EFFECT OF VARICOCELE AND VARICOCELECTOMY ON SOME SEX HORMONES AND TRANSFERRIN IN INFERTILE MEN
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The aim of the present study is to evaluate the possible effects of varicocele and varicocelectomy on serum levels of some sex hormones and on seminal plasma transferrin as a marker of Sertoli cell function. This study included 20 healthy normozoospermic fertile male volunteers as a normozoospermic group and 40 infertile male patients with grade II bilateral varicocele, classified into two groups; oligospermic group included 30 patients and azoospermic group included 10 patients. Serum testosterone, follicle stimulating hormone (FSH), estradiol (E2), prolactin (PRL) and seminal plasma transferrin levels were estimated in all cases before and 3 months after varicocelectomy in both patient groups. Pre-varicocelectomy, there was a significant decrease (P<0.05) in serum testosterone and significant increases (P<0.05) in serum FSH and E2 in both oligospermic and azoospermic groups as compared to the normozoospermic group. Post-varicocelectomy, serum testosterone was still significantly lower and serum FSH and E2 were still significantly higher (P<0.05) in azoospermic group only as compared to normal group. Postvaricocelectomy, testosterone levels were significantly increased (P<0.05) and FSH levels were significantly decreased (P<0.05) in both patient groups when compared with theft pre-varicocelectomy levels, while post-varicocelectomy E2 mean level was significantly decreased (P<0.05) in oligospermic group as compared to prevaricocelectomy level. Seminal plasma transferrin pre-varicocelectomy, was significantly decreased (P<0.001) in both oligospermic and azoospermic groups when compared with normozoospermic group. Post-varicocelectomy seminal plasma transferrin was higher, but the elevation was insignificant, in both patient groups when compared with pre-operative transferrin level. There was a positive significant correlation (r=0.69; P<0.001) between seminal plasma transferrin and sperm count in oligospermic group, but there were non-significant correlations between seminal plasma transferrin and other seminal parameters. It could be concluded that, men suffering from varicocele have lower mean sperm count and worse seminal parameters than those without varicocele. Varicocelectomy might promote the Sertoli and Leydig cell functions. The significant increase in serum testosterone levels resulted in significant improvement of sperm concentration, and motility. This work suggested that in men with azoospermia and oligosperrnia, who had palpable varicocele and increased pre-operative serum FSH levels, varicocelectomy may not be contraindicated and that still there is a hope of improving their fertility. Also, the findings of improvements in seminal parameters after varicocelectomy but non significant changes in seminal transferrin levels indicates that varicocelectomy results in a greater improvement in sperm quality than in Sertoli cell function.