Lewis Sheena E M
Centre for Public Health, Queens University Belfast and CEO Examenlab Ltd, Belfast, UK.
Reprod Biomed Online. 2022 Dec;45(6):1061-1063. doi: 10.1016/j.rbmo.2022.07.004. Epub 2022 Jul 14.
Varicocele is one of the most common, yet treatable, causes of male infertility. Varicoceles are present in more than 40% of infertile men with primary infertility, a figure that increases with age. Varicoceles impair semen parameters and sperm DNA and are linked with lower pregnancy and live birth rates. Until recently, men had seldom been examined in male fertility workups. This is changing as urologists have become recognized as team members in infertility. Hence identification and treatment are available as never before. Furthermore, as men become aware that they are as likely as their female partners to be infertile, they want equal 'couple care', requesting urological referrals as they realize that they can improve their semen quality and chances of fatherhood without or before fertility treatment. There is now a greater understanding of the mechanisms of varicocele-induced damage by oxidative stress, using sperm DNA as a sensitive biomarker of sperm quality. There is a current consensus that varicocele is linked to poor semen and repair improves semen and sperm DNA quality. Evidence is strengthening to indicate that varicocele repair increases pregnancy and live birth rates in natural conception and following fertility treatment.
精索静脉曲张是男性不育最常见但可治疗的原因之一。在原发性不育的男性中，超过40%存在精索静脉曲张，这一比例随年龄增长而增加。精索静脉曲张会损害精液参数和精子DNA，并与较低的妊娠率和活产率相关。直到最近，男性在男性生育检查中很少接受检查。随着泌尿科医生被认可为不孕症治疗团队的成员，这种情况正在改变。因此，现在比以往任何时候都更容易进行识别和治疗。此外，随着男性意识到他们与女性伴侣一样有可能不育，他们希望得到平等的“夫妻护理”，当他们意识到在没有进行生育治疗或在生育治疗之前可以改善精液质量和生育几率时，会要求转诊至泌尿科。目前，人们对氧化应激导致精索静脉曲张损伤的机制有了更深入的了解，将精子DNA作为精子质量的敏感生物标志物。目前的共识是，精索静脉曲张与精液质量差有关，修复可改善精液和精子DNA质量。越来越多的证据表明，精索静脉曲张修复术可提高自然受孕和生育治疗后的妊娠率和活产率。
