Varicocele and male infertility

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Varicocele refers to the spermatic vein because of various causes of recirculation or regurgitation caused by pathological phenomena and the

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Varicocele refers to the spermatic vein because of various causes of recirculation or regurgitation caused by pathological phenomena and the formation of local vein dilation and elongation of venous valve damage. It belongs to the category of traditional Chinese medicine in the treatment of tumors and tendons.

With the onset of puberty, the incidence of adult male is about 5% ~ 20%, the incidence of infertility is about 35%. The disease occurred in the left side, the left side accounted for about 95%, on both sides of about 20%.

Why does varicocele cause male infertility?

Mainly through the following aspects affect the quality of sperm:

1, testicular temperature rise: testicular hi cool afraid of heat, by the scrotum contraction and relaxation regulation temperature, generally lower than body temperature. Varicocele will increase the temperature of the testis, which affects the ability to produce sperm.

2, testicular microcirculation disorder: testicular small artery, micro artery contraction, affect the testicular blood supply, will interfere with the normal material exchange of seminiferous tubules, promote germinal epithelium damage.

3, testicular hypoxia: affect testicular function, sperm quantity and quality.

4, oxygen free radical damage: lipid peroxide increased, resulting in changes in sperm morphology, function and metabolic abnormalities. Damage caused by sperm membrane function

5, the toxic effects of vasoactive substances: the reflux of blood metabolites such as catecholamines, serotonin, prostaglandins and other counter flow into the testis. The toxic effects, which can cause testicular poisoning and injury, affect spermatogenesis and kill sperm. At last, the growth of testis was stopped and began to shrink.

6, nitric oxide mechanism: inhibition of energy production, reduce sperm motility, affect testosterone synthesis. In addition, nitrite toxicity can be produced.

7. The disorder of testosterone secretion: the decrease of testosterone cause the damage of interstitial cells and the function of hypothalamus pituitary gonad axis.

8, autoimmune function: immune barrier damage of testis and epididymis, anti sperm antibody (AsAb) level increased, the positive rate of AsAb is closely related to the severity and extent of damage of testicular seminiferous, more weight, more local immune response.

9, abnormal increase in apoptosis: in the seminal fluid of patients, we can see a lot of round cells, most of them belong to immature spermatogonia. There are about 25% ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~. Spermatogenic cells (primary spermatocytes and round spermatids are most sensitive to heat) and the increase in apoptosis leads to decreased fertility or infertility.

10, abnormal acrosome reaction

11, epididymis damage: infertility caused by fine tune is not only related to the structural function of the testis, but also may be closely related to the pathological changes of epididymis structure and function.

The male sterility caused by fine tune should be the result of the interaction of various factors, and all kinds of factors complement each other. The influence of a single factor can not fully explain the pathological changes of testis in male infertility patients

What are the symptoms of refined music?

Mainly for the scrotal ministry bulge and pain, can radiate to the lower abdomen and waist, stand too long or fatigue symptoms after supine rest and reduce symptoms. A considerable number of patients with no discomfort, or a slight discomfort, did not cause attention, often found in the physical examination.

How to diagnose varicocele?

The clinical diagnostic criteria of scrotum seminiferous local signs typical, with a mass of earthworm palpation of varicose vein of the standing vascular filling, supine after varicose signs disappeared.

Grade (mild): palpation is not obvious, but the Valsalva test can occur when.

Class II (moderate): palpable dilatation of the vein at palpation, but not seen.

Level 3 (severe): the patient can see dilated veins in the scrotum skin suddenly standing, such as clusters of earthworms, easy to touch.

Clinical ultrasound can be a good measure of the width of the vein, as well as the flow of blood, so there is a doubt when the clinical fine tune, will do the ultrasound examination.

Ultrasound diagnosis, the varicocele is divided into 4 levels, namely, subclinical varicocele, clinical varicocele grade.

Subclinical varicocele: negative in clinical palpation and ultrasound examination of spermatic vein in reflux, the maximal internal spermatic vein diameter DR:1.8-2.1mm, reflux time signal TR:0.8-2s;,

Clinical varicocele grade: clinical palpation positive and ultrasound DR:2.2-2.7mm, TR:2-4s;

Clinical varicocele II: clinical palpation and ultrasound examination of positive DR:2.8-3.1mm, TR:4-6s;

Clinical varicocele III: clinical palpation and ultrasound examination was DR > 3.1mm, TR > 6s.

Treatment of varicocele

1, surgical treatment

Surgery can improve the semen quality of 65%~70% patients, but the pregnancy rate is still not high. The effect of seminiferous surgery on fertility, there is a lack of large sample data observation evidence. Some scholars believe that surgery has not been able to improve the fertility of infertile patients with varicocele. It is also reported that the number and activity of sperm after surgery not only did not improve, but decreased.

The United States Institute of Department of Urology (AUA) to develop "varicocele and infertility report" clearly, fertility requirements of seminiferous patients should also meet the following 4 points: the party to treat scrotal palpable varicocele examination. The couple diagnosed infertility. The woman's fertility is normal or can treat infertility. The abnormal semen parameters and sperm function test abnormalities. At present no family planning and days after birth, need palpable varicocele with abnormal semen, also need treatment. Patients who have been born or have no fertility requirements, or those with normal semen parameters, are not within the scope of the recommended treatment.

Complications of fine plastic surgery?

Edema of scrotum and testis (incidence rate 3%~25%), subcutaneous emphysema, hydrocele of testis, testicular atrophy (generally not).

Recurrence rate of fine plastic surgery?

The recurrence rate was 0%~13% in foreign countries, mostly in 3 ~ 6 months after operation.

Failed to improve the rate of pregnancy?

The operation is not successful, still no change (varicose; semen quality: operation time, late ligation is not complete, recurrence); semen quality has improved, but is still not up to the requirements of fertility; blood testis barrier damage, AsAb, trigger immune infertility.

2, conservative treatment

Scope: second-degree following varicose patients with infertility; clinical requirements of non-surgical treatment and surgical treatment of patients with poor requirements of traditional Chinese medicine; treatment of infertility; to improve sperm quality in patients with severe varices after surgery; severe varicose infertility, but the sperm density or activity of one can, can try to treat with medicine first.

 

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