Lack of evidence of a genetic origin in the impaired spermatogenesis of a patient cohort with low-grade varicocele

Varicocele is the most common clinical finding in infertile men but controv ersy continues to surround the utility of its treatment. An increased respo nse of FSH to gonadotrophin-releasing hormone testing has been described in patients with varicocele, while the co-influence of Yq chromosome microdel etions in the infertility associated to this pathology is still under inves tigation. We studied 30 patients with first- and second-grade varicocele, 1 5 idiopathic oligozoospermic men and 21 age-matched healthy controls. All s ubjects underwent testicular Doppler ultrasonography, semen analysis, gonad otrophin-releasing hormone testing and baseline blood sampling for total an d free testosterone, PRL, 17 beta -estradiol, SHBG evaluation and Yq chromo some analysis. Apart from FSH, no difference in baseline hormonal levels wa s found between the groups. The patients with varicocele showed both an inc reased basal (p=0.007) and GnRH-induced FSH response (peak and AUG) (p=0.00 4) in comparison with the controls, while the idiopathic oligozoospermic me n had only higher GnRH-induced FSH AUC (p=0.04). In the varicocele group, F SH peaks after GnRH testing correlated positively with the grade of disease (r=0.42, p=0.02) and negatively with sperm count (r=-0.50, p=0.005) and bi lateral testis volume (r=-0.52, p=0.005). Sperm count and sperm motility we re similarly significantly reduced both in patients with varicocele and in patients with idiopathic oligozoospermia in comparison with healthy control s. Yq chromosome analysis by sequence-tagged site PCR revealed no microdele tion in the AZF regions in any subject studied. Given the quite small numbe r of subjects studied, our overall findings can only prompt us to suggest a possible causal role of varicocele in the impairment of spermatogenesis in our patients. Furthermore, although a genetic co-influence (i.e. Yq microd eletions) does not seem to be involved in the pathogenesis of infertility i n men with varicocele and mild to moderate oligozoospermia, genetic screeni ng seems to be advisable, especially in those patients who present a severe impairment of sperm count, as has been suggested by recent literature data . ((C))2001, Editrice Kurtis.