| Background AND Objectives:Varicocele(VC)is one of the most common causes of male infertility,but its specific pathogenic mechanism has not been fully elucidated.The current study find that the correlation between different reproductive hormones and semen parameters is not clear,and there is no predictor of whether VC ligation can effectively improve semen quality.Therefore,this study focuses on the above problems,and further studies the differences of reproductive hormones and semen parameters between normal people and patients with VC,the effects of unilateral and bilateral VC on reproductive hormones and semen quality,the effects of VC on different reproductive hormones,and the effect of surgical treatment in patients with different degrees of VC.The purpose of this study is to clarify the correlation between different reproductive hormones and semen parameters in patients with VC and to find out the predictive factors for the improvement of semen quality in patients with VC.Methods:Patients with VC admitted to our hospital from June 2018 to October 2019 were enrolled in the study according to strict inclusion and exclusion criteria.There were 122 patients with VC including 16 patients with degree ?,54 patients with degree II and 52 patients with degree ?.Bilateral VC was divided into different groups according to the highest grade.Patients with degree ? contained 14 patients with bilateral VC and patients with degree ? contained 21 patients with bilateral VC.A total of 19 normal people were recruited as the control group.Testicular Doppler ultrasound,Inhibin B(Inhibin B,INHB),testosterone(testosterone,T),progesterone,follicle-stimulating hormone(follicle stimulating hormone,FSH),luteinizing hormone(luteinizing hormone,LH),Estradiol(estradiol,E),prolactin,semen routine were measured.The hospitalized patients were treated with microscope surgery by 2 experienced doctors and were revisited between 3 and 6 months after operation.Spss 22.0 software was used for statistical analysis.Person correlation analysis was used to test the correlation among reproductive hormone,testicular volume and semen parameters.The critical value of reproductive hormone was obtained by using the subject's working characteristic curve(ROC).The reproductive hormone was further divided into high level group and low level group,and the semen abnormalities of the two groups were compared.T-test and one-way ANOVA were used to compare the mean of the two groups and multiple groups.Paired T test and Logistic regression analysis were used to compare the parameters before and after operation to find out the predictors of postoperative semen quality improvement.Results:(1)There was a linear negative correlation between FSH and INHB in patients with VC(?=-0.022,p<0.001).INHB and INHB/FSH was positively correlated with sperm concentration and forward motility rate,while FSH was negatively correlated with sperm concentration,forward motility rate,total sperm count and motile sperm count.INHB and INHB/FSH of patients with normal sperm concentration were significantly higher than those of patients with low sperm concentration.FSH of patients with normal sperm was significantly lower than that of patients with low sperm concentration.FSH of patients with normal sperm forward motility was significantly lower than that of patients with asthenospermia and FSH of patients with normal sperm count was significantly lower than that of patients with low sperm count.The proportion of abnormal semen in patients with INHB<119.43pg/ml,FSH>3.86mIU/ml and INHB/FSH<25.80 was significantly increased.(2)Multivariate logistic regression analysis found that testicular volume>17.9ml was an independent predictor of postoperative semen quality improvement(OR=14.400,95%CI:2.224-93.242,P=0.005).(3)There was no significant difference in clinical parameters between normal subjects and grade I VC.In normal subjects,the left testicular volume of normal subjects was significantly higher than that of degree ? VC.INHB was significantly higher than that of degree? and ? VC.FSH and LH were significantly lower than that of degree ? VC,but there was no significant difference in T,T/LH,T/E,progesterone,E,prolactin between normal subjects and patients with varicocele.The sperm concentration,total motility,forward motility rate and motile sperm count in normal subjects were significantly higher than those in left degree ? VC.(4)There was no significant difference in clinical parameters between patients with bilateral varicocele and unilateral varicocele.The proportion of bilateral varicocele in degree III VC was higher than that in degree ? VC.(5)The testicular volume and semen quality of patients with varicocele significantly improved after operation.There was no significant difference in reproductive hormone before and after operation.The semen quality of patients with abnormal semen was significantly improved after operation,and there was no significant difference in semen parameters in patients with normal semen before and after operation.The sperm concentration,forward motility rate,total sperm count and motile sperm count of degree ? VC increased significantly after operation,while only the sperm forward motility rate of degree II VC significantly increased after operation.Conclusion:The ratio of reproductive hormone INHB and INHB/FSH is positively correlated with sperm concentration and sperm forward motility rate,while FSH is negatively correlated with sperm concentration,sperm forward motility rate,total sperm count and motile sperm count.Testicular volume>17.9ml is an independent predictor of postoperative semen quality improvement.The other results of this study support the damaging effect of VC on reproductive hormone and semen quality,and the microscopic ligation of VC can significantly improve the semen quality of patients,but this study find that FSH reflects the change of sem en quality better than INHB and INHB/FSH.There is no significant correlation between serum testosterone and semen quality and varicocele has no significant effect on testosterone,which is different from some of the reported results,so it is worth further expanding the sample. |
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