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

The clinically obvious varicocele is perhaps the most common identifiable and correctable cause of male infertility. However, less is known about the subclinical (not palpable) varicocele and its relationship to infertility. We undertook this study to compare the ability of high-resolution sonography and radionuclide scrotal scanning to detect subclinical varicocele. Fifty patients who were referred to our department with a diagnosis of infertility, an abnormal semen analysis, and a normal physical examination of the scrotum underwent both sonography and nuclear scanning. The final study group included 20 men who agreed to surgical ligation of the spermatic vein(s) after a positive sonographic and/or radionuclide study. Sonography was considered positive for subclinical varicocele in 95% of patients, while nuclear scanning was considered positive in only 55%. Postoperatively, all patients showed improvement in their semen and 40% (eight patients) became fertile. Subclinical varicocele seems to be an important causal factor in infertility and, in our experience, high-resolution sonography is superior to radionuclide scanning in its diagnosis.
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PMID:Diagnosis of subclinical varicocele in infertility. 302 75

The urogenital inflammations may be considered as "apparatus pathology". We analyze only inflammatory diseases of the prostate gland, because it may be extensible to the entire male genital apparatus. Among aethiological agents of infections an important role belongs to Chlamydia and Mycoplasma; we describe various methods for diagnosis of the Chlamydia and Mycoplasma infections. When objective clinical findings are poor or absent (such in prostatosis and prostatodynia) the transrectal ultrasonography demonstrates characteristic pictures useful for diagnosis and follow-up. Our clinical data and anatomo-pathological remarks suggest a real correlation between varicocele and genital inflammations (26%). This association doesn't represent the only cause of infertility, but frequently reduces the probability of male fertility.
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PMID:Urogenital inflammations: aetiology, diagnosis and their correlation with varicocele and male infertility. 306 82

With the use of semi-thin sections of 88 testicular biopsies from 44 patients, we were able to separate a relatively uniform group of patients with idiopathic left varicocele and infertility into 4 groups with different pathophysiological conditions. Group 1 patients had atrophy of the Leydig cells, decreased Leydig cell ratio, low plasma testosterone, and normal luteinizing and follicle-stimulating hormone levels. Surgery resulted in a significant improvement in sperm count. Group 2 patients had undergone attempted repair of Leydig cells, and had a normal Leydig cell ratio, and normal testosterone, luteinizing hormone and follicle-stimulating hormone plasma values. Group 3 patients demonstrated hyperplasia and an increased Leydig cell ratio, high luteinizing and follicle-stimulating hormone values, and relatively high testosterone values. Group 4 patients had an increased Leydig cell ratio but severe atrophy of the Leydig cells and tubuli, indicating burned out testes with high luteinizing and follicle-stimulating hormone but low testosterone levels. A successful operation failed to increase the sperm count in the latter groups. The technique used should allow better patient selection for medical treatment, as well as lead to a better understanding of the etiopathogenesis of infertility in varicocele patients. Therefore, the histological technique has an important role in the evaluation of patients suffering from infertility in general.
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PMID:The value of testicular biopsy in patients with varicocele. 308 15

A total of 130 men presenting with oligospermia and clinically identifiable scrotal varicoceles was evaluated, treated surgically and followed for 1 year for pregnancy rate. The treatment outcome was compared to an age-matched cohort of 83 oligospermic men who had received empirical medical therapy with clomiphene citrate (25 mg. per day) for the same 1-year interval. This study was done to contrast treatment modalities in infertility and not as a strict control. Only eugonadotropic patients in both groups were used for comparison. In the varicocele group the over-all pregnancy rate was 38.5 per cent. Four variables (a lack of testicular atrophy, sperm density greater than 50 million per ejaculate, sperm motility 60 per cent or more and serum follicle-stimulating hormone values less than 300 ng. per ml.) proved to be accurate preoperative predictors of postoperative pregnancy success. Four other variables (varicocele size and laterality, sperm forward progression greater than 2 and normal sperm morphology 60 per cent or more) did not yield statistically significant rates of improvement in pregnancy postoperatively. The pregnancy rate of the eugonadotropic patients undergoing varicocele repair was 45.8 per cent. Despite statistical similarity in patient age, sperm density and mean gonadotropin levels the medically treated patients had a pregnancy rate of only 25.5 per cent, significantly lower than the surgically treated patients. In summary, patients with an identifiable varicocele had a greater chance of achieving a pregnancy following surgical correction than did those treated with empirical drug therapy. In addition, certain preoperative variables in the physical and laboratory analyses appeared to portend a greater surgical response.
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PMID:Predictive parameters of successful varicocele repair. 309 Feb 79

500 infertile patients (250 with and 250 without left side varicocele) and 33 fertile men were evaluated as far as seminal parameters and the hormonal status were concerned. Sperm motility was constantly lower in infertile patients also when infertile group was compared to fertile one with the same sperm density. Serum testosterone levels were lower in infertile groups when compared to fertile men, and this confirms the existence of an androgenic deficit as a common finding in infertility associated or not to varicocele. FSH and LH increased (p less than 0.001) when sperm density dropped to less than 5 X 10(6) spermatozoa/ml. A negative correlation was found between both gonadotropins and sperm count (p less than 0.001), also after exclusion of azoo- and oligozoospermic (less than 5 X 10(6) spermatozoa/ml) patients (p less than 0.01). Gonadotropins were moreover tightly correlated between each other (p less than 0.001). Our data suggest that both gonadotropins are tightly tuned with sperm output and thus with the spermatogenic potential.
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PMID:Hormonal and seminal parameters in infertile men. 310 47

To know the parameter related to improvement of each semen characteristic (sperm density and percentage of progressive motile sperm) after high ligation of the left internal spermatic vein, 119 men from infertile couples were investigated. In each individual, the semen characteristic was considered to be different from the postoperative mean value if it was over or below 2 SD of the preoperative mean. Although no relationship was detected with the age of the patient, the duration of infertility or the preoperative semen characteristics, a definite relationship was found between the degree of varicocele and the improvement in each semen characteristic. For improvement of the sperm density, each of the volume and the score count by Johnsen's scale of the affected and unaffected testes and the serum hormone values (LH, FSH and testosterone) showed correlations. Meanwhile, for the improvement of the percentage of progressive motile sperm, correlations were found only with each of the testicular volume on the unaffected side and the serum testosterone level.
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PMID:Preoperative parameters related to the improvement of semen characteristics after surgical repair of varicocele in subfertile men. 314 Nov 93

The presence of a varicocele in adult men has been correlated with infertility. This study documents the effect of an experimentally induced unilateral varicocele in 21-day-old juvenile prepubertal and 51-day-old adult rats (n = 10 per group) on subsequent adult testicular function. Varicoceles were induced by partial occlusion of the spermatic vein. There were ten sham-operated and five nonoperated control rats in each age group. The rats were sacrificed 1 month after surgery. Intrascrotal temperatures were elevated in both groups with varicoceles. Histologically, the ipsilateral testes of rats in both age groups demonstrated a decrease in the numbers of functioning seminiferous tubules and germ cells, but the decrease was significantly greater in the juveniles than in the adult rats. No changes were seen in the contralateral testes. Significant titers of cytotoxic sperm antibodies were present in all animals with varicoceles, which is in contrast to controls. The juveniles had significantly lower antibody titers (mean log2 +/- SEM; 3.2 +/- 0.09 vs. 8.5 +/- 1.1, P less than 0.001) than the adults. The induction of a unilateral varicocele damaged spermatogenesis and testicular function to a greater extent in juveniles than in adult rats. This damage may be immune complex-mediated.
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PMID:Pathological and immunological effects of surgically induced varicocele in juvenile and adult rats. 320 38

Seminal fructose, sperm count, and sperm motility were measured in 340 men attending an infertility clinic. Seminal fructose correlates negatively with sperm count but not with sperm motility. The best correlation between sperm count and seminal fructose was obtained using the logarithm (log) of sperm count. When seminal fructose was multiplied by the log of sperm count obtaining a value named "corrected fructose," the correlation with sperm count disappeared, and there was positive correlation between corrected seminal fructose and sperm motility. Therefore, corrected seminal fructose level was significantly lower in asthenospermic than in normomotile subjects, irrespective of the sperm count. Corrected seminal fructose, but not seminal fructose levels, was lowered in subjects with either low levels of serum testosterone (less than 3 ng/ml) or evidence of an obstructive process in the reproductive tract. In both situations sperm motility was also reduced. The corrected fructose level was not affected by the presence of varicocele, hyperprolactinemia, or hyperserotoninemia. Measurement of corrected seminal fructose rather than seminal fructose may be a useful marker of the secretory activity of the seminal vesicles.
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PMID:Corrected seminal fructose levels: index of secretory activity of seminal vesicles. 322 88

The purpose of this study is to compare the effectiveness of varicocelectomy for improving the spermogram in treating varicoceles diagnosed by physical examination and those diagnosed by Doppler but with a negative physical examination. The charts of 112 patients were retrospectively analyzed and the patients divided in two groups: group A, where the varicocele was detected by physical examination, and group B, where physical examination was negative but Doppler studies revealed the presence of stasis or backflow in the pampiniform plexus of the spermatic veins. In subjects complaining of infertility, the two groups were similar with regard to age distribution and duration of infertility. After varicocelectomy, 85% of patients in group A had improved spermogram, compared with only 27% in group B. This difference was statistically significant (P less than 0.0001).
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PMID:Effectiveness of varicocelectomy in varicoceles diagnosed by physical examination versus Doppler studies. 291 Jul 14

Ninety-six couples, consulting for primary (n = 73) or secondary (n = 23) infertility, and thought to be infertile due to a varicocele in the husband associated with sperm abnormalities, were subjected to a follow-up study. Of these, 57 were surgically corrected and 39 were not, depending only on the patient's choice. All women were intensively treated where necessary. From our data we conclude that (1) fertility prognosis is significantly better in couples with secondary subfertility than in couples with primary subfertility, (2) surgical correction of varicocele in cases of secondary subfertility does not increase subsequent pregnancy rates, and (3) surgical correction of varicocele in cases of primary subfertility significantly increases subsequent pregnancy rates, since cumulative observed pregnancy rates are more than double the cumulative theoretically expected treatment-independent pregnancy rates.
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PMID:Clinical aspects in the surgical treatment of varicocele in subfertile men. I. Comparison of observed and expected pregnancy rates. 333 7


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