Role of varicocele repair in the era of assisted reproductive technologies: Lessons from 2000 cases of microsurgical varicocele repair.

IF 2.7 3区医学 Q2 OBSTETRICS & GYNECOLOGY Reproductive Medicine and Biology Pub Date : 2024-06-27 eCollection Date: 2024-01-01 DOI:10.1002/rmb2.12589

Koji Shiraishi

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Abstract

Backgrounds: In an era of advanced maternal age, there is less conclusive evidence regarding the treatment outcomes of varicocele repair for assisted reproductive technology (ART). Progress in basic research on varicocele is notable whereas there are many clinically relevant points to discuss.

Methods: Based on our experience with more than 2000 cases of microsurgical varicocele repair, we focused on the effectiveness of varicocele repair, pathophysiology, surgical approaches, contributions to ART, sperm DNA fragmentation, and varicocele-associated azoospermia in this review with the aim of identifying clearer directions for basic and clinical research on varicocele.

Results: Microsurgical low ligation for varicocele repair is expected to remain the gold standard for surgical therapy. Based on the findings from a number of systematic reviews and meta-analyses, negative opinions regarding the efficacy of microsurgical varicocele repair in male infertility treatment have become virtually nonexistent. However, the majority of evidence regarding surgical indications and effectiveness pertains to improvements in semen parameters or non-ART pregnancy rates.

Conclusions: Further understandings regarding to pathophysiology of varicocele will likely be gained through comprehensive genetic, transcriptomic, and epigenetic analyses using blood and testicular samples from humans and we hope to develop new diagnostic methods and pharmacotherapy.

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精索静脉曲张修复术在辅助生殖技术时代的作用：从 2000 例精索静脉曲张显微修复手术中汲取的教训。

背景：在高龄产妇时代，有关辅助生殖技术（ART）精索静脉曲张修复治疗效果的确凿证据较少。精索静脉曲张的基础研究进展显著，但仍有许多与临床相关的问题需要讨论：根据我们 2000 多例精索静脉曲张显微手术修复的经验，我们在本综述中重点讨论了精索静脉曲张修复的有效性、病理生理学、手术方法、对 ART 的贡献、精子 DNA 断裂以及精索静脉曲张相关性无精子症，旨在为精索静脉曲张的基础和临床研究确定更明确的方向：结果：显微外科低位结扎术修复精索静脉曲张预计仍将是外科治疗的金标准。根据一些系统性综述和荟萃分析的结果，关于显微外科精索静脉曲张修复术在男性不育症治疗中的疗效的负面意见几乎已不存在。然而，大多数关于手术适应症和有效性的证据都与精液参数的改善或非非线性妊娠率有关：结论：通过对人类血液和睾丸样本进行全面的遗传学、转录组学和表观遗传学分析，我们可能会进一步了解精索静脉曲张的病理生理学，并希望能开发出新的诊断方法和药物疗法。

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来源期刊

Reproductive Medicine and Biology Multiple-

CiteScore

5.70

自引率

5.90%

发文量

审稿时长

20 weeks

期刊介绍： Reproductive Medicine and Biology (RMB) is the official English journal of the Japan Society for Reproductive Medicine, the Japan Society of Fertilization and Implantation, the Japan Society of Andrology, and publishes original research articles that report new findings or concepts in all aspects of reproductive phenomena in all kinds of mammals. Papers in any of the following fields will be considered: andrology, endocrinology, oncology, immunology, genetics, function of gonads and genital tracts, erectile dysfunction, gametogenesis, function of accessory sex organs, fertilization, embryogenesis, embryo manipulation, pregnancy, implantation, ontogenesis, infectious disease, contraception, etc.