Gorelick J I, Goldstein M
Department of Urology, New York Hospital-Cornell Medical Center, New York 10021.
Fertil Steril. 1993 Mar;59(3):613-6.
To test the hypothesis that men with varicocele who have already fathered children are immune to the detrimental effect of varicocele on their fertility and will continue to be fertile. If this were the case, one would expect a very low incidence of varicocele in currently infertile men who were able to father a child in the past (secondary infertility) compared with men who have never been fertile (primary infertility).
Survey of men with male factor infertility.
Tertiary care university medical center.
One thousand ninety-nine infertile men of whom 98 (9%) met our criteria for secondary infertility. Men with prior vasectomy and men whose partners were over age 40 were excluded.
Difference in the incidence of varicocele in men with secondary infertility versus primary infertility.
A varicocele was palpable in 35% (352/1,001) of men with primary infertility and 81% (79/98) of men with secondary infertility. This difference in the incidence of varicocele was highly significant. Men with secondary infertility and varicocele were slightly older (37.9 versus 33.5 years), had a lower mean sperm concentration (30.2 versus 46.1 x 10(6)/mL), more abnormally shaped sperm (72% versus 40%), and higher mean serum follicle-stimulating hormone levels (17.6 versus 7.9 mIU/mL,) compared with men with primary infertility and varicocele.
The incidence of varicocele is much higher in male factor secondary infertility compared with primary infertility. These findings suggest that varicocele causes a progressive decline in fertility and that prior fertility in men with varicocele does not predict resistance to varicocele induced impairment of spermatogenesis. Men with a varicocele may benefit from early evaluation and prophylactic varicocelectomy to prevent future infertility.
检验如下假设：已育有子女的精索静脉曲张男性对精索静脉曲张对其生育能力的有害影响具有免疫力，并将继续保持生育能力。如果情况确实如此，那么与从未生育过的男性（原发性不育）相比，人们会预期在过去能够生育子女但目前不育的男性（继发性不育）中精索静脉曲张的发病率非常低。
对男性因素不育的男性进行调查。
三级护理大学医学中心。
1099名不育男性，其中98名（9%）符合我们继发性不育的标准。排除既往有输精管切除术的男性以及其伴侣年龄超过40岁的男性。
继发性不育男性与原发性不育男性精索静脉曲张发病率的差异。
原发性不育男性中有35%（352/1001）可触及精索静脉曲张，继发性不育男性中有81%（79/98）可触及精索静脉曲张。精索静脉曲张发病率的这种差异具有高度显著性。与患有精索静脉曲张的原发性不育男性相比，患有精索静脉曲张的继发性不育男性年龄稍大（37.9岁对33.5岁），平均精子浓度较低（30.2对46.1×10⁶/mL），畸形精子更多（72%对40%），平均血清促卵泡生成素水平更高（17.6对7.9 mIU/mL）。
与原发性不育相比，男性因素继发性不育中精索静脉曲张的发病率要高得多。这些发现表明，精索静脉曲张会导致生育能力逐渐下降，并且患有精索静脉曲张的男性既往的生育能力并不能预测其对精索静脉曲张所致精子发生损害的抵抗力。患有精索静脉曲张的男性可能会从早期评估和预防性精索静脉结扎术中受益，以预防未来的不育。
