Decrease in apoptosis of germ cells in the testes of infertile men with varicocele

To determine whether the regulation of apoptosis in the testes of patients with varicocele testes was abnormal, affecting germ-cell differentiation an d sperm production, we studied apoptosis in the testes of normal men and in fertile men with varicocele. In all, 56 testicular biopsy specimens were co llected from 28 varicocele patients. The specimens from the testes of five normal volunteers with informed consent were used as controls. In situ end- labeled cells were counted with a CAS 200 image analyzer, and an apoptotic index (AI) was calculated by division of the number of labeled cells by the total number of spermatocytes and spermatogonia in over 20 seminiferous tu bules. The apoptosis was also examined by electron microscope. The mean AI was 9.67 +/- 0.93% in normal testes (n = 5). In contrast, the mean AIs dete rmined in the right and left testes of varicocele patients (n = 28) were 3. 90 +/- 2.28% and 3.78 +/- 2.87%, respectively. The AIs recorded for the tes tes of varicocele patients were significantly lower than those noted for no rmal men (P < 0.05). In varicocele patients the AI obtained in the right te stis was not statistically significantly different from that found in the l eft testis. The numbers of apoptotic cells per Sertoli cell also decreased in the testes of varicocele patients as compared with normal men (P < 0.01) . Evaluation of all specimens, including the normal controls, revealed no s ignificant correlation either between the AI and the sperm concentration on the seminogram or between the AI and Johnsen's mean score. There was also no relationship between the AI and the serum level of follicle-stimulating hormone, lutenizing hormone, testosterone, or estradiol. In conclusion, apo ptosis is decreased in germ cells in the testes of infertile men with varic ocele as compared with normal men.