Fertility disorders in men with varicocele

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Currently, about 15-20% of all pregnancies that occur end in failure – either an undeveloped pregnancy or miscarriage. Not so long ago, new data were obtained, due to which the male factor (for example, varicocele) was also considered the cause of miscarriage. It can be associated with changes such as gene mutations, microdeletions, aneuploidies, DNA damage, and chromatin compactification disorders.

Currently, in reproductive medicine, disorders of the paternal genome are receiving more and more attention. The main cause of these disorders is considered to be oxidative stress, which in turn serves as the leading pathophysiological mechanism of pathospermia in varicocele – one of the most common (15%) diseases in men of young fertile age. According to statistics, 40% of patients with varicocele have fertility disorders and 80% of infertile men suffer from this disease. The relationship between varicocele and spermogram parameters is evaluated ambiguously. In some cases, the effect on the fertilizing ability of the ejaculate is not detected, in others-a significant change in the spermogram and a violation of fertility is traced. Many authors believe that surgical treatment of varicocele can improve the parameters of the spermogram. However, despite this, the question of the true effect of varicocelectomy on the severity of oxidative stress remains open.

Erectile dysfunction, which can be ignored with the help of viagra, is not always to blame. What to do for those who are interested not only in sex, but in conceiving a child, but because of any disease it is impossible.

varicocele

Varicocele

Patients with left-sided varicocele and infertility who meet the inclusion/exclusion criteria underwent a comprehensive andrological examination: anamnesis collection, clinical examination, hormonal status study, infectious status study (urethral smear for analysis by polymerase chain reaction), scrotal ultrasound, transrectal prostate ultrasound, geneticist consultation, blood test for antisperm antibodies, spermogram. The collection and analysis of the ejaculate was carried out in accordance with the WHO recommendations (2010) [11]. Men abstained from sexual activity, baths, saunas, alcohol consumption, and medication for two to five days (an average of three days) before submitting sperm for analysis. The method of obtaining sperm for analysis was masturbation. Additionally, the fragmentation of sperm DNA was determined by chromatin dispersion and the level of antisperm antibodies of the immunoglobulin G class by direct MAR test.

After the examination, all patients underwent varicocelectomy according to the Marmara method. Patients of the first group (n = 42) did not receive spermoprotective therapy in the postoperative period. Patients of the second group (n = 38) from the first day after the operation were prescribed androdose of two pills twice a day for six months. The results of the spermogram and additional sperm tests were evaluated before the operation and six months after it.

In both groups of patients, there were no hormonal profile disorders, structural changes in the scrotal organs (in addition to the left-sided varicocele) and the prostate gland.

Before the operation, the volume, viscosity, number of spermatozoa, the proportion of live spermatozoa and spermatozoa with normal morphology were within the reference values in all patients, and the proportion of motile spermatozoa was below the reference values. In patients of the second group, after surgery followed by AndroDose, there was a statistically significant increase in the volume of ejaculate, sperm concentration, motility, and the proportion of live and morphologically normal spermatozoa. In the patients of the first group, there were no statistically significant changes within six months after the operation, although there was a tendency to increase sperm motility.

In both groups, before the operation, the values of the level of sperm DNA fragmentation were abnormal. In the second group, after the operation followed by AndroDose administration, there was a significant decrease in the level of sperm DNA fragmentation to the reference values. In the first group, in patients who underwent only surgery, the level of sperm DNA fragmentation decreased to intermediate values.

Conclusion – It is necessary to assess the level of sperm DNA fragmentation in patients with varicocele, even in normozoospermia (WHO, 2010). Surgical treatment for varicocele can improve the state of sperm DNA, which increases the chance of conception, or improve the prognosis during assisted reproductive technologies.

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