Températures et varicocèles

Varicocele is considered to be responsible for male infertility by several authors, while varicocele may also exist in fertile men. Hyperthermia or “raised” testicular temperature is one of the pathophysiological mechanisms proposed to explain impaired spermatogenesis when a varicocele is present in infertile men. The reported clinical data in humans and experimental results of surgically-induced varicocele in animals indicate the following findings. In most studies, mean testicular and scrotal temperatures are bilaterally increased in populations of men with unilateral left varicocele compared to control populations. Similar results are observed following surgical induction of experimental left varicocele in animals. In the case of bilateral varicocele, the increase in mean temperature is similar to that observed in unilateral varicocele. Data concerning the effects of varicocelectomy on testicular or scrotal temperatures are still inconclusive in humans because of the discordant results in the small number of studies dealing with this topic. However, experimental data indicate that varicocelectomy results in recovery of normal mean temperature in animals submitted to surgically-induced varicocele, but experimental animal models of varicocele have failed to provide any explanation for the increase in temperature. In conclusion, although there is a relationship between varicocele and testicular temperature, testicular temperature is not increased in every case of varicocele.     

Varicocèle: physiopathologie et approches thérapeutiques

Varicocele is a frequent disease in infertile men (30–40%) and has a harmful effect on growth of the testis and spermatogenesis, which deteriorates with increasing length of exposure to varicocele. Clinical varicocele (grade 2 and 3), especially in younger patients, represents a logical indication for treatment of varicocele in infertile men. However, all causes of infertility (male and female factors) must be considered before treatment. The main factors of failure of spermatogenesis are: hormonal disturbances (hypothalamo-hypophysogonadal status) and testicular thermoregulation anomalies. They should be considered to be prognostic factors for treatment.     

Profil spermiologique de l’époux dans les couples infertiles en milieu négro-africain au Sénégal

Objective

To define the role of male infertility in black African couples in Senegal and to establish the semen profile.

Material and Methods

We analysed 17,459 sperm counts and 5,563 post-coital tests from patients consulting for primary or secondary infertility between January 1982 and December 2002. Negative and deficient sperm counts of post-coital tests were studied to demonstrate the responsibility of male infertility. For sperm counts, we studied the patient’s age, the mode of semen collection, the volume of ejaculate and semen characteristics.

Results

Primary sterility (68.4%) was twice as frequent as secondary sterility (31.6%). Male infertility (31.7%) was twice as frequent as female infertility (14.7%). Twenty eight per cent of patients presented hypospermia. Isolated oligozoospermia was observed in 10% of cases and azoospermia was detected in 23% of cases. Qualitative sperm changes were observed in 44.3% of cases. A positive semen culture was reported in 21.3% of cases. Combinations (qualitative sperm changes and abnormalities of number) were observed in 43.4% of cases. Oligo-astheno-teratozoospermia (OATS) with spermatozoa with an elongated head, cytoplasmic remnants and angulation, characteristic of varicocele was significantly more frequent in patients with varicocele (97% of men with right varicocele and 98.2% of men with bilateral varicocele). Reactive epididymosemino-prostatic dystrophy was observed in 11.9% of cases

Conclusion

Male infertility plays a real role. The semen profile of the husband of a sterile couple in Senegal is characterized by the importance of polymorphic alterations such as oligo-astheno-teratospermia and secretory azoospermia.     

Spermatogenesis in varicoceles after correction of the blood supply to the testis

By means of light microscopy methods in experiments performed in 60 white rats with modelled venous congestion in the left testis and in 113 men suffering from varicocele of the 2d-3d degree complicated with certain disorders of fertility, the effect of blood correction has been studied in the gonads by switching off the caudal (inferior) epigastric vein. The experimental correction of the blood stream in the testes, according to the data of quantitative estimations, contributes to spermatogenesis. Corresponding positive results, while studying spermograms, are obtained in patients suffering from varicocele complicated with infertility. Application of this operation is expedient when conservative therapy as varicocele is uneffective.     

Decreased protein tyrosine phosphorylation and membrane fluidity in spermatozoa from infertile men with varicocele

Varicocele is a prevalent pathology among infertile men. The mechanisms linking this condition to infertility, however, are poorly understood. Our previous work showed a relationship between sperm functional quality and the ability of spermatozoa to respond to capacitating conditions with increased membrane fluidity and protein tyrosine phosphorylation. Given the reported association between varicocele, oxidative stress, and sperm dysfunction, we hypothesized that spermatozoa from infertile patients with varicocele might have a combined defect at the level of membrane fluidity and protein tyrosine phosphorylation. Semen samples from infertile patients with and without grade II/III left varicocele were evaluated for motion parameters (computer-assisted semen analysis [CASA]), hyperactivation (CASA), incidence and intensity of protein tyrosine phosphorylation (phosphotyrosine immunofluorescence and western blotting), and membrane fluidity (Laurdan fluorometry), before and after a capacitating incubation (6 hr at 37 degrees C in Ham's F10/BSA, 5% CO(2)). Spermatozoa from varicocele samples presented a decreased response to the capacitating challenge, showing significantly lower motility, hyperactivation, incidence and intensity of tyrosine phosphorylation, and membrane fluidity. The findings reported in this article indicate that the sperm dysfunction associated to infertile varicocele coexists with decreased sperm plasma membrane fluidity and tyrosine phosphorylation. These deficiencies represent potential new pathophysiological mechanisms underlying varicocele-related infertility.     

Impact de la varicocélectomie chez les patients ayant une azoospermie non obstructive ou une oligozoospermie sévère

Objective

To evaluate the changes induced by retroperitoneal varicocelectomy on infertile men with nonobstructive azoospermia or severe oligozoospermia.

Patients and methods

The records were retrospectively evaluated for 46 infertile men with severe oligozoospermia (group I) and 15 infertile men with non-obstructive azoospermia (group II). The parameters of sperm before and after surgery and unassisted pregnancy rate were comparatively analysed.

Results

In the severe oligozoospermia group, the mean age of patients was 35.5 ± 6.4 (23–47 years). The mean duration of infertility was 4.9 ± 3.4 years (1–13 years). Of these patients, 41(89.1%) had bilateral varicocele and five (10.9%) had unilateral left-side varicocele. The varicocele was classified as grade I in two cases (4.3%), grade II in 39 cases (84.7%) and grade III in five cases (10.9%). After surgery, the mean sperm count increased from 1.85 ± 1.4 to 8.3 ± 10.3 millions/ml and mean sperm normal motility from 43.3 ± 21.5 to 47.6 ± 29.2%. The mean sperm abnormal morphology decreased from 65.05 ± 21.6 to 50.08 ± 26.9%. After a mean follow-up of 26.2 ± 11.6 months, the unassisted pregnancy rate in this group was 26.1%. In the non-obstructive azoospermia group (N = 15), the mean age of patients was 40.8 ± 7.2 (27–47 years). The mean duration of infertility was 6 ± 3.1 years (3–15 years). After varicocelectomy, an induction of spermatogenesis was observed in three patients (20%) with presence of motile sperm in the ejaculate. In this group, only one of the 15 men achieved unassisted pregnancy.

Conclusion

Retroperitoneal varicocele repair resulted in spermatogenesis induction with presence of motile ejaculated spermatozoa for some men with non-obstructive azoospermia. It induced spermatogenesis and fertility enhancement in men with severe oligozoospermia. Varicocele repair should be considered in men with non-obstructive azoospermia or severe oligozoospermia.     

Current management of adolescent varicocele

The finding of varicocele in an adolescent male is common. Varicocele rarely causes symptoms and is often diagnosed on the routine physical examination. There is clear association between varicocele and male factor infertility; however, there is debate about whether, when, and whom to treat when present in adult or adolescent males. This review of the epidemiology, etiology, pathophysiology, and treatment of the adolescent with varicocele will provide the reader with tools to make appropriate decisions in dealing with this condition.     

Testicular Biopsy in Evaluation of Male Infertility

Testicular biopsy findings in 100 infertile men were correlated with the clinical findings. Mild or moderately severe tubular lesions were seen in 57 cases and severe changes in 43. Clinical examination and semen analysis were no guide to the severity of the testicular lesion. Though patients with normal sized testes more commonly had mild tubular lesions, many were severe. Patients with small testes more often had severe lesions but some had only mild tubular changes. Biopsy findings in both aspermic and oligospermic patients ranged from normal to a complete loss of germinal tissue.Testicular biopsy is advocated in infertile men for the complete assessment of the case and for identifying those which are potentially treatable. Patients with a severe lesion can be spared further investigations. The choice and results of treatment are discussed, particularly the surgical treatment of varicocele or obstruction. Only patients with a mild or moderate testicular tubular lesion should participate in future trials with drugs for male infertility.     

Etiologie des infertilités secondaires de l’homme

Introduction

Secondary infertility is defined as the inability to achieve a new pregnancy for a couple that has been able to procreate in the past.

Material and methods

Over a 16-year period, 49 patients consulted for male secondary infertility. Clinical, laboratory or ultrasound assessment demonstrated the cause of infertility.

Results

These patients had a mean age of 33.6 years (range: 26 to 44 years). These couples had an average of 1 living child per family, corresponding to a girl in two-thirds of cases and a boy in one-third. In these patients, infertility was due to the presence of varicocele in 15 patients (31% of cases), infection in 14 patients (29%), and varicocele associated with infection in 11 cases (22%).

Conclusion

This assessment revealed two main aetiologies, but some causes remain obvious, such as surgery with resection of the prostate or testicles, or certain cytotoxic therapies.     

Approche clinique d'une OAT

The clinical approach of the male partner of infertile couples seems to be still a problem. Indeed, clinical history and examination are too often lacking. Such an attitude induces that the treatment of male infertility tends to be based for most part on the examination of seminal fluid alone. With the consequence that the treatment of the semen rather the man is the focus of attention. Oligozoospermia (OAT) is a common finding among infertile men. This OAT can be due to factors that may be found through anamnesis, clinical examination and semen analysis. Anamnesis indicates history of cryptorchidism, urogenital infections, surgery for inguinal hernia. One of the most studied factors that can be found during clinical examination is varicocele, and recent data indicate that the surgical treatment of varicocele when associated with OAT could be beneficial to fertility of infertile men. Semen infection, a difficult diagnosis mainly based on bacteriospermia and leukospermia, could benefit from other diagnosis tools such as echography of the male reproductive tract and biochemical markers of the seminal plasma. Finally, when no potential factors responsible for an OAT are found, such an OAT is named “idiopathic”. However, some of these “idiopathic OAT” are false idiopathic OAT, as shown through three examples, such as unilateral testicular obstruction, partial ejaculatory duct obstruction and thermal pathologies of the testes, when anamnesis and clinical examination are adequately associated with semen analysis.     

An update of Coenzyme Q10 implications in male infertility: biochemical and therapeutic aspects

This review is focused upon the role of coenzyme Q(10) in male infertility in the light of a broader issue of oxidative damage and antioxidant defence in sperm cells and seminal plasma. Reactive oxygen species play a key pathogenetic role in male infertility besides having a well-recognized physiological function. The deep involvement of coenzyme Q(10) in mitochondrial bioenergetics and its antioxidant properties are at the basis of its role in seminal fluid. Following the early studies addressing its presence in sperm cells and seminal plasma, the relative distribution of the quinone between these two compartments was studied in infertile men, with special attention to varicocele. The reduction state of CoQ(10) in seminal fluid was also investigated. After the first in vitro experiments CoQ(10) was administered to a group of idiopathic asthenozoospermic infertile patients. Seminal analysis showed a significant increase of CoQ(10) both in seminal plasma and in sperm cells, together with an improvement in sperm motility. The increased concentration of CoQ(10) in seminal plasma and sperm cells, the improvement of semen kinetic features after treatment, and the evidence of a direct correlation between CoQ(10) concentrations and sperm motility strongly support a cause/effect relationship. From a general point of view, a deeper knowledge of these molecular mechanisms could lead to a new insight into the so-called unexplained infertility.     

Clinico-roentgenologic diagnosis of chronic venous insufficiency of the ovaries

The paper is devoted to clinico-roentgenological correlations of venous reno-gonadal hemodynamics in 168 women of reproductive age (151 women with infertility, habitual abortion, disordered menstrual function and 17 patients without disorders of the reproductive tract). Clinico-laboratory investigation was followed by visceral and parietal phlebography for the detection of a pathological venous reflux into the ovarian pampiniform plexus. A retrograde blood flow along the internal ovarian vein with the development of venostasis and secondary pelvic varicocele was diagnosed in 67 women with disturbed reproductive function. In 17 women without disorders of reproductive function a reno-gonadal venous reflux was undetectable. Clinico-roentgenological semiotics of chronic venous ovarian insufficiency was analyzed. Infertility was shown to be the main clinical manifestation of ovarian varicocele.     

Reversible meiotic abnormalities in azoospermic men with bilateral varicocele after microsurgical correction.

Because of a possible relationship between microenvironmental disturbances and meiotic abnormalities and of a straight relationship between lower-quality semen in patient carrying a varicocele and first meiotic non-disjunction, bilateral bipolar testicular biopsies are realized according the thermic differential gradient described in varicocele. Systematic meiotic studies of multiple testicular biopsies from 65 azoospermic men with bilateral varicocele were done in a multi-centric study on microsurgical correction of bilateral varicocele with microthermic intra-operative evaluation using minimally invasive thermal microsensors (Betatherm 10K3MCD2). In the present study abnormal temperature raising, histomorphometric abnormalities (spermatocyte arrest) and meiotic abnormalities (class IIC) are strongly correlated. In the ten patients submitted to another testicular biopsy procedure six months after surgery for TESE, normal thermal differential is registered and no meiotic abnormalities recurrences are found.     

Y chromosome micro-deletions in idiopathic infertility from Northern India

Azoospermia factor locus (AZF) is assumed to contain the genes responsible for spermatogenesis. Deletions in these genes are thought to be pathologically involved in some cases of male infertility associated with azoospermia or oligozoospermia. An attempt was made to establish the prevalence of micro-deletions on the Y chromosome in 79 infertile North Indians with azoospermia and oligozoospermia. Detail clinical examinations as well as endocrinological parameters were also done. Polymerase chain reaction (PCR) micro-deletion analysis was done in 79 infertile men. For this, genomic DNA was extracted from the peripheral blood. Seven sets of primers were used encompassing AZFa, AZFb and AZFc regions. Micro-deletions in five of the 79 cases (6.3%) showed deletions of at least one of the STS markers. Deletions were detected with known and unknown aetiology and at least in one of the infertile male with varicocele. AZF micro-deletions seen in idiopathic infertile males suggest the need for molecular screening in non-idiopathic cases.     

Selenium,Copper and Zinc in Seminal Plasma of Men with Varicocele,Relationship with Seminal Parameters

Varicocele has been associated with decrease in seminal parameters. Selenium (Se), copper (Cu), and zinc (Zn) are trace elements essential for normal spermatogenesis of mammals and play a critical role as antioxidant defense system enzymes. Se, Cu, and Zn are associated with sperm quality in fertile and infertile men. However, there is little information about Se, Cu, and Zn concentrations in semen in patients with varicocele and its association with seminal parameters. The purpose of this study was to determine the concentrations of Se, Cu, and Zn in semen of patients with varicocele and the relationship with seminal parameters. Total Reflection X-Ray Fluorescence was used for the fist time in the seminal fluid analysis. The concentration of selenium in men with varicocele was smaller than the normozoospermic group, while no differences were observed for both concentrations of zinc and copper. A significant positive correlation between zinc and selenium concentration was observed. Selenium in seminal plasma correlates with a good spermatozoa concentrations, motility, and morphology. Additionally, a significant positive correlation was observed between zinc levels and sperm count. In conclusion, a decrease in selenium concentration was associated with detriment of seminal parameters. A study should be conducted to evaluate the benefits of both zinc and selenium supplementation to improve seminal parameters in patients with varicocele.     

Alexis Boyer (1760–1833), éminent chirurgien et anatomiste. La place de l’andrologie dans son œuvre. Varicocèle et hypospadias comme facteurs d’infécondité

Alexis Boyer, professor of clinical surgery at La Charité, first surgeon to Napoleon, baron of the empire, left a considerable volume of works devoted to all aspects of external pathology. A large part of his work deals with andrology. The chapters on varicocele and hypospadias illustrate the astonishingly high level of Boyer’s knowledge in the fields of andrology and infertility.     

ELV对青春期大鼠睾丸中VEGF与VEGFR2蛋白表达的影响

目的研究血管内皮生长因子(VEGF)及其受体2(VEGFR2)在实验性左侧精索静脉曲张大鼠睾丸中的表达和定位,探讨精索静脉曲张中VEGF和VEGFR2的可能作用。方法通过部分结扎左肾静脉建立大鼠实验性左侧精索静脉曲张模型,于术后2周和4周取材,采用免疫组化法检测VEGF、VEGFR2在睾丸上的表达变化。结果 ELV2周与4周组大鼠两侧睾丸中VEGF蛋白表达均上调,但ELV组间VEGF蛋白表达没有明显变化;ELV2周组大鼠睾丸中VEGFR2蛋白的表达与对照组比较增强,而4周组比对照组和2周组均显著增强。结论实验性左侧精索静脉曲张对VEGF、VEGFR2蛋白的表达有影响,说明它们与男性不育可能有一定的关系。     

Facteurs de stress psychologique et qualité du sperme dans une population de 450 hommes infertiles slovènes

The purpose of this prospective study was to examine the relationship between psychological stress and male reproductive function. The study population consisted of 450 men attending the infertility outpatient clinic and 45 men participating in an IVF-ICSI programme. Psychological stress was measured in four ways. Firstly, the “WHO (five) Well-Being Index” (1995 version) assessed the risk of depression in the previous two-week period. Secondly, Zung’s Anxiety Scale Inventory was used to assess the features and severity of anxiety. Thirdly, the global reaction to various types of chronic life stress events related to family, partner, sexual behaviour, job strain and stress related to infertility treatment, with a more intense reaction corresponding to a higher score. Fourthly, the participant indicated by no (=1) or yes (=2) whether he had been exposed to the following acute stress situations: unemployment, moving house, personal illness or illness of a close relative, road accident. All questionnaires were completed after collection of the semen sample. The incidence of depression and anxiety symptoms in the two study populations (6.5% and 5.3%, and 20.3% and 30.8%, respectively) was twice as high as that observed in the general population. Anxiety was more pronounced (50%) in ICSI patients than in conventional IVF patients. To assess a relationship between psychological stress factors and male reproductive function, we used multiple regression analysis after adjustment of sperm parameters for age, sexual abstinence, type of infertility (primary or secondary), elevated body temperature, varicocele, and history of cryptorchidism and genital infection. Depression scoring was associated with increased sperm concentration (a 7.3% increase by score unit), an intense reaction to chronic stress was associated with a decreased sperm count (3.1% by score unit), and decreased motility “a”, motility “a+b”, and vitality (0.5, 0.5, and 0.6% by score unit, respectively). Exposure to acute stress was associated with increased motility “a+b” (3.5% when the man was exposed to acute stress). Analysis using dichotomous division of fertile and infertile men did not reveal any significant correlation between any stress factor and infertility. These findings indicate that depression and anxiety are frequent in a population of infertile men attending the outpatient clinic or during IVF-ICSI attempts, while significant changes of sperm characteristics are related to depression (decreased sperm concentration), intense reaction to chronic stress (decreased sperm count, motility “a” and “a+b”, and vitality) and exposure to acute stress (better motility “a+b”). This study confirms that stress factors must be taken into account in the management of infertile couples with particular attention to depression and reaction to stress.     

Influence de la cure chirurgicale de la varicocele sur la qualite du sperme

The aim of this study was to assess the efficacy of surgical varicocèle repair in terms of sperm quality. We have performed a retrospective study including 62 patients. All of them underwent clinical evaluation. A sperm analysis has been done before and after surgical repair. Before sugery, the spermogram was normal in only 11.3%. Oligospermia was found in 62.1 % of cases while 6.5% of patients had azoospermia. Abnormalities like microcephalia were encountered in 36.8% of cases. All patients underwent surgical varicocele repair. They were followed up every three months up to 18 months. A significant improvement of sperm count was found in 18 cases, with a pregnancy rate of 6.45%. Alterations of sperm quality was most severe in older patients. We think that as far as natural history of varicocele is not well established, the duration of its evolution is well correlated with the severity of sperm alterations. So, need for precocious diagnosis in order to lessen the risk of infertility.