الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Varicocele is the most common identifiable cause of male infertility, found in approximately 35% of men with primary infertility and 80% of men with secondary infertility.
The exact mechanism of impaired testicular function in patients with varicocele is not yet known. A number of theories have been proposed to explain the observed pathophysiology of varicocele including; hyperthermia, reflux of renal and adrenal metabolites, hormonal dysfunction, hypoxia, abnormal blood flow, antisperm antibodies and genetic defects.
Although some controversy remains, new studies on the testicular tissues of men with varicoceles pointed towards the role of ROS and apoptosis stimulation in varicocele-associated infertility.
In the current study we tried to study the role of apoptosis and reactive oxygen species in spermatogenic dysfunction in infertile men with varicocele.
In the present study, twenty five infertile azoospermic or severe oligospermic male patients were included, 15 patients with varicocele as the sole cause of infertility and 10 obstructive azoospermic patients. The 10 obstructive azoospermic patients served as controls. All patients were selected from the Andrology outpatient clinic of the Alexandria Main University Hospital. For each patient, the following was done after taking a written informed consent: history taking, both general and local genital examination with special attention to the testicular volume, grade of varicocele, semen analyses on atleast two different occasions. Morning urine analyses to exclude the presence of infection. Determination of serum FSH levels was done.
Testicular biopsies were obtained, and testicular tissue MDA levels determined by photocolorimetry, and caspase 3 level estimated by ELISA.
The following points were observed:
- Of the patients group, 33.3% had unilateral varicocele and 66.7% had bilateral varicocele. Four patients (26.7%) had grade I varicocele, 7 patients (46.6%) with grade II varicocele, and 4 patients (26.7%) with grade III varicocele.
- Serum FSH was normal in 73.3% of patients and elevated in 26.11% of patients.
- The mean left testicular MDA was 107.35±35.42 nmol/gram tissue, mean right testicular MDA was 108.07±34.85 nmol/gram tissue. A statistically significant elevation of testicular MDA was demonstrated in the testicular tissue of infertile men with varicocele.
- The mean left testicular caspase-3 levels was 6.18±3.44 ng/mg protein with a mean right testicular value of 6.25±3.17 ng/mg protein. A statistically significant elevation of testicular caspase-3 level was demonstrated in the testicular tissue of infertile partients with varicocele.
- No correlation was found between testicular tissue MDA and the age of the patients. Similarly, no correlation was found between testicular tissue caspase 3 level and the age of the patients.
- Increased testicular tissue MDA levels correlated with the varicocele grade and not the testicular size.
- Increasing varicocele grade was significantly associated with higher caspase-3 levels.
- No correlation was found between the testicular tissue caspase-3 levels and testicular volume.
- Testicular tissue caspase-3 levels was significantly correlated with MDA levels within patients group. Testicular biopsy caspase-3 and MDA were not significantly correlated within the controls.