https://doi.org/10.4081/aiua.2020.4.366
Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia
Submitted: June 21, 2020
Accepted: August 24, 2020
Published: December 21, 2020
Accepted: August 24, 2020
Abstract Views: 810
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Introduction: In comparison to its clinical analogue, the subclinical varicocele represents a questionable entity and specific guidelines for the optimal management are lacking. In our previous study of patients with subclinical varicocele, we showed that bilateral condition is associated with risk of dyspermia. In the present study, we evaluated the risk of deterioration of semen quality in men with bilateral disease and impaired motility according to WHO criteria. Materials and methods: Men with bilateral subclinical varicocele, not desiring fatherhood at the time of presentation, were included in study. During initial evaluation, the number of Total Motile Sperm Count (TMSC) was calculated and the patients’ age, total testicular volume (TTV), maximum venous size and mean resistive index (RI) of the intratesticular arteries were recorded. We classified the participants in five classes according to the TMSC reading: class A-: TMSC < 5 x 106, class A: TMSC between 5-10 x 106, class B: TMSC between 10-15 x 106, class C: TMSC between 15-20 x 106, and class D: TMSC > 20 x 106 per ejaculate. The participants were seen after 6 months for a repeat spermiogram and physical examination. If clinical varicocele was diagnosed or a new abnormality in the spermiogram was noted, the participants were excluded from the study. The remaining patients were allocated to two groups according to the repeat TMSC reading: patients sub-classified into a lower class (group 1), and patients remaining at the same class (group 2). A comparative analysis was performed between two groups. Results: Nineteen men were included. Nine patients were subclassified (group 1). Three patients moved to A- class (< 5 x 106). Ten patients remained in the same class having no deterioration (group 2). Comparing the two groups, no statistically significant difference was recognized for age, TTV, maximum venous size on both sides, and mean RI (p > 0.05). However, the initial reading for TMSC was 14.57 x 106 in group 1, and 22.84 x 106 in group 2, respectively. This difference was statistically significant (p < 0.05). Additionally, in a paired analysis there was a significant difference in TMSC after 6 months (p < 0.05), too. Summary Conclusions: Young men with bilateral varicocele and asthenospermia seem to be at risk of deterioration in their semen quality after a follow-up of 6 months. The measurement of TMSC can unmask patients at risk, whereas men with the lowest readings seem to be at highest risk for deterioration. The possibility of a worsening sperm quality should be considered in the appropriate clinical context.
R. Belay, G. Huang, J.-C. Shen, and E. K. Ko, “Diagnosis of clinical and subclinical varicocele: how has it evolved?,” Asian J. Androl., vol. 18, no. 2, p. 182, 2016, doi: 10.4103/1008-682X.169991.
DOI: https://doi.org/10.4103/1008-682X.169991
V. Patil, S. M. C. C. Shetty, and S. K. Das, “Redefining the criteria for grading varicoceles based on reflux times: A clinicoradiological correlation,” Ultrasound Q., vol. 32, no. 1, pp. 82–85, Mar. 2016, doi: 10.1097/RUQ.0000000000000168.
DOI: https://doi.org/10.1097/RUQ.0000000000000168
R. M. Cervellione, M. Corroppolo, and A. Bianchi, “Subclinical Varicocele in the Pediatric Age Group,” vol. 179, no. February, pp. 717–719, 2008, doi: 10.1016/j.juro.2007.09.095.
DOI: https://doi.org/10.1016/j.juro.2007.09.095
N. Zampieri and A. Dall’Agnola, “Subclinical varicocele and sports: A longitudinal study,” Urology, vol. 77, no. 5, pp. 1199–1203, 2011, doi: 10.1016/j.urology.2010.09.057.
DOI: https://doi.org/10.1016/j.urology.2010.09.057
A. Jungwirth, T. Diemer, and Z. Kopa, “Male Infertility. EAU guidelines.,” 2016.
J. T. Seo, K. T. Kim, M. H. Moon, and W. T. Kim, “The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele.,” Fertil. Steril., vol. 93, no. 6, pp. 1907–1910, Apr. 2010, doi: 10.1016/j.fertnstert.2008.12.118.
DOI: https://doi.org/10.1016/j.fertnstert.2008.12.118
D. Unal, E. Yeni, A. Verit, and O. F. Karatas, “Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: A prospective randomized study,” Int. J. Urol., vol. 8, no. 5, pp. 227–230, 2001, doi: 10.1046/j.1442-2042.2001.00289.x.
DOI: https://doi.org/10.1046/j.1442-2042.2001.00289.x
N. Zampieri and M. Pellegrino, “Effects of bioflavonoids in the management of subclinical varicocele,” pp. 505–508, 2010, doi: 10.1007/s00383-010-2574-9.
DOI: https://doi.org/10.1007/s00383-010-2574-9
N. Ou et al., “Bilateral is superior to unilateral varicocelectomy in infertile men with bilateral varicocele: Systematic review and meta-analysis.,” Andrologia, vol. 51, no. 11, p. e13462, Dec. 2019, doi: 10.1111/and.13462.
DOI: https://doi.org/10.1111/and.13462
S. S. S. Chen, “Significant predictive factors for subfertility in patients with subclinical varicocele,” Andrologia, vol. 49, no. 10, pp. 1–5, 2017, doi: 10.1111/and.12781.
J. Hallak, “Asymptomatic male currently not desiring fertility with bilateral subclinical varicocele found on ultrasound evaluation and borderline semen analysis results,” Asian J. Androl., vol. 18, no. 2, p. 315, 2016, doi: 10.4103/1008-682X.172645.
DOI: https://doi.org/10.4103/1008-682X.172645
G. Tsampoukas, A. Dellis, and A. Papatsoris, “Bilateral disease and intratesticular haemodynamics as markers of dyspermia in patients with subclinical varicocele: A prospective study.,” Arab J. Urol., vol. 17, no. 4, pp. 298–304, 2019, doi: 10.1080/2090598X.2019.1647676.
DOI: https://doi.org/10.1080/2090598X.2019.1647676
E. J. Borges, “Total motile sperm count: a better way to rate the severity of male factor infertility?,” JBRA assisted reproduction, vol. 20, no. 2. Brazil, pp. 47–48, May-2016, doi: 10.5935/1518-0557.20160012.
DOI: https://doi.org/10.5935/1518-0557.20160012
A. V Hirsh, K. M. Cameron, J. P. Tyler, J. Simpson, and J. P. Pryor, “The Doppler assessment of varicoceles and internal spermatic vein reflux in infertile men.,” Br. J. Urol., vol. 52, no. 1, pp. 50–56, Feb. 1980.
DOI: https://doi.org/10.1111/j.1464-410X.1980.tb02919.x
R. L. Gonda, J. J. Karo, R. A. Forte, and K. T. O’Donnell, “Diagnosis of subclinical varicocele in infertility,” Am. J. Roentgenol., vol. 148, no. 1, pp. 71–75, 1987, doi: 10.2214/ajr.148.1.71.
DOI: https://doi.org/10.2214/ajr.148.1.71
Y. Gat, G. N. Bachar, Z. Zukerman, A. Belenky, and M. Gornish, “Varicocele: a bilateral disease.,” Fertil. Steril., vol. 81, no. 2, pp. 424–429, Feb. 2004, doi: 10.1016/j.fertnstert.2003.08.010.
DOI: https://doi.org/10.1016/j.fertnstert.2003.08.010
Y. Gat, G. N. Bachar, Z. Zukerman, A. Belenky, and M. Gorenish, “Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities.,” J. Urol., vol. 172, no. 4 Pt 1, pp. 1414–1417, Oct. 2004, doi: 10.1097/01.ju.0000138540.57137.5f.
DOI: https://doi.org/10.1097/01.ju.0000138540.57137.5f
R. H. Donkol and T. Salem, “Paternity After Varicocelectomy,” pp. 593–599, 2007.
DOI: https://doi.org/10.7863/jum.2007.26.5.593
J. A. M. Hamilton et al., “Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system.,” Hum. Reprod., vol. 30, no. 5, pp. 1110–1121, May 2015, doi: 10.1093/humrep/dev058.
DOI: https://doi.org/10.1093/humrep/dev058
E. J. Borges, A. S. Setti, D. P. A. F. Braga, R. C. S. Figueira, and A. J. Iaconelli, “Total motile sperm count has a superior predictive value over the WHO 2010 cut-off values for the outcomes of intracytoplasmic sperm injection cycles.,” Andrology, vol. 4, no. 5, pp. 880–886, Sep. 2016, doi: 10.1111/andr.12199.
DOI: https://doi.org/10.1111/andr.12199
M. K. Samplaski, K. C. Lo, E. D. Grober, A. Zini, and K. A. Jarvi, “Varicocelectomy to ‘upgrade’ semen quality to allow couples to use less invasive forms of assisted reproductive technology.,” Fertil. Steril., vol. 108, no. 4, pp. 609–612, Oct. 2017, doi: 10.1016/j.fertnstert.2017.07.017.
DOI: https://doi.org/10.1016/j.fertnstert.2017.07.017
N. Thirumavalavan et al., “The Impact of Microsurgical Repair of Subclinical and Clinical Varicoceles on Total Motile Sperm Count: Is There a Difference?,” Urology, vol. 120, pp. 109–113, Oct. 2018, doi: 10.1016/j.urology.2018.06.036.
DOI: https://doi.org/10.1016/j.urology.2018.06.036
S. S. Chen, “Significant predictive factors for subfertility in patients with subclinical varicocele,” no. November 2016, pp. 1–5, 2017, doi: 10.1111/and.12781.
DOI: https://doi.org/10.1111/and.12781
K. Shiraishi, H. Takihara, and K. Naito, “Internal spermatic vein diameter and age at operation re ¯ ect the response to varicocelectomy,” vol. 355, pp. 351–355, 2001.
DOI: https://doi.org/10.1046/j.1439-0272.2001.00452.x
M. R. Goren, G. Erbay, C. Ozer, M. V. Kayra, and E. Hasirci, “Can we predict the outcome of varicocelectomy based on the duration of venous reflux?,” Urology, vol. 88, no. 4, pp. 81–86, 2016, doi: 10.1016/j.urology.2015.11.032.
DOI: https://doi.org/10.1016/j.urology.2015.11.032
S. Freeman et al., “Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading,” Eur. Radiol., vol. 30, no. 1, pp. 11–25, Jan. 2020, doi: 10.1007/s00330-019-06280-y.
DOI: https://doi.org/10.1007/s00330-019-06280-y
N. Zampieri, V. Zuin, M. Corroppolo, A. Ottolenghi, and F. S. Camoglio, “Relationship between varicocele grade, vein reflux and testicular growth arrest,” Pediatr. Surg. Int., vol. 24, no. 6, pp. 727–730, 2008, doi: 10.1007/s00383-008-2143-7.
DOI: https://doi.org/10.1007/s00383-008-2143-7
M. J. Mohseni et al., “Shunt-type and stop-type varicocele in adolescents: Prognostic value of these two different hemodynamic patterns,” Fertil. Steril., vol. 96, no. 5, pp. 1091–1096, 2011, doi: 10.1016/j.fertnstert.2011.08.024.
DOI: https://doi.org/10.1016/j.fertnstert.2011.08.024
H. Sakamoto, Y. Ogawa, and H. Yoshida, “Relationship between testicular volume and varicocele in patients with infertility.,” Urology, vol. 71, no. 1, pp. 104–109, Jan. 2008, doi: 10.1016/j.urology.2007.08.019.
DOI: https://doi.org/10.1016/j.urology.2007.08.019
N. Akcar, M. Turgut, B. Adapinar, and I. R. Ozkan, “Intratesticular arterial resistance and testicular volume in infertile men with subclinical varicocele.,” J. Clin. Ultrasound, vol. 32, no. 8, pp. 389–393, Oct. 2004, doi: 10.1002/jcu.20059.
DOI: https://doi.org/10.1002/jcu.20059
A. Zini, M. Buckspan, D. Berardinucci, and K. Jarvi, “The influence of clinical and subclinical varicocele on testicular volume.,” Fertil. Steril., vol. 68, no. 4, pp. 671–674, Oct. 1997, doi: 10.1016/s0015-0282(97)00311-7.
DOI: https://doi.org/10.1016/S0015-0282(97)00311-7
G. M. Pinggera et al., “Assessment of the intratesticular resistive index by colour Doppler ultrasonography measurements as a predictor of spermatogenesis,” BJU Int., vol. 101, no. 6, pp. 722–726, 2008, doi: 10.1111/j.1464-410X.2007.07343.x.
DOI: https://doi.org/10.1111/j.1464-410X.2007.07343.x
J. H. Hillelsohn, K. W. Chuang, E. Goldenberg, and B. R. Gilbert, “Spectral doppler sonography: A noninvasive method for predicting dyspermia,” J. Ultrasound Med., vol. 32, no. 8, pp. 1427–1432, 2013, doi: 10.7863/ultra.32.8.1427.
DOI: https://doi.org/10.7863/ultra.32.8.1427
S. Akdemir et al., “Different surgical techniques and L-carnitine supplementation in an experimental varicocele model.,” Andrologia, vol. 46, no. 8, pp. 910–916, Oct. 2014, doi: 10.1111/and.12172.
DOI: https://doi.org/10.1111/and.12172
S. D. Milingos, “The epidymal factor — a diagnostic approach,” Int. J. Androl., vol. 8, no. 6, pp. 417–420, 1985, doi: 10.1111/j.1365-2605.1985.tb00854.x.
DOI: https://doi.org/10.1111/j.1365-2605.1985.tb00854.x
L. Mongioi et al., “The role of carnitine in male infertility.,” Andrology, vol. 4, no. 5, pp. 800–807, Sep. 2016, doi: 10.1111/andr.12191.
DOI: https://doi.org/10.1111/andr.12191
B. Pajovic, A. Dimitrovski, N. Radojevic, and M. Vukovic, “A correlation between selenium and carnitine levels with hypo-osmotic swelling test for sperm membrane in low-grade varicocele patients.,” Eur. Rev. Med. Pharmacol. Sci., vol. 20, no. 4, pp. 598–604, 2016.
K. De Caestecker, N. Lumen, A.-F. Spinoit, K. Everaert, T. Fiers, and W. Oosterlinck, “Varicocele: the origin of benign prostatic hypertrophy? Testosterone dosages in the periprostatic plexus.,” Acta Clin. Belg., pp. 1–3, Jun. 2016, doi: 10.1179/2295333715Y.0000000062.
DOI: https://doi.org/10.1179/2295333715Y.0000000062
Y. Gat and M. Goren, “Benign Prostatic Hyperplasia: Long-term follow-up of prostate volume reduction after sclerotherapy of the internal spermatic veins.,” Andrologia, vol. 50, no. 2, Mar. 2018, doi: 10.1111/and.12870.
DOI: https://doi.org/10.1111/and.12870
R. A. Condorelli et al., “Varicocele and concomitant dilation of the periprostatic venous plexus: effects on semen viscosity sperm parameters.,” J. Endocrinol. Invest., vol. 39, no. 5, pp. 543–547, May 2016, doi: 10.1007/s40618-015-0401-9.
DOI: https://doi.org/10.1007/s40618-015-0401-9
K. Ni et al., “A comprehensive investigation of sperm DNA damage and oxidative stress injury in infertile patients with subclinical, normozoospermic, and astheno/oligozoospermic clinical varicocoele,” Andrology, vol. 4, no. 5, pp. 816–824, 2016, doi: 10.1111/andr.12210.
DOI: https://doi.org/10.1111/andr.12210
How to Cite
Tsampoukas, G., Dellis, A., Katsouri, A., Brown, D., Deliveliotis, K., Moussa, M., Buchholz, N., & Papatsoris, A. (2020). Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia. Archivio Italiano Di Urologia E Andrologia, 92(4). https://doi.org/10.4081/aiua.2020.4.366
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