| Objective: Approximately 15% of couples fail to achieve pregnancy within 1 year of unprotected intercourse.In approximately 50% of infertile couples,a male factor is at least partly responsible for the failure to conceive .In the male population,evaluated for infertility,varicocele is present in approximately one-third of patients. Many studies have described the effects of varicocelectomy on fertility. Improvement in sperm concentration,sperm motility and testicular size has been observed. Nevertheless,randomized controlled studies on the effect of varicocele treatment on pregnancy rates are contradictory. Semen analysis is widely used and accepted as a marker of spermatogenesis. However intra-and interlaboratory variations may affect the results of the semen analyses. Also,intra-and interindividual variations may occur. To again more insight into the effect of treatment of varicocele on spermatogenesis,more accurate markers would be useful. In recent years,the serum inhibinB level has emerged as a sensitive marker of spermatogenesis. The development of specific assays for the bioactive forms of inhibin (dimmers inhibinA and inhibinB) has enabled greater insight into inhibin physiology. It has been demonstrated that inhibinB is the physiologically important form of inhibin in males. This glycoprotien is secreted by Sertoli cells in response to FSH and regulates the production of FSH by the pituitary gland. Serum inhibinB levels are negatively correlated with serum FSH levels in the male. Recently, it was shown that serum inhibin B levels are positively correlateled with sperm count ,testicular volume and the state of the spermatogenetic epithelium. Several studies have reported an exaggerated gonadotrophin response to GnRH,which could be normalized by varicocele treatment , implying impairment of gonadotrophin control mechanisms in infertile men with varicocele. It has been suggested that, in varicocele patients,inhibin production may be less sensitive to FSH stimulation. Now that a sensitive and specific assay for inhibinB is available, the effect of varicocelectomy on the serum level of this hormone, hence Sertoli cell function, can be investigated in more detail. The aim of this study was to examine the effect of varicocele treatment on the quality of spermatogenesis, as reflected by serum inhibinB levels, and to investigate the involvement of Sertoli cell-germ cell interaction in the pahtophysiological mechanism. Methods: 30 infertile men with varicocele were studied. All patients were treated surgically by high spermatic vein ligation. Serum inhibinB, FSH,LH,T and sperm concentration were measured before and after operation, and I calculated their changes and correlation. Use enzyme linkedimmunosorbent assay (ELISA) testing serum inhibin B level. Use radioimmunoassay to test serum FSH,LH ,PRL,T levels. To compare the endocrine and semen parameters before and after treatment,the Wilcoxon paired rank test was used. spearman's test was used to calculate correlations. With p<0.05 considered significant. Results: In men receiving varicocele operation, a significant increase in serum inhibinB levels was observed from 156.41±45.36pg/ml pretreatment to 179.94±48.27pg/ml after treatment P<0.05. No significant changes were observed in serum levels of FSH,LH and T. Semen analysis showed a significant improvement in sperm concentration, form 16.62±10.33×106/ml pretreatment to 23.70±11.34×106/ml after treatment. P<0.01;Serum levels of inhibinB were inversely correlated with serum FSH levels both before and after treatment (r=-0.58,P<0.05and r=-0.46, p=0.011 ,respectively ).The serum inhibinB level was not correlated with serum FSH,LH and T levels. A positive correlation between serum inhibinB levels and sperm concenlration was foundl( r=-0.53,P<0.05 and r=0.44 ,p=0.015). Conclusions: Varicocele treatment can inerease serum inhibinB levels, indicating improvement of spermatogenesis and sertoli cell function. So the infertile patients with varicocele shoud be operated. This finding also suggests that the pathophy...
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