Role of varicocele repair for male infertility in the era of assisted reproductive technologies

Reproductive Medicine and Biology - Tập 13 Số 4 - Trang 185-192 - 2014
Masaki Kimura1,2, Kōichi Nagao3
103-3964-1211
2Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
3Department of Urology, Toho University School of Medicine, Tokyo, Japan

Tóm tắt

AbstractVaricocele is an abnormal condition characterized by dilatation of the pampiniform plexus veins draining the testis and is present in 15 % of men. Varicoceles have an adverse effect on spermatogenesis and are the most common cause of male infertility. Approximately 35 % of infertile men and more than 70 % of men with secondary infertility were reported to have varicoceles. Although data on methods of varicocele repair are accumulating, there remains controversy regarding the indications and techniques for varicocele repair. In addition, the role of varicocele repair in this era of assisted reproductive technologies continues to be debated. In this study, we performed a comprehensive PubMed search in order to review the current status of varicocele repair for male infertility. We reviewed English‐language studies published from 1992 through 2013. After reviewing the articles, we identified a recent meta‐analysis of four randomized controlled trials, which found that varicocele repair for oligozoospermic men was associated with better pregnancy rates as compared with observation. Our review of prospective studies showed that all semen parameters, including sperm concentration, motility, and progressive motility, were significantly improved after varicocele repair. We also summarize the findings of recent studies reporting beneficial effects of varicocele repair, i.e., decreased oxidative stress and sperm DNA fragmentation after varicocele repair and superior cost effectiveness versus in vitro fertilization/intracytoplasmic sperm injection alone, which may be important in the era of assisted reproductive technologies. Varicocele repair is a widespread, well‐established procedure that can improve semen parameters in men with infertility. The effect of such treatment on the pregnancy rate is unclear because evidence is limited due to difficulties in recruiting patients for studies. Among the repair techniques, microsurgical repair using a subinguinal approach is potentially the best practice, although this procedure requires training in microsurgery. All these topics require further research in studies with sufficient patient enrollment and follow‐up.

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Tài liệu tham khảo

World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization. Fertil Steril. 1992;57:1289–93.

10.1046/j.1464‐410x.1999.00942.x

10.1016/S0015-0282(16)54288-5

10.1093/humupd/7.5.473

10.1093/humupd/7.1.59

Moore RDaQ WJ, 1923, The scrotum as a temperature regulator for the r\testes, Am J Physiol, 68, 70, 10.1152/ajplegacy.1924.68.1.70

10.1016/S0022-5347(17)38874-2

10.1016/j.urology.2008.07.053

10.1159/000332156

10.1016/j.fertnstert.2004.04.071

10.1016/j.fertnstert.2007.03.057

10.1038/nrurol.2012.197

10.1016/j.fertnstert.2009.12.039

Zalata AA, 2004, Relationship between acrosin activity of human spermatozoa and oxidative stress, Asian J Androl, 6, 313

10.1016/S0015‐0282(97)00236‐7

10.1089/ars.2010.3186

10.1046/j.1365‐2605.2001.00296.x

10.1016/j.juro.2007.09.039

10.1097/MOU.0b013e328358e115

10.1016/j.fertnstert.2007.07.1377

10.1016/j.fertnstert.2009.10.046

10.2164/jandrol.111.013433

10.1016/j.juro.2012.11.024

10.1093/humrep/deh701

10.1016/j.fertnstert.2005.08.032

10.1016/S0022-5347(17)39102-4

Sofikitis N, 1993, Left adrenalectomy in varicocelized rats does not inhibit the development of varicocele‐related physiologic alterations, Int J Fertil Menopausal Stud, 38, 250

10.1016/j.eururo.2012.04.048

10.2164/jandrol.107.003467

10.1016/S0015-0282(16)54970-X

10.1155/2012/597495

10.1097/01.ju.0000138540.57137.5f

10.1093/oxfordjournals.humrep.a019362

10.1016/S0022‐5347(01)66245‐1

10.7863/jum.1983.2.6.271

10.1007/s00345‐011‐0701‐4

10.1016/j.juro.2012.11.011

10.1016/j.juro.2010.05.053

10.1097/MOU.0b013e3281ddb30c

10.1046/j.1464‐410X.2001.00110.x

10.1007/s11934‐007‐0057‐x

10.1046/j.1464‐410X.92.s1.9.x

10.1016/j.ucl.2004.04.012

10.1542/peds.2007‐0340

10.1016/j.eururo.2012.04.048

10.1016/j.juro.2007.03.169

10.1016/j.eururo.2011.06.018

10.1097/01.ju.0000097400.67715.f8

10.2164/jandrol.108.005967

10.1111/j.1464‐410X.2010.09959.x

Evers JL, 2001, Surgery or embolisation for varicocele in subfertile men, Cochrane Database Syst Rev, 1, CD000479

10.1016/S0140‐6736(03)13503‐9

10.1038/nrurol.2009.143

10.1016/j.eururo.2010.12.008

10.1016/j.juro.2009.08.161

10.1111/j.1365‐2605.2009.01048.x

10.1080/00365590802028141

10.1016/j.fertnstert.2005.07.1293

10.1111/j.1464‐410X.2006.05915.x

10.3109/19396368.2012.692431

10.1016/j.juro.2010.06.004

10.2164/jandrol.110.011932

10.1016/j.fertnstert.2011.10.033

10.1111/j.1464‐410X.2008.07656_2.x

10.1080/01485010490425250

10.1590/S1677‐55382005000600005

10.1016/j.ijsu.2009.05.009

10.1016/j.fertnstert.2007.12.065

10.1097/MOU.0b013e328358e27b

10.1016/j.fertnstert.2003.10.036

10.1016/j.juro.2009.06.028

10.1016/S0090‐4295(96)00379‐2

10.1016/S0022‐5347(05)64175‐4

10.1016/j.fertnstert.2008.05.053

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Reproductive Medicine and Biology

Tập 13 Số 4

185-192

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