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

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. All patients who were corrected were subjected to scrotal exploration in a search for epididymal anomalies. From our data we conclude that (1) on a statistical basis, comparing observed with expected pregnancy rates, varicocelectomy is useful in primary infertility and unnecessary in secondary infertility and (2) on an individual basis, patients with primary infertility and 'pure' varicoceles have a better prognosis than patients with concomitant epididymal dysfunction.
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PMID:Clinical aspects in the surgical treatment of varicocele in subfertile men. II. The role of the epididymal factor. 333 8

A clinical statistical analysis was conducted of the patients with varicocele who visited the Department of Urology, Osaka City University, and its related hospitals. Regarding the age distribution, patients younger than 50 years old were predominant; this age group included 20 of 24 cases, or 83%. An overwhelming majority of the cases, 75%, had the main complaint of infertility; they had not been able to have children even after 2 to 3 years of marriage. The next most common complaint was swelling and/or an uncomfortable feeling of the contents of the scrotum. In all of the cases, the lesion was seen in the left side of the scrotum. When the patients were classified on the basis of the sperm count, oligospermia was predominant; it was seen in 15 cases (62.5%). A study on the relationship between the sperm count and the grade of varicocele revealed a tendency for the sperm count to show an inverse relationship with the grade. Testicular atrophy showed a direct correlation with the grade. Of the patients with varicocele, 5 patients had one or more children, while 8 patients (61.5%) complained of their inability to have a child. No particular relationship could be identified between the age at the time of visiting our Department as outpatients and the degree of testicular atrophy.
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PMID:[Clinical studies of varicocele. 1: Clinical statistical analysis of varicocele]. 337 24

To assess the existence of a possible immunologic factor in varicocele-associated infertility, we searched for antispermatozoal antibodies in serum, seminal plasma, and bound to spermatozoa in 32 infertile men with varicocele and 22 infertile patients without palpable varicocele, with the use of an enzyme-linked immunosorbent assay. In addition, we performed morphologic and microbiologic analyses of the semen and urethral smears for isolation of Chlamydia trachomatis. Twenty-nine men from the varicocele group (90.6%) demonstrated antispermatozoal antibodies, compared with only 9 men (40.9%) in the control group. The antibodies in both groups, when present, were mainly serum and seminal plasma immunoglobulins IgA and IgM. A significant quantitative difference between the varicocele and control groups was also observed for serum IgA, seminal plasma IgA and IgM, and sperm-bound IgG, IgA, and IgM. Oligozoospermia and asthenozoospermia were significantly more prevalent in the varicocele men. An asymptomatic genital tract infection with C. trachomatis, Ureaplasma urealyticum, and Escherichia coli was traced in 40.6% of the varicocele men and in 45.5% of the control group. No interaction could be demonstrated between the infection and antispermatozoal antibody formation. These data suggest that an immunologic factor may play a role in varicocele-associated infertility; however, its impact on reproduction has yet to be assessed.
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PMID:Demonstration of antispermatozoal antibodies in varicocele-related infertility with an enzyme-linked immunosorbent assay (ELISA). 351 15

After some introductory remarks on the investigation of the infertile couple in general, more specific new technologies in diagnosis and ways of treatment of infertility are discussed. In the infertile male with a varicocele the advantages of phlebography and embolisation over surgical ligation of the internal spermatic vein is presented. The value of the hamster ovum penetration test in order to evaluate the fertilizing capacity of spermatozoa is commented. A new method for diagnosis of immunologic infertility in men is briefly explained as well as the possibility for treatment of immunologic infertility by means of corticosteroids. In women the indications and disadvantages of LHRH ovulation induction are presented as well as the advantages of monitoring follicle growth during ovulation induction or stimulation by means of ultrasound. The major breakthrough in infertility therapy of course is in vitro fertilization (IVF): only a few indications other than tubal occlusion are commented and the impact and some future aspects of IVF for other medical disciplines are briefly discussed.
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PMID:[Current developments in the study and management of unwanted childlessness]. 352 94

In order to study the ability of the sperm penetration assay (SPA) to correctly classify the fertility status of men, we prospectively examined the results of the SPA performed on the semen of three groups of men of known fertility status. The groups included 67 normal men without varicoceles whose wives were pregnant (VARN), 51 men with a palpable varicocele whose wives were pregnant (VARF), and 30 infertile men with varicoceles (VARI). Two SPAs were done on each subject. Ninety-seven percent of the VARIs showed less than 15% penetration on a single test, and 91% showed less than 15% on both tests. On a single test 61% of the VARNs and 68% of the VARFs were less than 15%. If 0 penetration were used as the criteria of infertility, then 40% of the VARIs, 27% of the VARFs, and 12% of the VARNs would be classified as being infertile. These data suggest that the SPA cannot independently define male fertility status and should be used in conjunction with the standard semen analysis and clinical evaluation of the couple to assess male fertility potential.
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PMID:The use of sperm penetration assay in evaluation of men with varicocele. 355 48

In the past 8 years we found 41 infertile men with poor semen quality in whom an overlooked right varicocele might have been the reason for failure to improve after previous left varicocelectomy. None had ever fathered a child. After we performed sequential right varicocelectomy in these 41 patients, semen quality improved in 23 (56%). Twenty-seven pregnancies have been achieved to date by the wives of 18 (43%) of the patients whose semen improved. No pregnancies were caused by those whose semen failed to improve. Infertile men should be carefully examined for varicoceles on both sides, and bilateral varicocelectomy should be performed when indicated. Selected infertile patients who have failed to improve after left varicocelectomy and are found subsequently to have a right varicocele may yet improve following correction of the right varicocele.
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PMID:Right varicocelectomy in selected infertile patients who have failed to improve after previous left varicocelectomy. 356 59

The presence of a varicocele was confirmed in 121 of 123 patients complaining of scrotal pain or infertility, in whom radionuclide scanning was performed. In the first 29 patients (retrospective study), a high ligation of the internal spermatic vein was performed. In 94 patients, a percutaneous venography was done via the jugular vein followed by embolization by Gianturco coils (occluding spring embolus, Cook Group Company, USA) in 84 of them. In eight patients, due to technical difficulties during the embolization trial, a high ligation was performed at a later date. Eleven patients underwent embolization after failed high ligation. A posttreatment follow-up radionuclide study revealed recurrences in two of the 95 patients who underwent embolization. Embolization can be performed on an outpatient basis with minimal risks. Reembolization is feasible, and it in no way prevents a further high ligation should this be necessary.
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PMID:High ligation or embolization of varicocele. 357 Jul 30

It now appears that the incidence of bilateral varicoceles in infertile men with varicocele may be around 50 per cent to 60 per cent. Infertile men should be examined carefully for varicoceles on both sides, and bilateral varicocelectomy should be performed when indicated. Furthermore, we have demonstrated that selected infertile patients who have failed to improve after left varicocelectomy may yet improve after correction of the right varicocele.
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PMID:Therapeutic implications of left, right, and bilateral varicocelectomy. 360 11

Although the objective of this article was to discuss the specific medically treatable causes of male infertility, the reader will be impressed by the fact that many of the treatments seem less than "specific." The need to treat infections to improve fertility is ill defined. The utilization of a scrotal cooling device as "specific" nonsurgical treatment for varicocele is yet to be defined. Immunologic suppression is indeed a specific form of therapy for a measurable phenomenon; unfortunately, the significance of that phenomenon as well as the best means and location of its assessment are undergoing significant reevaluation. An exciting frontier is the prospect of preventing infertility in the patient undergoing therapy for cancer, thus obviating the need for treatment of the ensuing infertility. Before specific therapies can be anticipated to have a predictable beneficial effect, these areas require active investigation to define the problem more clearly.
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PMID:Specific nonsurgical therapy in male infertility. 361 68

Receiver operating characteristic curves and accuracy parameters were computed for traditional sperm characteristics (concentration, motility, morphology) and the number of peroxidase negative cells, and the concentration of adenosine triphosphate (ATP) in semen from populations of fertile and infertile men, and men who achieved a pregnancy after varicocele treatment. The percentage and concentration per millilitre of spermatozoa with rapid linear progressive motility, and the ATP concentration, provided the best discrimination between fertile and treated fertile from infertile men. The misclassification rate was higher for sperm morphology, total progressive motility and viability, whereas sperm concentration and the total sperm count per ejaculate had the worst discriminating power. The number of peroxidase negative cells per 100 spermatozoa was highly specific in identifying men who achieved pregnancy after varicocele treatment. The lower limit of normality of sperm characteristics was remarkably different between fertile men and men achieving pregnancy after treatment or during infertility work-up.
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PMID:Reassessment of the accuracy of traditional sperm characteristics and adenosine triphosphate (ATP) in estimating the fertilizing potential of human semen in vivo. 369 15


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