Clinical Presentations 2021 Varicocele

Infertile patients with varicocele present with higher levels of ROS and lower levels of seminal antioxidants leading to increased OS [78] . Published data have shown that the grade of varicocele has an impact on the levels of seminal ROS, which were proven to decline following the surgical correction of varicocele [78]. The relationship between varicocele and OS is not fully understood; however, some mechanisms have been proposed. Significant amount of nitric oxide (NO) production are released from the dilated pampiniform plexus of veins leading to OS [79] . Additionally, NO may also interact with superoxide anion resulting in the production peroxynitrate, which result in further sperm damage [80] .

Patients diagnosed with infertility and varicocele had significantly higher levels of OS and sperm DNA damage compared to healthy controls [64]. This could indicate a potential pathway for sperm DNA damage resulting from OS in these patients with varicocele [ 64 ] . OS and its resulting sperm dysfunction were estimated to cause infertility in 15% of males with varicocele [81] . Another potential cause of sperm DNA damage in varicocele patients is apoptosis. Levels of apoptosis are higher in ejaculated spermatozoa from varicocele patients than in spermatozoa from healthy men [52] .

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