Hudson R W
Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
Fertil Steril. 1988 Feb;49(2):199-208. doi: 10.1016/s0015-0282(16)59700-3.
There is good evidence of an associated abnormality in testicular hormone production and spermatogenesis in some men with varicoceles. This abnormality can be demonstrated with dynamic tests of the hypothalamic-pituitary-testicular axis and by measuring seminal plasma androgen levels. A high proportion of oligozoospermic men who have abnormal hormone profiles will respond favorably to correction of their varicosities. Several oligozoospermic men with varicoceles have normal hormonal profiles. To date, in our unit, none of these men has had an improvement in seminal characteristics after varicocelectomy. This result would suggest that these men have incidental varicoceles. It is not clear what the testicular defect is leading to abnormal spermatogenesis in these men. Clearly, more studies are required in this group of men and in the men with sperm densities greater than 30 X 10(6)/ml, the majority of whom have normal responses to GnRH infusion. More information is needed regarding the intratesticular control of hormone production and spermatogenesis. As our knowledge of the paracrine system within the testis increases, so should our understanding of the mechanisms involved in the association of varicoceles and infertility.
有充分证据表明，一些患有精索静脉曲张的男性存在睾丸激素生成和精子发生方面的相关异常。这种异常可通过下丘脑 - 垂体 - 睾丸轴的动态测试以及测量精浆雄激素水平来证实。很大一部分激素水平异常的少精子症男性在精索静脉曲张得到纠正后会有良好反应。有几位患有精索静脉曲张的少精子症男性激素水平正常。到目前为止，在我们科室，这些男性在精索静脉结扎术后精液特征均未得到改善。这一结果表明这些男性患有偶然性精索静脉曲张。尚不清楚导致这些男性精子发生异常的睾丸缺陷是什么。显然，对于这组男性以及精子密度大于30×10⁶/ml的男性（其中大多数对GnRH输注反应正常），需要进行更多研究。关于睾丸内激素生成和精子发生的控制，还需要更多信息。随着我们对睾丸内旁分泌系统认识的增加，我们对精索静脉曲张与不育症关联机制的理解也应加深。
