Cases reported "Infertility, Male"

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1/18. Sperm mitochondrial mutations as a cause of low sperm motility.

    We report the unique case of a 28-year-old man who, in spite of having a varicocele and a sperm concentration of 5 million/mL, of which 10% were motile and 20% had normal forms (oligoasthenoteratozoospermia [OAT]), was fertile. This was confirmed by paternity testing using 16 autosomal and 6 Y-chromosomal short tandem repeat (STR) loci. An analysis of mitochondrial genes that included cytochrome oxidase I (COI), cytochrome oxidase II (COII), adenosine triphosphate synthase6 (ATPase6), ATPase8, transfer ribonucleic acid (tRNA) serine I, tRNA lysine, and NADH dehydrogenase3 (ND3) revealed, for the first time, 9 missense and 27 silent mutations in the sperm's mitochondrial dna (mtDNA) but not in the dna from the blood cells. There was a 2-nucleotide deletion in the mitochondrial COII genes, introducing a stop codon, which might be responsible for low sperm motility.
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ranking = 1
keywords = varicocele
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2/18. Simultaneous laparoscopic varicocelectomy and removal of an intrascrotal atrophic testicle.

    We report on the concomitant removal of an atrophic intrascrotal left testicle secondary to mumps orchitis and a right varicocelectomy for athenospermia done laparoscopically. The procedure proved to be quite simple to complete, avoiding the need for secondary incisions, which would have been required otherwise if a standard open approach was chosen. The convalescence period was uneventful with the patient returning to regular activities within 72 h of the procedure. We feel that in selected cases a laparoscopic orchiectomy offers distinct advantages to conventional open surgical approaches.
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ranking = 5
keywords = varicocele
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3/18. finasteride-associated male infertility.

    finasteride is a potent and specific inhibitor of the 5alpha-reductase enzyme in men. Clinical studies have shown that finasteride 1mg/day is effective for promoting hair growth in men with male pattern hair loss. However, there is a concern about the use of finasteride, especially in young fertile patients, because of its action on testosterone metabolism. This paper describes 3 cases of young patients who had very poor seminal quality during finasteride treatment (1 mg/day), and their seminal quality greatly improved after cessation of finasteride treatment. Two of them presented with a left varicocele and the other was obese. We hypothesize that finasteride may not dramatically change the spermatogenesis process in healthy men, but in patients with conditions related to infertility, an amplification of the negative influence of finasteride could occur. Future studies should be done to clarify the extent of the effect of finasteride in patients fertility problems.
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ranking = 1
keywords = varicocele
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4/18. Evaluation and management of genital anomalies in two patients with klinefelter syndrome and review of literature.

    OBJECTIVES: To present the evaluation and management of cryptorchidism and varicocele in patients with klinefelter syndrome and review the literature. Recent advances in reproductive medicine have resulted in fertility in patients with klinefelter syndrome. However, cryptorchidism and varicocele can affect the fertility potential on their own. methods: We present 2 cases and review the literature with an emphasis on the fertility potential. RESULTS: germ cells were present in the testicular biopsy of an infant with cryptorchidism but not in the adolescent with a varicocele. The latter biopsy showed tubular sclerosis. CONCLUSIONS: The fertility potential of patients with klinefelter syndrome and cryptorchidism may be preserved or enhanced by an early orchiopexy. However, the potential benefit of ligation of internal spermatic veins in patients with klinefelter syndrome and a varicocele warrants further study. cryopreservation should be considered early in adolescence or adulthood as germ cells become depleted at an accelerated rate after puberty.
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ranking = 4
keywords = varicocele
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5/18. Isolated right-sided varicocele as a salvage pathway for portal hypertension.

    Retrograde blood flow can occur in the testicular veins and in the pampiniformis plexus in the absence of valves or if the valves are incompetent, resulting in tortuosity and dilatation of the veins. These abnormal alterations in the anatomy of the veins, termed varicoceles, are associated with infertility in the male. Most varicoceles occur on the left. We report the case of a rare isolated right-sided varicocele in a male evaluated for infertility in whom extensive work-up revealed venous anomalies and a spontaneous porto-systemic shunt. In such cases, standard approaches to infertility treatment are fruitless.
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ranking = 7
keywords = varicocele
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6/18. Ultrasound findings of an intratesticular varicocele. Report of a new case and review of the literature.

    The authors present a new case of intratesticular varicocele(ITV). The ultrasound findings on gray-scale and color Doppler imaging as well as the pertinent clinical manifestations are discussed. A review of the literature is also presented. According to our knowledge only 34 cases of ITV have been reported in the literature and the clinical significance of this lesion is not yet well established. This is the first reported case of infertility caused by a solely ITV, showing that the clinical implications of this entity may be more significant than previously thought.
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ranking = 5
keywords = varicocele
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7/18. Phleboliths in varicoceles presenting as spermatic cord mass.

    OBJECTIVE: To discuss the diagnosis and management of phleboliths in the dilated veins of a varicocele. DESIGN: Case report. SETTING: Two healthy patients in an academic andrology center. PATIENT(S): Two healthy patients undergoing evaluation and treatment of male factor infertility. INTERVENTION(S): ultrasonography and varicocele repair. MAIN OUTCOME MEASURE(S): Improvement in male factor infertility. RESULT(S): One patient had a phlebolith diagnosed ultrasonographically by echogenicity and acoustic shadowing within a dilated vein of a varicocele. Another patient had a hard mass found within a dilated vein of a varicocele at the time of surgical repair. CONCLUSION(S): A hard rounded mass within a spermatic vein identified at surgery or sonographically within the veins of the spermatic cord should be considered a phlebolith. Decisions regarding treatment depend on clinical presentation.
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ranking = 8
keywords = varicocele
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8/18. Increasing infertility in myotonia dystrophica Curschmann-Steinert. A case report.

    A 26-year-old male came to our andrologic out-patient clinic because of his desire to have children. Preliminary examinations revealed a varicocele left and a subclinical varicocele right. Testicular volume was smaller than normal, and spermiogram values were already poor (vitality, motility and morphology). Basic hormones were normal. The anamnesis gave no information on hereditary disorders. Surgical treatment of the varicocele did not bring the desired outcome. A testicular biopsy showed Leydig cell hyperplasia with strongly reduced spermiohistogenesis. In a renewed and extensive anamnesis, the patient revealed that he suffers from myotonia dystrophica Curschmann-Steinert. This disorder causes sclerosis of the tubuli seminiferi contorti, which can ultimately lead to azoospermia.
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ranking = 3
keywords = varicocele
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9/18. Concomitant incidence of fertility chance reducing varicocele and chromosome aberration.

    Authors describe the case of a male patient with varicocele, oligozoospermatism and subfertility, a 46 XY t (8; 10) (q22; p15) balanced chromosome carrier. Following varicectomy, successful pregnancy has developed even with balanced translocation meaning only 50% fertility chance. Prenatal diagnostics by chorion biopsy showed a fetus of normal chromosome constellation. Authors call attention to the fact that even minor, step-by-step improvements in fertility chance may lead to success in multiple aberrations.
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ranking = 5
keywords = varicocele
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10/18. Varicoceles and male infertility.

    Approximately 15 percent of the postpubertal male population develops varicoceles, and one-third of men seen in fertility clinics have this lesion. semen samples commonly show diminished sperm counts, decreased motility and immature cellular morphology. Treatment is usually surgical, although percutaneous methods are now available. early diagnosis and treatment may prevent the testicular insult.
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ranking = 1
keywords = varicocele
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