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PubMedDate not supplied

Effect of body weight on sperm concentration in normozoospermic males.

A total of 274 men (aged: 26 +/- 4.9 years) with normozoospermia were enrolled into this study. Their body mass index (BMI: kg/m2) varied between 17 and 39. According to BMI, the patients were divided into four groups: Group 1: 17-20, Group 2: 20.1-25, Group 3: 25.1-30 and Group 4: 30.1-39. Twenty-nine subjects were found in the first, 96 in the second, 91 in the third and 58 men in the fourth group. Sperm concentration was significantly lower in the obese group (29 x 10(6)/ml, p < 0.05) than in the group of BMI 17-20, 20-25 and 25-30. In advance, in the obese group, sperm count continuously decreased with aging. We conclude that obesity is associated with a lower sperm count in case of normozoospermia.

Adolescent↗

PubMed2003

Social class and semen analysis.

It has often been postulated that certain occupations may be hazardous to semen counts, but there are many conflicting views, with others finding either no differences in sperm count or only subtle differences in semen variables. We studied the effect of occupation (in relation to social class) on 207 men attending the fertility clinic of a district general hospital. In our own population azoospermic men were more likely to be of social class 3 m (3 semi-skilled manual) and below. Men who failed to provide a sample were more likely to be of social class 3 m. There was no statistical occupation difference in men whose sperm counts were normal or low. It may not be occupation alone, but also lifestyle differences between social classes which affect semen parameters.

Adult↗

PubMed1995

Effects of testosterone buciclate on testicular and epididymal sperm functions in bonnet monkeys (Macaca radiata)

The effects of testosterone buciclate (TB), a long-acting androgen ester given i.m. at four sites (20 mg/site) on days 1 and 91 of the study period (360 days), on reproductive and hormonal parameters were evaluated in five adult male bonnet monkeys; untreated animals (n = 5) acted as controls to monitor seasonal changes in these parameters. In control animals, testicular volume remained unchanged throughout the study; sperm count, motility and gel penetrability decreased while the percentage of spermatozoa showing retention of cytoplasmic droplet and coiled tail increased in June-July (days 210-240), preceded by reduction in serum testosterone (T) levels on days 120-150 (March-April). The TB-treated animals showed reduced testicular volume (days 90-270), suppressed sperm motility and gel penetrability (days 45-240 except on day 120), decreased sperm count (days 75-270), and an increased percentage of spermatozoa showing retention of cytoplasmic droplet and coiled tail (days 45-240 except on day 120). Even though serum T levels remained elevated until day 300, these levels were within the physiological range. The changes induced by TB were reversible. The suppression of testicular and epididymal functions by TB indicates that this long-acting androgen may have the potentiality to induce and maintain reversible sterility, but further evaluation needs to be carried out to develop an appropriate dosage regimen that would prevent return to normal functions in order to develop this long-acting androgen as a hormonal male contraceptive.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2006

Alleviation of pre-exposure of mouse brain with low-dose 12C6+ ion or 60Co gamma-ray on male reproductive endocrine damages induced by subsequent high-dose irradiation.

Irradiation has been widely reported to damage organisms by attacking on proteins, nucleic acid and lipids in cells. However, radiation hormesis after low-dose irradiation has become the focus of research in radiobiology in recent years. To investigate the effects of pre-exposure of mouse brain with low-dose (12)C6+ ion or 60Co gamma (gamma)-ray on male reproductive endocrine capacity induced by subsequent high-dose irradiation, the brains of the B6C3F1 hybrid strain male mice were irradiated with 0.05 Gy of (12)C6+ ion or 60Co gamma-ray as the pre-exposure dose, and were then irradiated with 2 Gy as challenging irradiation dose at 4 h after pre-exposure. Serum pituitary gonadotropin hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), testosterone, testis weight, sperm count and shape were measured on the 35th day after irradiation. The results showed that there was a significant reduction in the levels of serum FSH, LH, testosterone, testis weight and sperm count, and a significant increase in sperm abnormalities by irradiation of the mouse brain with 2 Gy of (12)C6+ ion or 60Co gamma-ray. Moreover, the effects were more obvious in the group irradiated by (12)C6+ ion than in that irradiated by 60Co gamma-ray. Pre-exposure with low-dose (12)C6+ ion or 60Co gamma-ray significantly alleviated the harmful effects induced by a subsequent high-dose irradiation.

Animals↗

PubMedDate not supplied

Seminal plasma fructose and glucose in normal and pathological conditions.

A total number of ninety four semen samples were analysed which included normozoospermia (39), oligozoospermia (6), oligoasthenozoospermia (10), asthenozoospermia (15) and azoospermia (24). A positive correlation (r = 0.344) was existing between sperm count and motility in normozoospermia. Seminal plasma was estimated for fructose (94) and glucose (73). It was found that there was a statistical difference between the values of oligozoospermia and all other groups studied for fructose. A strong positive correlation (r = 0.394) was existing between percentage of motility of spermatozoa and fructose in normozoospermia showing that fructose is very essential for increased number of motile spermatozoa. Likewise a relationship (r = 0.451) was seen between sperm count and glucose in normal. This gives an impression that both these are regulated by one source.

Adolescent↗

PubMed1982

The effect of levonorgestrel and estrone rods on male reproductive function.

The effect on spermatogenesis of the implantation of six rods containing levonorgestrel and three estrone rods was studied in seven volunteers aged 32-40, with normal pre-treatment spermiogram. None of the subjects achieved azoospermia. The lowest sperm count was below 1 million/ml in three subjects and below 12 million/ml in the other four. Plasma FSH and testosterone were severely depressed during the study, but LH was only transiently depressed for the first two months. Four subjects recovered pre-treatment sperm counts in spite of the FSH levels below 1.5 mIU/ml and testosterone levels below 1 ng/ml, which is contradictory to the current concept on hormonal regulation of spermatogenesis.

Adult↗

PubMed2005

[Analysis of Yq microdeletions in idiopathic infertile males with azoospermia and oligospermia in Shaanxi Province].

OBJECTIVE: To evaluate the frequency of microdeletions in the long arm of Y chromosome of idiopathic infertile males with azoospermia and oligospermia in Shaanxi province in China and to investigate the relevance of sperm count to Y microdeletion frequencies. METHODS: According to the sequence of sequence-tagged sits (STS) AZFa, AZFb, AZFc and SRY, 4 of the azoospermic factor regions on Y chromosome long-term supplied by GenBank, 5 sets of primers were synthesized. The Y microdeletions in AZF regions were screened by polymerase chain reaction (PCR) in 64 idiopathic cases of azoospermia and oligospermia and 20 men of known fertility. RESULTS: No microdeletion was detected in the 20 normospermic subjects. Deletion of the AZFc/DAZ was detected in 11 individuals and one patient had both AZFb and AZFc deletion; no deletion of AZFa and SRY region was found. The frequency of Y microdeletions in the subgroups with different sperm count showed the highest value among azoospermic men (3 cases, 21.4%). The percentage progressively decreased with the deletion frequency (20.0%, 17.9% and 8.3%) in the subgroups with sperm counts of < 1 x 10(6)/ml, < (1-5) x 10(6)/ml and < (1 to approximately 10) x 10(6)/ml, respectively. CONCLUSION: Y chromosome microdeletions are specifically associated with severe spermatogenic failure. The rate of deletion involving AZF region of the Y-chromosome is higher in infertile men with azoospermia and oligospermia. PCR amplification of AZF locus is useful for the diagnosis of microdeletions in the Y-chromosome.

Adult↗

PubMed1999

Antioxidant treatment of patients with asthenozoospermia or moderate oligoasthenozoospermia with high-dose vitamin C and vitamin E: a randomized, placebo-controlled, double-blind study.

In a randomized, placebo-controlled, double-blind study we investigated whether high-dose oral treatment with vitamins C and E for 56 days was able to improve semen parameters of infertile men. Ejaculate parameters included semen volume, sperm concentration and motility, and sperm count and viability. Thirty-one patients without genital infection but with asthenozoospermia (< 50% motile spermatozoa) and normal or only moderately reduced sperm concentration (> 7 x 10(6) spermatozoa/ml) (according to WHO criteria) were examined. To investigate the influence of the epididymal storage period on semen parameters, the patients were asked to deliver two semen samples with abstinence times of 2 and 7 days both before and at the end of vitamin treatment. After randomization, the patients received either 1000 mg vitamin C and 800 mg vitamin E (n = 15) or identical placebo capsules (n = 16). No changes in semen parameters were observed during treatment, and no pregnancies were initiated during the treatment period. Combined high-dose antioxidative treatment with vitamins C and E did not improve conventional semen parameters or the 24-h sperm survival rate. Prolonged abstinence time increased ejaculate volume (P < 0.05), sperm count (P < 0.05), sperm concentration (P < 0.05) and the total number of motile spermatozoa (P < 0.05).

Administration, Oral↗

PubMed1992

Leukocytospermia and function of the seminal vesicles on seminal quality.

OBJECTIVE: To determine possible relationships between number of leukocytes, function of seminal vesicles, and seminal quality. DESIGN: The study was carried out on men who consecutively attended an infertility clinic between June 1989 to June 1991. SETTING: This study was conducted in a private immunological center for infertility, a tertiary care center, The Centro Immunológico-Sección Esterilidad y Reproducción. PATIENTS: Semen samples from 280 infertility patients attending an Immunological Center for Infertility were analyzed. MAIN OUTCOME MEASURE: We evaluated the effect of leukocytospermia in the presence of normal or abnormal function of seminal vesicles on seminal quality. RESULTS: Sperm count, percent of motile sperm, and percent of sperm vitality were significantly reduced when both leukocytospermia and hypofunction of seminal vesicles were present (P less than 0.01). Leukocytospermic subjects with normal function of seminal vesicles showed similar seminal parameters to those nonleukocytspermics. The incidence of subjects with antisperm antibodies measured by direct immunobeads was significantly higher in leukocytospermic men with hypofunction of seminal vesicles. No differences in the incidence of antisperm antibodies with nonleukocytospermic samples were observed in those with both leukocytospermia and normal function of seminal vesicles. CONCLUSIONS: These data provide evidence that white blood cells were deleterious for seminal quality when seminal vesicles were also affected.

Acid Phosphatase↗

PubMed1987

Effects of cryopreservation on the motility characteristics of human spermatozoa.

Ejaculates (164) were obtained from 17 donors serving on an artificial insemination by donor panel. Semen analysis was performed before and after freezing by an integrated microcomputerized system employing the multiple-exposure photography (MEP) method. Sperm count, motility, velocity, motility index (MI; product of the sperm velocity and percentage of motile spermatozoa) and motile density (MD) were determined for each ejaculate. After the initial evaluation the ejaculates were frozen in liquid nitrogen, thawed 24 h later, and assessed for post-thaw motility, velocity, MI and MD. The mean +/- s.e. sperm count and volume for this group of donors was 148 +/- 4 x 10(6)/ml and 3.1 +/- 0.1 ml, respectively. Mean +/- s.e. values obtained from the prefreeze analysis were: motility = 64 +/- 1%, velocity = 30 +/- 0.4 microns/sec, MI = 19 +/- 0.5 microns/sec and MD = 94 +/- 3 x 10(6)/ml. Post-thaw analysis revealed a significant reduction (P less than 0.01) in all values measured. Motility was reduced to 27 +/- 1%, MI was reduced to 5 +/- 0.3 microns/sec, and MD was reduced to 33 +/- 1 x 10(6)/ml. Velocity was the least affected by cryopreservation, being reduced to 21 +/- 0.5 microns/sec (P less than 0.01). Cryopreservation resulted in a marked shift in the frequency distribution of sperm motility and motility index towards subnormal values while in the majority of ejaculates velocity and motile density were maintained in the normal range. Significant differences were noted amongst donors in the percentage change of the various semen measures as a result of cryopreservation. When within-subject coefficients of variation were calculated, velocity was the least variable parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Count↗

PubMed2006

Seminal plasma zinc concentration and alpha-glucosidase activity with respect to semen quality.

This study was conducted to examine the relationship between the concentration of zinc and neutral alpha-glucosidase (NAG) with semen quality. Semen samples from 75 male partners of couples who were attending the Obstetrics and Gynecology Department were analyzed for semen quality. Based on sperm count, the subjects were divided into three groups. Zinc and neutral alpha-glucosidase activity were estimated in seminal plasma. Results showed that mean the alpha-glucosidase activity was lowest among the azoospermic group with respect to oligozoospermic and normozoospermic groups. Mean zinc levels were also lower among azoospermics compared to oligozoospermic and normospermic groups. The difference was statistically significant (p < 0.05). A significant positive correlation was observed between zinc levels and sperm count (r = 0.29, p < 0.05) and zinc and alpha-glucosidase activity (r = 0.31, p < 0.05) in seminal plasma. These results suggest that zinc and neutral alpha-glucosidase seem to play an important role in human reproduction.

Humans↗

PubMed2001

The lack of influence of age on male fertility.

OBJECTIVE: This study was undertaken to determine the effect of male aging on sperm quality as determined by semen analysis, the fertilization rate of human oocytes in vitro, and live birth rates. STUDY DESIGN: Retrospective analysis correlating outcome measures with male age was performed for 558 oocyte donation cycles in 441 couples. The oocyte donation model was chosen because it controls for oocyte quality and endometrial receptivity, which allows variations in sperm quality as a function of male age to be the only dependent variable. Outcome measures analyzed were semen analysis, fertilization rates in vitro, pregnancy rates, live birth rates, and cumulative live birth rates by life-table analysis. RESULTS: There was a negative correlation between male age and total sperm count, but there was no correlation between male age and any of the other parameters in the semen analysis. There was no association between male age and the fertilization rate of donated oocytes in vitro, pregnancy rates, or live birth rates. Recipient couples were grouped by quartiles of male age, and cumulative live birth rates were the same in the 4 groups. CONCLUSION: Whereas male aging is associated with a significant decline in total sperm count, this change is not reflected in a decreased fertilization rate or a decreased live birth rate in the oocyte donation model.

Adult↗

PubMed1979

Bromocriptine treatment of oligospermia: a double blind study.

A double blind controlled study of bromocriptine treatment of oligospermia was carried out. Out of fifty-one men who originally volunteered to the study there were forty who took the drug for 12 weeks as requested. All the partners of these men had failed to conceive, and in each case the pretreatment sperm count had been below 40 million/ml on two or several occasions. The pretreatment serum prolactin concentrations were similar in patients given bromocriptine (N = 20) and placebo (N = 20). There were three men in either group whose pretreatment serum prolactin concentration was in excess of 30 micrograms/l, the highest value being 96 micrograms/l. While bromocriptine effectively decreased the serum prolactin concentration, it had no significant effect over placebo on sperm volume, motility and morphology. In the bromocriptine group, sperm count increased to or above 40 million/ml in five out of twenty men, while in the placebo group this occurred in nine out of twenty patients. The plasma testosterone and dihydrotestosterone levels increased slightly during treatment in both groups, but no significant difference was observed between bromocriptine and placebo treated patients. One wife of a bromocriptine-treated man and two wives of placebo-treated men became pregnant during treatment. In this study bromocriptine was no more effective than placebo in the treatment of oligospermia.

Adult↗

PubMedDate not supplied

A study on occupational exposure to petrochemicals and smoking on seminal quality.

A cross-sectional study of 68 petrochemical workers (23 had never smoked [E/NS], 45 were current smokers [E/S]) and 130 subjects with no known history of exposure to petrochemicals (49 had never smoked [NE/NS], 81 were current smokers [NE/S]) was conducted to assess the effect of occupational exposure to petrochemicals and smoking on semen quality. In-person interviews revealed occupational history, smoking habit, and lifestyle. Semen parameters such as volume, viability, sperm forward progression rate, sperm density, and total sperm count were determined for all subjects. The results show that the E/NS workers had a lower sperm forward progression rate (P < .05) compared with controls (NE/NS). Individuals in the NE/S group showed a significant inverse relationship between years smoked and sperm density (r = -.24, P < .05). The data also revealed that cigarette smokers who had worked in a petrochemical plant had significantly poorer quality semen, including sperm density, total sperm count, and forward progression rate, compared with the control (NE/NS) group (P < .01). Furthermore, there was a significant inverse correlation between combined exposure and smoking years, and sperm density (r = -.28, P < .05). These findings suggest that occupational exposure to petrochemical compounds may aggravate the adverse effect that smoking has on semen quality.

Adult↗

PubMed2003

The 'oestrogen hypothesis'- where do we stand now?

The original 'oestrogen hypothesis' postulated that the apparent increase in human male reproductive developmental disorders (testis cancer, cryptorchidism, hypospadias, low sperm counts) might have occurred because of increased oestrogen exposure of the human foetus/neonate; five potential routes of exposure were considered. This review revisits this hypothesis in the light of the data to have emerged since 1993. It addresses whether there is a secular increasing trend in the listed disorders and highlights the limitations of available data and how these are being addressed. It considers whether new data has emerged to support the suggestion that increased oestrogen exposure could cause these abnormalities and reviews new data on potential routes via which such increased exposure could have occurred. Secular trends: The disorders listed above are now considered to represent a syndrome of disorders (testicular dysgenesis syndrome, TDS) with a common origin in foetal life. Testicular cancer has increased in incidence in Caucasian men worldwide and lifetime risk is 0.3-0.8%. Secular trends in cryptorchidism are unclear but it is by far the commonest (2-4% at birth) congenital abnormality in either sex. Secular trends for hypospadias are not robust, although most studies suggest a progressive increase; registry data probably under-estimates incidence, but based on this data hypospadias is the second most common (0.3-0.7% at birth) congenital malformation. Retrospective analyses of sperm count data show a global downward trend but this is inconclusive - prospective studies using standardized methodology show significant differences between countries and very low sperm counts in the youngest cohort of men. For all disorders, other then testis cancer, standardized prospective studies are the best way forward and are in progress across Europe. Oestrogen effects: Evidence that foetal exposure to oestrogens can induce the above disorders has strengthened. New pathways via which such changes could be induced have been identified, including suppression of testosterone production by the foetal testis, suppression of androgen receptor expression and suppression of insulin-like factor-3 (InsL3) production by foetal Leydig cells. Other evidence suggests that the balance between androgen and oestrogen action may be important in induction of reproductive tract abnormalities. Oestrogen exposure: Although many new environmental oestrogens have been identified, their uniformly weak oestrogenicity excludes the possibility that they could induce the above disorders. However, emerging data implicates various environmental chemicals in being able to alter endogenous levels of androgens (certain phthalates) and oestrogens (polychlorinated biphenyls, polyhalogenated hydrocarbons), and the former have been shown to induce a similar collection of disorders to TDS. Other mechanisms via which increased fetal exposure to pregnancy oestrogens might occur (increasing trend in obesity, dietary changes) are also discussed.

Estrogens↗

PubMed2005

Intrauterine insemination with controlled ovarian hyperstimulation in the treatment of subfertility.

OBJECTIVE: To determine the success rate of intrauterine insemination (IUI), following controlled ovarian hyperstimulation (COH) and to identify the prognostic factors associated with successful outcome in couples undergoing this form of assisted reproduction. DESIGN: Case series. PLACE AND DURATION OF STUDY: Concept Fertility Centre, Karachi, Pakistan from January - December 2004. PATIENTS AND METHODS: A total of 290 IUI procedures carried out for the treatment of unexplained and male factor subfertility were included. The age of women ranged from 20 to 44 years and the duration of subfertility were variable. All women had tubal patency confirmed before undergoing COH with one of the three regimens. IUI was performed at follicular maturity of > 16 mm and endometrial thickness of > 7 mm. Main outcome measures analyzed were pregnancy rate per cycle of IUI, miscarriage rate and ongoing pregnancy rate. Other variables observed were the various prognostic factors associated with successful outcome in IUI, such as maternal age, effect of different regimen of COH, motile sperm count and numbers of pre-ovulatory mature follicles > 16 mm. Data was collected and entered in SPSS version 10. Chi- square test of significance was applied and p-value determined. RESULTS: The cycle pregnancy rate (CPR), miscarriage rate and ongoing pregnancy rate was 10%, 13.8% and 8.6% respectively. CPR was 12% in women <35 years compared to 3% in >35 years (p-value 0.03). Significant difference was not observed in the CPR with three different COH regimes. CPR increased dramatically with motile sperm count of >10 millions/ml compared with < 10 millions/ml (12.3% vs. 2.8%, p-value 0.02). Significantly higher pregnancy rate was observed with increasing number of mature follicles >16 mm (6.2%, 12.9% and 30% with one, two and three follicles, p-value 0.0019). There was no case of OHSS and only one case of twin gestation. CONCLUSION: The overall CPR in patients undergoing IUI following COH at our clinic is comparable to the pregnancy rates as shown in different studies. Younger age, motile sperm count of > 10 millions/ml and two or three mature follicles >16 mm are good prognostic factors for successful outcome. However, no significant difference was observed in CPR with different COH regimes.

Adult↗

PubMed1994

The effects of disease progression and zidovudine therapy on semen quality in human immunodeficiency virus type 1 seropositive men.

OBJECTIVE: To investigate the effects of disease progression and zidovudine antiretroviral therapy on semen parameters in human immunodeficiency virus type 1 (HIV-1) seropositive men. DESIGN: Cross-sectional analysis of semen parameters of 166 HIV-1 seropositive men in various stages of disease progression as defined by peripheral CD4+ cell count. Clinical symptoms and zidovudine therapy status were obtained from medical records and clinical interviews. PATIENTS: Human immunodeficiency virus type 1 seropositive men participating in clinical studies at the Fenway Community Health Center (Boston, MA), the University of San Francisco (San Francisco, CA), and Brown University (Providence, RI). MAIN OUTCOME MEASURES: Ejaculate volume; sperm concentration, motility, forward progression, morphology, total sperm count; seminal immature germ cell; and white blood cell (WBC) concentrations. RESULTS: Human immunodeficiency virus type 1 seropositive men that were not on zidovudine therapy and were in early disease stage (> 200 CD4+ cells/mm3) had normal semen parameters as defined by World Health Organization criteria. In contrast untreated men in advanced disease stage (< or = 200 CD4+ cells/mm3) had significant reductions in sperm concentration and total sperm count and an increased percentage of abnormal sperm forms. Men receiving zidovudine antiretroviral therapy, regardless of disease stage, had normal semen parameters similar to those of untreated early disease stage patients. Seminal WBC concentrations were not affected significantly by disease progression but were reduced in patients receiving zidovudine. CONCLUSION: Most HIV-1-infected men in this study had semen parameters consistent with fertility. Disease progression was associated with reduced semen quality, but this effect appeared to be abrogated by zidovudine therapy. Zidovudine was also associated with a significant reduction of WBC numbers in semen. As seminal WBC are principal HIV-1 host cells in ejaculates of HIV-1-infected men, this effect could explain recent laboratory and epidemiological evidence that zidovudine therapy is associated with a reduced prevalence of HIV-1 in semen and a lower rate of sexual transmission.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Surgery or embolisation for varicocele in subfertile men.

BACKGROUND: A varicocele is a meshwork of distended blood vessels in the scrotum, usually left-sided, due to dilatation of the spermatic vein. Although the concept that varicocele causes, and varicocelectomy cures, male subfertility has been around for almost fifty years, the mechanisms by which varicocele would affect fertility have not yet been satisfactorily explained, and neither have the mechanisms by which varicocelectomy would restore fertility. Furthermore, it has been questioned whether a causal relation exists at all between the distension of the pampiniform plexus and impairment of fertility. OBJECTIVES: To evaluate the effect of varicocele treatment on pregnancy rate in subfertile couples. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched 12 Sept 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004) and reference lists of articles. In addition, we hand searched 22 specialist journals in the field from their first issue until 2004. We also checked cross references, references from review articles, and contacted researchers in the field. SELECTION CRITERIA: RCTs were included if they were relevant to the clinical question posed, if they reported pregnancy rates as an outcome measure, and if they reported data in treated (surgical ligation or radiological embolization of the internal spermatic vein) and untreated groups. DATA COLLECTION AND ANALYSIS: Nine studies met the inclusion criteria for this review. One was an extension of a previously published study (Nieschlag 1995/1998), which left eight studies for analysis (Nilsson 1979; Breznik 1993; Madgar 1995; Yamamoto 1996; Nieschlag 1995/1998; Grasso 2000; Unal 2001; Krause 2002). All eight only included men from couples with subfertility problems, one (Madgar 1995) excluded men with sperm counts <5 mill/mL, one (Krause 2002) men with sperm counts <2 mill/mL and/or progressive motility <10%, two trials involving clinical varicoceles included some men with normal semen analysis (Nilsson 1979; Breznik 1993). Three studies (Yamamoto 1996; Grasso 2000; Unal 2001) specifically addressed only men with subclinical varicoceles. Two authors independently screened potentially relevant trials. Any differences of opinion were resolved by consensus (none occurred for this review). Studies were excluded from meta-analysis if they made comparisons other than those specified above. MAIN RESULTS: The combined Peto odds ratio (OR) of the eight studies is 1.10 (95%CI 0.73 to 1.68), indicating no benefit of varicocele treatment over expectant management in subfertility couples in whom varicocele in the man is the only abnormal finding. REVIEWERS' CONCLUSIONS: There is no evidence that treatment of varicocele in men from couples with otherwise unexplained subfertility improves the couple's chance of conception.

Embolization, Therapeutic↗