A varicocele is a tortuous distension of intra-scrotal veins of the pampiniform plexus, and is regarded as one of the leading causes of male infertility with a prevalence of about 15-20% among the general adult men population and up to 40% in infertile males . The aetiology of a varicocele is likely to be multifactorial , Pathophysiological^, clinical varicoceles are characterized by hyperthermia of the scrotum and the affected testicle leading to spermatogenic damage  possibly induced by oxidative stress mediated apoptosis  with an increased expression of apoptosis-related proteins in spermatozoa . Moreover, endocrine and paracrine imbalances compromising Sertoli cell function have been described ,
Due to the release of nitric oxide synthase and xanthin oxidase significantly higher levels of oxidative stress were detected in the spermatic vein [122-124]. Additionally, Mostafa et al.  found that, apart from increased levels of oxidative stress as determined by means of the seminal concentrations of MDA, hydrogen peroxide and nitric oxide, levels of antioxidants (SOD, catalase, GPx, vitamin C) were significantly reduced in spermatic venous blood as compared to peripheral blood. This finding is consistent with the observation by Shamsi and Dada (2010; personal communication) that seminal concentrations of MDA and antioxidants significantly and positively correlate with those in the blood. In turn, if there is a positive correlation between genital oxidative stress with that found in the blood, this raises the question if this could possibly also be the case if there is a systemic infection or generally too high systemic oxidative stress with high levels of oxidants. The latter might then cause increased oxidative stress in the genital tract system, leading to infertility.
It is also not surprising that the seminal concentrations of ROS and total antioxidant capacity (TAC) were increased and decreased, respectively . Consequently, vari-cocele not only does affect spermatogenesis leading to poor sperm count, morphology and DNA integrity  but also leads to deteriorated sperm functionality by seminal oxidative stress. The latter could possibly be induced by the inflammatory effect caused by varicocele and which is resulting in significantly elevated levels of IL-6 or IL-8, comparable to those found in patients with genital tract infections ,
On the contrary, another research group [ 129 ] presented data questioning an impact of clinical varicocele on testicular size and seminal ROS levels on male fertility, at least in fertile men. For patients with unknown fertility status, these authors conclude that increased ROS levels may be indicative of an early sign for a decline in fertility if the condition is untreated. Thus, these authors differentiate regarding varicocele-associated fertility problems between fertile and infertile men.
Varicocelectomy, in turn, has been shown to significantly attenuate seminal oxi-dative stress including the resultant sperm DNA damage 3 months after the operation [130, 131]] Recently, data supporting the clinical value of varicocelectomy have been reported in a randomized controlled study .
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