madman
Super Moderator
Abstract
Varicocele is the most common correctable cause for male infertility, but not all men with varicocele are affected equally by this condition. The pathophysiology of varicocele-induced fertility remains ill-defined. While evidence suggests that oxidative stress remains a central factor, other mechanisms likely include scrotal hyperthermia, reflux of metabolites, hypoxia and cadmium accumulation. Microsurgical varicocelectomy remains the gold standard treatment option for infertile men with a clinically palpable varicocele and abnormal semen parameters. Newer evidence suggests a potential role for antioxidant supplementation and a meaningful role of varicocelectomy for patients destined for ART to improve pregnancy outcomes.
Key points
• The effects of oxidative stress extend beyond the local scrotal environment, involving other hormonal axes.
• Microscopic subinguinal varicocelectomy confers high pregnancy rate, compared to other procedures.
• Empirical use of antioxidants supplementation can be beneficial in men with suboptimal outcomes following. varicocele repair.
• Varicocelectomy may reduce the need of ART or improve the efficacy of ART in achieving a pregnancy.
Potential areas of research
• Long-term end points, such as pregnancy, and safety profiles of various antioxidants are required before these therapies can become a standard treatment option.
• Only a portion of men who undergo varicocelectomy will achieve spontaneous pregnancy. Future studies can seek to better stratify those who are most likely to benefit.
• Prospective longitudinal data comparing surgical intervention and observation are needed to guide diagnosis and management of pediatric and adolescent varicocele.
5 | CONCLUSION
Varicocele is the most common and correctable cause of male factor infertility. While the pathophysiology of varicocele-induced infertility may be multi-factorial, extensive evidence supports the central role of oxidative stress in negatively affecting various semen parameters, spermatogenesis and hormonal levels. Varicocelectomy remains the first-line treatment option in infertile men with palpable varicocele and abnormal semen parameters, with the microsurgical subinguinal approach conveying the greatest success rate and fewest complications. The empirical use of antioxidant supplement may confer some benefits in men to reduce oxidative damage. However, more robust data are needed to establish their efficacy as a standard management option. Varicocele repair may obviate the need for ART or augment ART therapy by improving outcomes.
Varicocele is the most common correctable cause for male infertility, but not all men with varicocele are affected equally by this condition. The pathophysiology of varicocele-induced fertility remains ill-defined. While evidence suggests that oxidative stress remains a central factor, other mechanisms likely include scrotal hyperthermia, reflux of metabolites, hypoxia and cadmium accumulation. Microsurgical varicocelectomy remains the gold standard treatment option for infertile men with a clinically palpable varicocele and abnormal semen parameters. Newer evidence suggests a potential role for antioxidant supplementation and a meaningful role of varicocelectomy for patients destined for ART to improve pregnancy outcomes.
Key points
• The effects of oxidative stress extend beyond the local scrotal environment, involving other hormonal axes.
• Microscopic subinguinal varicocelectomy confers high pregnancy rate, compared to other procedures.
• Empirical use of antioxidants supplementation can be beneficial in men with suboptimal outcomes following. varicocele repair.
• Varicocelectomy may reduce the need of ART or improve the efficacy of ART in achieving a pregnancy.
Potential areas of research
• Long-term end points, such as pregnancy, and safety profiles of various antioxidants are required before these therapies can become a standard treatment option.
• Only a portion of men who undergo varicocelectomy will achieve spontaneous pregnancy. Future studies can seek to better stratify those who are most likely to benefit.
• Prospective longitudinal data comparing surgical intervention and observation are needed to guide diagnosis and management of pediatric and adolescent varicocele.
5 | CONCLUSION
Varicocele is the most common and correctable cause of male factor infertility. While the pathophysiology of varicocele-induced infertility may be multi-factorial, extensive evidence supports the central role of oxidative stress in negatively affecting various semen parameters, spermatogenesis and hormonal levels. Varicocelectomy remains the first-line treatment option in infertile men with palpable varicocele and abnormal semen parameters, with the microsurgical subinguinal approach conveying the greatest success rate and fewest complications. The empirical use of antioxidant supplement may confer some benefits in men to reduce oxidative damage. However, more robust data are needed to establish their efficacy as a standard management option. Varicocele repair may obviate the need for ART or augment ART therapy by improving outcomes.
Last edited by a moderator:
