Waroń – Rokowania, prognozy i postęp choroby

Waroń
Rokowania, prognozy i postęp choroby

Waroń (varicocele) jest istotnym czynnikiem wpływającym na męską płodność, występującym u około 40% mężczyzn z pierwotną oraz 80% z wtórną niepłodnością. Pomimo powszechności, aż 45% pacjentów z klinicznie stwierdzonym waroniem ma prawidłowe parametry nasienia, a 80% pozostaje płodnych. Najlepszym prognostykiem poprawy parametrów nasienia po mikrochirurgicznej warikocelektomii są wyjściowe wartości gęstości i ruchliwości plemników, a także stopień zaawansowania waronia (I lub II stopień wiąże się z 70,83% szansą na poczęcie po embolizacji u partnerów w wieku 24-33 lat). Dodatkowo, młodszy wiek pacjenta, wyższy poziom testosteronu, większa objętość jąder oraz brak ekspozycji zawodowej na toksyny stanowią korzystne czynniki prognostyczne. Fragmentacja DNA plemników oraz stres oksydacyjny są kluczowymi parametrami oceny wpływu waronia na płodność, a ich badanie powinno być rutynowo włączane do diagnostyki.

Wprowadzenie do prognozy waroń

Waroń (varicocele) stanowi istotny problem medyczny, szczególnie w kontekście płodności męskiej. Dotyczy on około 40% mężczyzn z pierwotną niepłodnością oraz, co zadziwiające, nawet 80% mężczyzn z niepłodnością wtórną¹. Pomimo powszechnego występowania, prognozy pooperacyjne i efekty leczenia warikocelektomii pozostają przedmiotem kontrowersji w środowisku medycznym²³. Warto podkreślić, że szacunkowo aż 45% mężczyzn z klinicznie stwierdzonym waroniem ma prawidłowe parametry nasienia, a około 80% mężczyzn z waroniem jest płodnych⁴.

Czynniki prognostyczne pozytywnych wyników po leczeniu waronia

Parametry nasienia przed zabiegiem

Najlepszym predyktorem parametrów nasienia po warikocelektomii są parametry nasienia przed zabiegiem⁵. Wyższy wyjściowy poziom gęstości plemników konsekwentnie stanowi czynnik prognostyczny dla naturalnego poczęcia lub większej skuteczności technik wspomaganego rozrodu (ART)⁶. Obecność prawidłowej ruchliwości postępowej plemników przed leczeniem jest również pozytywnym czynnikiem prognostycznym dla uzyskania ciąży po embolizacji waronia⁷.

Stopień zaawansowania waronia

Największą poprawę parametrów nasienia obserwuje się u mężczyzn z większymi waroniami⁸. Jednakże badania wskazują, że umiarkowany do niskiego stopień ciężkości waronia (stopień I lub II) może pozytywnie wpływać na sukces embolizacji waronia, oceniany jako osiągnięcie ciąży/żywego urodzenia⁹¹⁰. Analiza danych wykazała, że pacjent płci męskiej bez wysokiego stopnia ciężkości waronia (ze stopniem I lub II) ma 70,83% szans na poczęcie po leczeniu embolizacją, jeśli wiek jego partnerki mieści się w przedziale 24-33 lat, z dokładnością 70,59%¹¹.

Wiek pacjenta

Młodszy wiek pacjenta jest uważany za korzystny czynnik prognostyczny dla poprawy parametrów nasienia po warikocelektomii¹². Młodszy wiek mężczyzny wpływa również pozytywnie na szanse osiągnięcia ciąży po embolizacji waronia¹³.

Poziom testosteronu i wielkość jąder

Wyższy poziom testosteronu oraz większa wielkość jąder, w niektórych badaniach, przewidują poprawę parametrów nasienia po warikocelektomii¹⁴. Te parametry fizjologiczne mogą odzwierciedlać lepszą funkcję jąder i większy potencjał regeneracyjny po leczeniu.

Wpływ zawodu pacjenta

Interesującym odkryciem jest to, że zawód pacjenta może mieć wpływ na sukces leczenia. Zawód, który nie wiąże się z kontaktem z potencjalnie toksycznymi środowiskami lub produktami, jest pozytywnym czynnikiem prognostycznym dla sukcesu embolizacji waronia¹⁵.

Biomarkery prognostyczne w warniu

Metabolity w plazmie nasienia

Badania z wykorzystaniem ukierunkowanej i nieukierunkowanej analizy metabolicznej wykazały, że waroń znacząco wpływa na metabolizm nasienia, a mikrochirurgiczna warikocelektomia może odwrócić te metaboliczne nieprawidłowości¹⁶¹⁷. Zidentyfikowano 8 metabolitów i 3 dipeptydy jako potencjalne biomarkery waronia¹⁸. Zmniejszenie poziomu tych dipeptydów może przyczyniać się do poprawy jakości nasienia po mikrochirurgii¹⁹. Jednak zastosowanie tych biomarkerów do wczesnej diagnozy lub przewidywania efektu chirurgicznego jest nadal badane²⁰.

Fragmentacja DNA plemników

Fragmentacja DNA plemników jest istotnym parametrem oceny wpływu waronia na płodność. Zgodnie z wytycznymi, naprawa waronia powinna być oferowana jako część opcji leczenia dla wszystkich mężczyzn z niepłodnych par, u których występują wyczuwalne palpacyjnie waronie i uszkodzenie DNA plemników, niezależnie od wyników konwencjonalnej analizy nasienia²¹. Badania dostarczają dalszych dowodów potwierdzających niekorzystny wpływ waronia na DNA plemników u mężczyzn z normozoospermią oraz potrzebę włączenia testów fragmentacji DNA plemników do rutynowej oceny mężczyzn z waroniem poszukujących płodności²².

Stres oksydacyjny w nasieniu

Zainteresowanie stresem oksydacyjnym w nasieniu jest porównywalne do zainteresowania uszkodzeniem DNA plemników, przy czym oba parametry są coraz częściej badane w kontekście waronia²³. Wzrastające zainteresowanie tymi markerami odzwierciedla ich potencjalną wartość prognostyczną w ocenie efektów leczenia waronia.

Prognoza po mikrochirurgicznej warikocelektomii

Poprawa parametrów nasienia

Mikrochirurgiczna warikocelektomia może prowadzić do poprawy parametrów nasienia, jednak skuteczność tego zabiegu nie może być efektywnie przewidziana²⁴. Pomimo zastosowania mikrochirurgii, około 30% do 40% pacjentów nie wykazuje poprawy parametrów nasienia²⁵. Opracowano nomogram do przewidywania parametrów nasienia po warikocelektomii na podstawie przedoperacyjnych parametrów nasienia, stopnia waronia i wieku mężczyzny²⁶.

Wpływ na odwracalność metabolicznych nieprawidłowości

Mikrochirurgiczna warikocelektomia może odwrócić metaboliczne nieprawidłowości związane z waroniem²⁷²⁸. Jest to istotny aspekt prognostyczny, który może przyczyniać się do poprawy jakości nasienia po zabiegu.

Prognoza zdolności do poczęcia po leczeniu waronia

Naturalne poczęcie

Wyższy wyjściowy poziom gęstości plemników konsekwentnie przewiduje wyższe wskaźniki naturalnego poczęcia po naprawie waronia²⁹. Jednakże, wiele osób z waroniem nie ma problemów z zajściem w ciążę³⁰. Nadal trudno jest przewidzieć, który pacjent będzie miał poprawę parametrów nasienia w porównaniu z innym, a także trudno jest przewidzieć spontaniczną płodność i wyniki reprodukcyjne po naprawie waronia³¹.

Skuteczność technik wspomaganego rozrodu

Wyższy wyjściowy poziom gęstości plemników przewiduje również wyższe wskaźniki ciąż przy zastosowaniu technik wspomaganego rozrodu (ART)³². Korzyści z naprawy waronia dla zwiększenia szans na naturalnego poczęcie lub sukces ART są nadal przedmiotem kontrowersji, co uniemożliwia jego rutynowe włączenie do klinik leczenia niepłodności³³.

Prognostyczne metody przewidywania wyników leczenia

Modele predykcyjne

Opracowano nomogram do przewidywania parametrów nasienia po warikocelektomii na podstawie przedoperacyjnych parametrów nasienia, stopnia waronia i wieku mężczyzny³⁴. Pozwala to na bardziej zindywidualizowane podejście do leczenia waronia.

Techniki analizy danych

Połączone zastosowanie technik statystycznych i eksploracji danych może przyczynić się do znalezienia wzorców związanych z waroniem, ponieważ na sukces jego leczenia może wpływać wiele parametrów, co utrudnia analizy³⁵. Zastosowanie algorytmów takich jak k-means i FP-growth pozwoliło zidentyfikować interesujące wzorce danych sugerujące pozytywne czynniki prognostyczne dla sukcesu embolizacji waronia³⁶.

Wnioski prognostyczne

Obecnie możemy zacząć wykorzystywać konkretne parametry, takie jak wyjściowa jakość nasienia, stopień waronia i wiek pacjenta, do przewidywania jakości nasienia po naprawie i potencjału płodności po warikocelektomii³⁷. Jednakże, pomimo postępów w zrozumieniu mechanizmów zaangażowanych w patofizjologię waronia, nadal trudno jest klinicznie przewidzieć, który waroń będzie wiązał się z upośledzeniem parametrów nasienia i płodności³⁸.

Wyniki badań wskazują, że korzyści z naprawy waronia w zakresie poprawy szans na naturalne poczęcie lub sukces technik wspomaganego rozrodu są nadal kontrowersyjne³⁹. Niemniej jednak, identyfikacja kluczowych czynników prognostycznych i opracowanie modeli predykcyjnych stanowi obiecujący kierunek w personalizacji leczenia i optymalizacji wyników reprodukcyjnych po naprawie waronia.

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Materiały źródłowe

#1 SciELO Brazil – What does a varicocele do to a man’s fertility? There is much more than meets the eye What does a varicocele do to a man’s fertility? There is much more than meets the eye
https://www.scielo.br/j/ibju/a/Z48FvD7tXN3rBCWkBzW8gxy/
Varicoceles are so common in infertile men they are believed to be a leading cause of male infertility. Up to 40% of men with primary infertility have varicoceles, and this figure increases to a staggering 80% of men with secondary infertility. […] The benefits of varicocele repair on improving the chance of either natural conception or successful ART are still sufficiently controversial to prevent its routine inclusion in fertility clinics. […] According to the guidelines above, varicocele repair should be offered as part of the treatment option for all male partners of infertile couples presenting with palpable varicoceles and sperm DNA damage, regardless of the conventional semen analysis results. […] The study by Jeremias and co-workers provides further evidence supporting the adverse impact of varicocele on sperm DNA of normozoospermic men, and the need for including sperm DNA fragmentation testing in the routine evaluation of men with varicocele seeking fertility.
#2 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.210202
This study provides a comprehensive analysis of research trends on the etiology, mechanisms, potential risk factors, diagnosis, prognosis, surgical and non-surgical treatment of varicocele, and clinical outcomes before and after varicocele repair. […] Studies on diagnostic and prognostic aspects of varicocele were more numerous than studies on varicocele prevalence, mechanistic studies and studies focusing on etiological and risk factors. […] To evaluate the impact of varicocele and its treatment, researchers mainly analyzed basic semen parameters, although markers of seminal oxidative stress are being increasingly investigated in the last decade, while reproductive outcomes such as live birth rate were under-reported in the literature. […] It has been estimated that up to 45% of all males with clinical varicocele have normal semen parameters, and approximately 80% of men with varicocele are fertile. Thus, despite advances in the understanding of the mechanisms involved in the pathophysiology of varicocele, it remains difficult to predict clinically which varicocele will be associated with an impairment of sperm parameters and fertility.
#3 SciELO Brazil – What does a varicocele do to a man’s fertility? There is much more than meets the eye What does a varicocele do to a man’s fertility? There is much more than meets the eye
https://www.scielo.br/j/ibju/a/Z48FvD7tXN3rBCWkBzW8gxy/
Varicoceles are so common in infertile men they are believed to be a leading cause of male infertility. Up to 40% of men with primary infertility have varicoceles, and this figure increases to a staggering 80% of men with secondary infertility. […] The benefits of varicocele repair on improving the chance of either natural conception or successful ART are still sufficiently controversial to prevent its routine inclusion in fertility clinics. […] According to the guidelines above, varicocele repair should be offered as part of the treatment option for all male partners of infertile couples presenting with palpable varicoceles and sperm DNA damage, regardless of the conventional semen analysis results. […] The study by Jeremias and co-workers provides further evidence supporting the adverse impact of varicocele on sperm DNA of normozoospermic men, and the need for including sperm DNA fragmentation testing in the routine evaluation of men with varicocele seeking fertility.
#4 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.210202
This study provides a comprehensive analysis of research trends on the etiology, mechanisms, potential risk factors, diagnosis, prognosis, surgical and non-surgical treatment of varicocele, and clinical outcomes before and after varicocele repair. […] Studies on diagnostic and prognostic aspects of varicocele were more numerous than studies on varicocele prevalence, mechanistic studies and studies focusing on etiological and risk factors. […] To evaluate the impact of varicocele and its treatment, researchers mainly analyzed basic semen parameters, although markers of seminal oxidative stress are being increasingly investigated in the last decade, while reproductive outcomes such as live birth rate were under-reported in the literature. […] It has been estimated that up to 45% of all males with clinical varicocele have normal semen parameters, and approximately 80% of men with varicocele are fertile. Thus, despite advances in the understanding of the mechanisms involved in the pathophysiology of varicocele, it remains difficult to predict clinically which varicocele will be associated with an impairment of sperm parameters and fertility.
#5 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#6 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#7 Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization
https://www.mdpi.com/2077-0383/10/16/3503
The combined use of statistical and data mining techniques can contribute towards finding patterns associated with varicocele, since several parameters may be influencing the success of its treatment and thus muddle analyses. […] We were able to identify interesting data patterns with different algorithms (k-means and FP-growth), which suggests that the success of varicocele embolization, evaluated through the achievement of a pregnancy/live birth, is positively influenced by the presence of a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, a young male patient age, and a male patient occupation that does not involve contact with putatively toxic environments or products.
#8 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#9 Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization
https://www.mdpi.com/2077-0383/10/16/3503
We carried out a retrospective analysis of infertile couple data using several methodologies and data analysis techniques, including the application of a novel data mining approach for analyzing varicocele treatment outcomes. […] Following this study, we can predict that a male patient without a high varicocele severity grade (with grade I or II) has a 70.83% chance of conceiving after embolization treatment if his partnersâ age is between 24 and 33 with an accuracy of 70.59%. […] Varicocele embolization success, defined as whether the manâs partner got pregnant, was able to be predicted with an accuracy of 70.59% by stating that a male patient without a high varicocele severity grade (with grade I or II) has a 70.83% chance (i.e., (17/(7 + 17) = 70.83%) of conceiving after the embolization treatment if his partner is between the ages of 24 and 33 years old inclusively.
#10 Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization
https://www.mdpi.com/2077-0383/10/16/3503
The combined use of statistical and data mining techniques can contribute towards finding patterns associated with varicocele, since several parameters may be influencing the success of its treatment and thus muddle analyses. […] We were able to identify interesting data patterns with different algorithms (k-means and FP-growth), which suggests that the success of varicocele embolization, evaluated through the achievement of a pregnancy/live birth, is positively influenced by the presence of a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, a young male patient age, and a male patient occupation that does not involve contact with putatively toxic environments or products.
#11 Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization
https://www.mdpi.com/2077-0383/10/16/3503
We carried out a retrospective analysis of infertile couple data using several methodologies and data analysis techniques, including the application of a novel data mining approach for analyzing varicocele treatment outcomes. […] Following this study, we can predict that a male patient without a high varicocele severity grade (with grade I or II) has a 70.83% chance of conceiving after embolization treatment if his partnersâ age is between 24 and 33 with an accuracy of 70.59%. […] Varicocele embolization success, defined as whether the manâs partner got pregnant, was able to be predicted with an accuracy of 70.59% by stating that a male patient without a high varicocele severity grade (with grade I or II) has a 70.83% chance (i.e., (17/(7 + 17) = 70.83%) of conceiving after the embolization treatment if his partner is between the ages of 24 and 33 years old inclusively.
#12 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#13 Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization
https://www.mdpi.com/2077-0383/10/16/3503
The combined use of statistical and data mining techniques can contribute towards finding patterns associated with varicocele, since several parameters may be influencing the success of its treatment and thus muddle analyses. […] We were able to identify interesting data patterns with different algorithms (k-means and FP-growth), which suggests that the success of varicocele embolization, evaluated through the achievement of a pregnancy/live birth, is positively influenced by the presence of a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, a young male patient age, and a male patient occupation that does not involve contact with putatively toxic environments or products.
#14 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#15 Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization
https://www.mdpi.com/2077-0383/10/16/3503
The combined use of statistical and data mining techniques can contribute towards finding patterns associated with varicocele, since several parameters may be influencing the success of its treatment and thus muddle analyses. […] We were able to identify interesting data patterns with different algorithms (k-means and FP-growth), which suggests that the success of varicocele embolization, evaluated through the achievement of a pregnancy/live birth, is positively influenced by the presence of a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, a young male patient age, and a male patient occupation that does not involve contact with putatively toxic environments or products.
#16 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
The influence of varicocele and microsurgical varicocelectomy on semen quality remains unclear. […] Here, we used the non-targeted and targeted metabolic analysis to investigate the different metabolites in seminal plasma within normal, varicocele, and varicocelectomy groups. We clearly showed that varicocele significantly affects semen metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] Our results may be applied to earlier diagnosis or to predict the outcome of microsurgery for varicocele. […] However, although varicocelectomy can improve sperm quality and clinical outcomes, the precise mechanisms that underlie these effects have yet to be elucidated. Furthermore, the outcome of microsurgical treatment cannot be predicted effectively and despite the application of microsurgery, approximately 30% to 40% of patients show no improvements in their sperm parameters.
#17 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
Our results clearly show that varicocele significantly affects sperm metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] We also identified that certain dipeptides existed in the metabolites of seminal plasma in patient with varicocele; a reduction in the levels of these dipeptides may contribute to the improvement of semen quality after microsurgery. […] 8 metabolites and 3 dipeptides were identified to be potential biomarkers for varicocele. […] We believe that the dipeptide in the semen of patients with varicocele may be a biomarker of varicocele, However, whether it can be applied to early diagnosis or prediction of surgical effect is still under investigation.
#18 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
Our results clearly show that varicocele significantly affects sperm metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] We also identified that certain dipeptides existed in the metabolites of seminal plasma in patient with varicocele; a reduction in the levels of these dipeptides may contribute to the improvement of semen quality after microsurgery. […] 8 metabolites and 3 dipeptides were identified to be potential biomarkers for varicocele. […] We believe that the dipeptide in the semen of patients with varicocele may be a biomarker of varicocele, However, whether it can be applied to early diagnosis or prediction of surgical effect is still under investigation.
#19 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
Our results clearly show that varicocele significantly affects sperm metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] We also identified that certain dipeptides existed in the metabolites of seminal plasma in patient with varicocele; a reduction in the levels of these dipeptides may contribute to the improvement of semen quality after microsurgery. […] 8 metabolites and 3 dipeptides were identified to be potential biomarkers for varicocele. […] We believe that the dipeptide in the semen of patients with varicocele may be a biomarker of varicocele, However, whether it can be applied to early diagnosis or prediction of surgical effect is still under investigation.
#20 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
Our results clearly show that varicocele significantly affects sperm metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] We also identified that certain dipeptides existed in the metabolites of seminal plasma in patient with varicocele; a reduction in the levels of these dipeptides may contribute to the improvement of semen quality after microsurgery. […] 8 metabolites and 3 dipeptides were identified to be potential biomarkers for varicocele. […] We believe that the dipeptide in the semen of patients with varicocele may be a biomarker of varicocele, However, whether it can be applied to early diagnosis or prediction of surgical effect is still under investigation.
#21 SciELO Brazil – What does a varicocele do to a man’s fertility? There is much more than meets the eye What does a varicocele do to a man’s fertility? There is much more than meets the eye
https://www.scielo.br/j/ibju/a/Z48FvD7tXN3rBCWkBzW8gxy/
Varicoceles are so common in infertile men they are believed to be a leading cause of male infertility. Up to 40% of men with primary infertility have varicoceles, and this figure increases to a staggering 80% of men with secondary infertility. […] The benefits of varicocele repair on improving the chance of either natural conception or successful ART are still sufficiently controversial to prevent its routine inclusion in fertility clinics. […] According to the guidelines above, varicocele repair should be offered as part of the treatment option for all male partners of infertile couples presenting with palpable varicoceles and sperm DNA damage, regardless of the conventional semen analysis results. […] The study by Jeremias and co-workers provides further evidence supporting the adverse impact of varicocele on sperm DNA of normozoospermic men, and the need for including sperm DNA fragmentation testing in the routine evaluation of men with varicocele seeking fertility.
#22 SciELO Brazil – What does a varicocele do to a man’s fertility? There is much more than meets the eye What does a varicocele do to a man’s fertility? There is much more than meets the eye
https://www.scielo.br/j/ibju/a/Z48FvD7tXN3rBCWkBzW8gxy/
Varicoceles are so common in infertile men they are believed to be a leading cause of male infertility. Up to 40% of men with primary infertility have varicoceles, and this figure increases to a staggering 80% of men with secondary infertility. […] The benefits of varicocele repair on improving the chance of either natural conception or successful ART are still sufficiently controversial to prevent its routine inclusion in fertility clinics. […] According to the guidelines above, varicocele repair should be offered as part of the treatment option for all male partners of infertile couples presenting with palpable varicoceles and sperm DNA damage, regardless of the conventional semen analysis results. […] The study by Jeremias and co-workers provides further evidence supporting the adverse impact of varicocele on sperm DNA of normozoospermic men, and the need for including sperm DNA fragmentation testing in the routine evaluation of men with varicocele seeking fertility.
#23 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.210202
Among studies reporting the impact of varicocele and its treatment on outcomes, semen parameters are the most covered outcomes being mentioned in 915 articles. […] The second most reported outcome has been vasculature and blood flow, being addressed in 314 articles. […] The interest in seminal oxidative stress is comparable to the interest in sperm DNA damage or sperm DNA fragmentation, reported in 98 and 92 publications, respectively. […] The interest in both seminal oxidative stress and sperm DNA fragmentation in varicocele publications has increased over time. […] Our results suggest that although some aspects of varicocele are well studied, there are still many facets of varicocele and male infertility that have not been fully elucidated and therefore require greater attention.
#24 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
The influence of varicocele and microsurgical varicocelectomy on semen quality remains unclear. […] Here, we used the non-targeted and targeted metabolic analysis to investigate the different metabolites in seminal plasma within normal, varicocele, and varicocelectomy groups. We clearly showed that varicocele significantly affects semen metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] Our results may be applied to earlier diagnosis or to predict the outcome of microsurgery for varicocele. […] However, although varicocelectomy can improve sperm quality and clinical outcomes, the precise mechanisms that underlie these effects have yet to be elucidated. Furthermore, the outcome of microsurgical treatment cannot be predicted effectively and despite the application of microsurgery, approximately 30% to 40% of patients show no improvements in their sperm parameters.
#25 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
The influence of varicocele and microsurgical varicocelectomy on semen quality remains unclear. […] Here, we used the non-targeted and targeted metabolic analysis to investigate the different metabolites in seminal plasma within normal, varicocele, and varicocelectomy groups. We clearly showed that varicocele significantly affects semen metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] Our results may be applied to earlier diagnosis or to predict the outcome of microsurgery for varicocele. […] However, although varicocelectomy can improve sperm quality and clinical outcomes, the precise mechanisms that underlie these effects have yet to be elucidated. Furthermore, the outcome of microsurgical treatment cannot be predicted effectively and despite the application of microsurgery, approximately 30% to 40% of patients show no improvements in their sperm parameters.
#26 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#27 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
The influence of varicocele and microsurgical varicocelectomy on semen quality remains unclear. […] Here, we used the non-targeted and targeted metabolic analysis to investigate the different metabolites in seminal plasma within normal, varicocele, and varicocelectomy groups. We clearly showed that varicocele significantly affects semen metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] Our results may be applied to earlier diagnosis or to predict the outcome of microsurgery for varicocele. […] However, although varicocelectomy can improve sperm quality and clinical outcomes, the precise mechanisms that underlie these effects have yet to be elucidated. Furthermore, the outcome of microsurgical treatment cannot be predicted effectively and despite the application of microsurgery, approximately 30% to 40% of patients show no improvements in their sperm parameters.
#28 Effects of varicocele and microsurgical varicocelectomy on the metabolites in semen | Scientific Reports
https://www.nature.com/articles/s41598-022-08954-y
Our results clearly show that varicocele significantly affects sperm metabolism, and microsurgical varicocelectomy can reverse this metabolic abnormality. […] We also identified that certain dipeptides existed in the metabolites of seminal plasma in patient with varicocele; a reduction in the levels of these dipeptides may contribute to the improvement of semen quality after microsurgery. […] 8 metabolites and 3 dipeptides were identified to be potential biomarkers for varicocele. […] We believe that the dipeptide in the semen of patients with varicocele may be a biomarker of varicocele, However, whether it can be applied to early diagnosis or prediction of surgical effect is still under investigation.
#29 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#30 Varicocele: Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/15239-varicocele
Varicoceles can affect fertility. Varicoceles can contribute to about 40% of all cases of male infertility. However, many people with varicoceles have no problems achieving pregnancy. […] Many people with varicoceles have no symptoms at all. Some people who have varicoceles have fertility issues. If you have concerns about your ability to have a biological child, talk to a healthcare provider. Theyll help you understand your options. […] A varicocelectomy can repair a varicocele and sometimes improve your fertility.
#31 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.210202
If, according to the guidelines of the American Urological Association (AUA)/American Society for Reproductive Medicine (ASRM) and European Association of Urology (EAU), infertility with altered sperm parameters is an indication for varicocele repair, it is difficult to predict which patient will have an improvement in sperm parameters compared to another. Similarly, it is still difficult to predict spontaneous fertility and reproductive outcomes after varicocele repair. […] Results indicate that the most reported area was on the prediction of clinical outcomes, followed by the indication of surgical or medical treatment in varicoceles and the post-operative recurrence, whereas biochemical markers were reported less frequently. […] Surgical approaches were well studied, while the non-surgical approaches for varicocele analyzed included pharmaceutical treatment, treatment with antioxidants as well as radiological and complementary approaches.
#32 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#33 SciELO Brazil – What does a varicocele do to a man’s fertility? There is much more than meets the eye What does a varicocele do to a man’s fertility? There is much more than meets the eye
https://www.scielo.br/j/ibju/a/Z48FvD7tXN3rBCWkBzW8gxy/
Varicoceles are so common in infertile men they are believed to be a leading cause of male infertility. Up to 40% of men with primary infertility have varicoceles, and this figure increases to a staggering 80% of men with secondary infertility. […] The benefits of varicocele repair on improving the chance of either natural conception or successful ART are still sufficiently controversial to prevent its routine inclusion in fertility clinics. […] According to the guidelines above, varicocele repair should be offered as part of the treatment option for all male partners of infertile couples presenting with palpable varicoceles and sperm DNA damage, regardless of the conventional semen analysis results. […] The study by Jeremias and co-workers provides further evidence supporting the adverse impact of varicocele on sperm DNA of normozoospermic men, and the need for including sperm DNA fragmentation testing in the routine evaluation of men with varicocele seeking fertility.
#34 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#35 Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization
https://www.mdpi.com/2077-0383/10/16/3503
The combined use of statistical and data mining techniques can contribute towards finding patterns associated with varicocele, since several parameters may be influencing the success of its treatment and thus muddle analyses. […] We were able to identify interesting data patterns with different algorithms (k-means and FP-growth), which suggests that the success of varicocele embolization, evaluated through the achievement of a pregnancy/live birth, is positively influenced by the presence of a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, a young male patient age, and a male patient occupation that does not involve contact with putatively toxic environments or products.
#36 Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization
https://www.mdpi.com/2077-0383/10/16/3503
The combined use of statistical and data mining techniques can contribute towards finding patterns associated with varicocele, since several parameters may be influencing the success of its treatment and thus muddle analyses. […] We were able to identify interesting data patterns with different algorithms (k-means and FP-growth), which suggests that the success of varicocele embolization, evaluated through the achievement of a pregnancy/live birth, is positively influenced by the presence of a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, a young male patient age, and a male patient occupation that does not involve contact with putatively toxic environments or products.
#37 Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults – PubMed
https://pubmed.ncbi.nlm.nih.gov/26732108/
The effect of varicocele repair on male fertility remains controversial. […] A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. […] We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. […] The greatest improvements in semen parameters were found in men with larger varicoceles. […] While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. […] A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man. […] With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. […] In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.
#38 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.210202
This study provides a comprehensive analysis of research trends on the etiology, mechanisms, potential risk factors, diagnosis, prognosis, surgical and non-surgical treatment of varicocele, and clinical outcomes before and after varicocele repair. […] Studies on diagnostic and prognostic aspects of varicocele were more numerous than studies on varicocele prevalence, mechanistic studies and studies focusing on etiological and risk factors. […] To evaluate the impact of varicocele and its treatment, researchers mainly analyzed basic semen parameters, although markers of seminal oxidative stress are being increasingly investigated in the last decade, while reproductive outcomes such as live birth rate were under-reported in the literature. […] It has been estimated that up to 45% of all males with clinical varicocele have normal semen parameters, and approximately 80% of men with varicocele are fertile. Thus, despite advances in the understanding of the mechanisms involved in the pathophysiology of varicocele, it remains difficult to predict clinically which varicocele will be associated with an impairment of sperm parameters and fertility.
#39 SciELO Brazil – What does a varicocele do to a man’s fertility? There is much more than meets the eye What does a varicocele do to a man’s fertility? There is much more than meets the eye
https://www.scielo.br/j/ibju/a/Z48FvD7tXN3rBCWkBzW8gxy/
Varicoceles are so common in infertile men they are believed to be a leading cause of male infertility. Up to 40% of men with primary infertility have varicoceles, and this figure increases to a staggering 80% of men with secondary infertility. […] The benefits of varicocele repair on improving the chance of either natural conception or successful ART are still sufficiently controversial to prevent its routine inclusion in fertility clinics. […] According to the guidelines above, varicocele repair should be offered as part of the treatment option for all male partners of infertile couples presenting with palpable varicoceles and sperm DNA damage, regardless of the conventional semen analysis results. […] The study by Jeremias and co-workers provides further evidence supporting the adverse impact of varicocele on sperm DNA of normozoospermic men, and the need for including sperm DNA fragmentation testing in the routine evaluation of men with varicocele seeking fertility.