical observation of 32 fertile cases with varicocele interesting findings were made. Normal semen, a sperm density above 40 million/ml and a motile sperm rate of over 60% were observed in 46.9% of the cases. Furthermore, a sperm density of more than 40 million/ml was found in 75% and a motile sperm rate of more than 50% was detected in 81.3%, indicating normal or adequate spermogram data. A difference in right-left testicular size was recognized in 35.5% (11 cases). Only 2 of the cases had oligospermia and 9 cases had normospermia. Two cases had low testosterone values and low motile sperm rates were also detected. Secondary infertility occurred in 33.3%. In 25% of the cases, scrotal scintigraphy revealed an accumulation of high radioactivity indicating venous blood pooling over the affected site in the early phase of dynamic images. In the other cases, different venous flow characteristics were detected visually.
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PMID:Clinical observations on fertile males with varicocele. 271 13

A combined study, including phlebography, phlebotonometry, orchidometry, morphometric determination of microcirculatory testicular volume, microscopic and biochemical ejaculate studies, determination of peripheral blood levels of adrenocortical mineral glucocorticoid hormones before and after ACTH administration in the blood, sampled from various veins prior to phlebography, assessment of osmolality, pO2 and pCO2 in the blood samples from spermatic venous plexus, left renal vein and intrarenal portion of the vena cava inferior, and determination of plasma renin activity in renal veins, was conducted in 55 patients with varicocele. A considerable increase in orthostatic blood pressure of the left spermatic venous plexus is demonstrated that may be due to retrograde blood flow in the left testicular venous plexus, resulting in a microcirculatory disturbance and gradual atrophy of a testicle. There was a correlation between the severity of varicocele and left-testicular volume which was absent for total testicular volume, while microcirculatory volumes of the testes differed significantly, suggesting the absence of hemodynamic disorders in the contralateral testicle and, consequently, no spermatogenetic impairment due to hemodynamic changes in cases of a unilateral varicocele. Phlebographic and phlebotonometric evidence points to a retrograde blood flow through the central vein of the left adrenal. The results of adrenal functional studies demonstrate a significant tendency to adrenal hypersynthesis of aldosterone and cortisol in patients with varicocele. A correlation demonstrated between peripheral blood cortisol level and the proportion of spermatozoa with abnormal headpiece structure in the ejaculate has suggested a cause-and-effect relationship between adrenal dysfunction and infertility in patients with varicocele.
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PMID:[The role of disorders of mineralocorticoid function of the adrenal glands in the development of infertility in patients with left-side varicocele]. 272 40


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