https://doi.org/10.4081/aiua.2024.12545
Can serum 17-hydroxy progesterone predict an improvement in semen parameters following micro-varicocelectomy? A prospective study
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 2 October 2024
Background & objectives: Notably, 17-hydroxy progesterone (17-OHP) (17-OHP) is a precursor for testosterone (T) synthesis, and intratesticular testosterone (ITT) is essential for spermatogenesis. Varicocele (Vx) has an estimated prevalence of 15% in the general population and 35% in those with primary infertility. We aimed to evaluate the correlation between changes of serum 17-OHP after sub-inguinal micro-varicocelectomy and improvement of semen parameters.
Patients and methods: The current prospective study included 45 infertile men attending the andrology clinic form February 2021 to August 2021. Two semen analyses and hormonal profile were evaluated. Colored duplex ultasonography (CDUS) was done in standing and supine position for accurate measurements of testicular volumes and confirmation of Vx. Patients underwent sub-inguinal micro-varicocelectomy using a surgical microscope HB surgitech. We followed them prospectively up for three months following micro-varicocelectomy with serum TT and 17-OHP.
Results: Sperm concentration improved significantly from 8.36 ± 5.04 million/ml to 12.52 ± 8.42 million/ml after 3 months following sub-inguinal micro-varicocelectomy (p= 0.001), with normalization of concentration in 15/45 (33%) patients. Total motility did not improve significantly but progressive motility improved significantly from 8.62 ± 8.74% to 16.24 ± 14.45% (p=0.001). Abnormal forms significantly declined from 96.67 ± 2.03% to 95.75 ± 2.47% (p=0.009). Serum 17 OHP and 17 OHP/total testosterone (TT) improved significantly from 1.21 ± 0.45 ng/ml and 0.26 ± 0.09 to 1.42 ± 0.76 ng/ml and 0.3 ± 0.16 (p= 0.013, p= 0.004), respectively, while serum TT did not improve significantly. A significant correlation was found between improvement in sperm concentration and both serum 17 OHP and 17 OHP/TT ratio (p=0.001, p=004). Furthermore, change in abnormal sperm forms showed significant correlations with changes in both 17-OHP and 17-OHP/TT.
Conclusion: 17 OHP and 17OHP/ TT ratio can be used as biomarkers to detect improvement in semen parameters following sub-inguinal micro-varicocelectomy.
Downloads
Jungwirth A, Giwercman A, Tournaye H, et al. European Association of Urology guidelines on Male Infertility: the 2012 update. Eur Urol. 2012;62:324–332. DOI: https://doi.org/10.1016/j.eururo.2012.04.048
Sharpe RM, Cooper, I. Intratesticular secretion of a factor(s) with major stimulatory effects on Leydig cell testosterone secretion in vitro. Mol Cell Endocrinol. 1984;37:159-168. DOI: https://doi.org/10.1016/0303-7207(84)90048-0
Roth M, Page S, Lin K, et al. Dose-dependent increase in intratesticular testosterone by very low-dose human chorionic gonadotropin in normal men with experimental gonadotropin deficiency. J Clin Endocrinol Metab. 2010;95:3806-3813. DOI: https://doi.org/10.1210/jc.2010-0360
Duarte‐Neto AN, Teixeira TA, Caldini et al. Testicular pathology in fatal COVID-19: A descriptive autopsy study. Andrology. 2022;10:13–23. DOI: https://doi.org/10.1111/andr.13073
Kelly D, Jones T. Testosterone and obesity. Obes Rev. 2015;16:581-606. DOI: https://doi.org/10.1111/obr.12282
Amory JK, Coviello AD, Page ST, et al. Serum 17-hydroxyp-rogesterone strongly correlates with intratesticular testosterone in gonadotropin-suppressed normal men receiving various dosages of human chorionic gonadotropin. Fertil Steril. 2008;89:380-386. DOI: https://doi.org/10.1016/j.fertnstert.2007.02.059
Roth MY, Lin K, Bay K, et al. Serum insulin-like factor 3 is highly correlated with intratesticular testosterone in normal men with acute, experimental gonadotropin deficiency stimulated with low-dose human chorionic gonadotropin: a randomized, controlled trial. Fertil Steril. 2013;9:132-139. DOI: https://doi.org/10.1016/j.fertnstert.2012.09.009
Patel A, Patel P, Bitran J, Ramasamy R. Can serum 17-hydroxyprogesterone and insulin-like factor 3 be used as a marker for evaluation of intratesticular testosterone? Transl Androl Urol. 2019;8:S58–S63. DOI: https://doi.org/10.21037/tau.2019.01.16
Alharbi M, Zini A. Epidemiology of varicocele in pediatric, adolescent, and adult populations. In: Esteves S., Cho CL., Majzoub A., Agarwal A. (eds), Varicocele and male infertility. Cham, Springer; 2019. pp. 97-106. DOI: https://doi.org/10.1007/978-3-319-79102-9_8
Alsaikhan B, Alrabeeah K, Delouya G, Zini A. Epidemiology of varicocele. Asian J Androl. 2016;18:179–181. DOI: https://doi.org/10.4103/1008-682X.172640
Zohdy W, Ghazi S, Arafa M. Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility. J Sex Med. 2011;8:885-893. DOI: https://doi.org/10.1111/j.1743-6109.2010.01974.x
Li F, Yue H, Yamaguchi K, et al. Effect of surgical repair on testosterone production in infertile men with varicocele: A meta‐analysis. Int J Urol. 2012;19:149-154. DOI: https://doi.org/10.1111/j.1442-2042.2011.02890.x
Hsiao W, Rosoff JS, Pale JR, et al. Varicocelectomy is associated with increases in serum testosterone independent of clinical grade. Urology. 2013;81: 1213–1217. DOI: https://doi.org/10.1016/j.urology.2013.01.060
Lima TFN, Frech FS, Patel P, et al. Effect of microsurgical varicocelectomy on semen parameters, serum, and intratesticular testosterone levels. BJUI Compass. 2020;1:93-99. DOI: https://doi.org/10.1002/bco2.15
Bellastella G, Carotenuto R, Caiazzo F, et al. Varicocele: an endocrinological perspective. Front Reprod Health. 2022;4:863695. DOI: https://doi.org/10.3389/frph.2022.863695
World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–2194. DOI: https://doi.org/10.1001/jama.2013.281053
World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Available from: https://iris.who.int/handle/10665/44261
Schauer I, Madersbacher S, Jost R, Hübner WA, Imhof M. The impact of varicocelectomy on sperm parameters: a meta-analysis. J Urol. 2012;187:1540-1547. DOI: https://doi.org/10.1016/j.juro.2011.12.084
Rodriguez Peña M, Alescio L, Russell A, et al. Predictors of improved seminal parameters and fertility after varicocele repair in young adults. Andrologia. 2009;41:277–281. DOI: https://doi.org/10.1111/j.1439-0272.2009.00919.x
Kalantan M, Vienney N, Guillot Tantay C, et al. [Résultats des cures de varicocèles microchirurgicales sous-inguinales].[Article in French]. Prog Urol. 2023;33:481-487. DOI: https://doi.org/10.1016/j.purol.2023.07.004
Bridges N, Trofimenko V, Fields S, et al. Male factor infertility and clomiphene citrate: A meta-analysis of the effect of clomiphene citrate on oligospermia. Urol Pract. 2015;2:199-205. DOI: https://doi.org/10.1016/j.urpr.2014.10.007
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.