Varicocele repair works by reducing oxidant stress

Houston-Results of a study of infertile men before and after varicocele repair supports the hypothesis that this operation may help to restore fertility by reducing oxidant stress, said researchers from the Baylor College of Medicine, Houston.

The retrospective study identified 64 infertile men who had undergone varicocele repair from 2001 to 2007 and who had data on reactive oxygen species (ROS) activity levels in semen measured pre- and postoperatively. Median ROS activity measured 2 months prior to varicocele repair was 3.65, and it decreased significantly to 2.00 at 6 months after surgery, first author Mohit Khera, MD, assistant professor of urology at Baylor, told attendees at the AUA annual meeting in Orlando, FL.

"A varicocele is the leading cause of infertility in the world. Oxidative stress, which can cause sperm dysfunction through various pathways, has been proposed as an underlying mechanism for this association," said Dr. Khera, who worked on the study with Larry Lipshultz, MD, and colleagues.

Levels of ROS activity in semen in the varicocele patients also were compared to levels in semen of 2,224 infertile men without a varicocele and 17 men who became fertile after vasectomy reversal. These analyses showed statistically significant differences among the three groups. Mean ROS activity was 2.0 in the infertile patients without a varicocele and 1.3 in the vasectomy reversal group.

"Our study results show that varicocele repair can reduce ROS activity in semen to a level comparable to that found in other infertile patients, but not to the level of fertile men," Dr. Khera said.

At the Baylor College of Medicine fertility clinic, antioxidant treatment, including vitamin C, vitamin E, and celecoxib (Celebrex), is prescribed to infertile men with elevated ROS activity.

"Anecdotal experience from our large infertility practice indicates antioxidants are beneficial in reducing ROS activity in seminal fluid, and we have measured significant reductions after just 1 month. Now it would be interesting to investigate the effects of combined oral treatment with surgical repair on ROS activity in seminal fluid and to correlate the changes with pregnancy rates," Dr. Khera said.