ABSTRACT
This prospective study was designed to estimate seminal plasma [SP] levels of soluble Fas [sFas] in infertile men with varicocele as a trial to evaluate the role imposed by apoptosis on the outcome of varicocelectomy in terms of seminal parameters. The study comprised 40 subfertile patients with varicocele and 10 fertile men as controls. All men were evaluated clinically for varicocele grading and determination of testicular dimensions. Patients were assigned to undergo bilateral varicocelectomy by subinguinal approach with arterial and lymphatic sparing procedure. Semen samples were divided into two parts for routine semen analysis and estimation of SP sFas; prior to and 4 months after surgery. There were 23 patients with grade I, 10 with grade II and 7 with grade III varicocele. There were 15 patients with hypotrophic testes; 5 bilateral and 10 had left hypotrophic testes. Postoperative seminal parameters showed significant improvement in comparison to preoperative ones, but were still significantly different compared to control levels. Mean preoperative SP sFas concentration was 3.12 +/- 1.14 ng/ml, whereas in controls it was 5.42 +/- 1.74 with a significant decrease of patients concentration. Mean SP sFas concentration in oligospermic patients was 2.62 +/- 1.11, while in non-oligospermic patients was 3.36 +/- 1.08 with a significant decrease in oligospermic compared to non-oligospermic concentrations. Mean SP sFas levels in patients was inversely correlated with the varicocele grade and a positive significant correlation with sperm concentration. Postoperative SP sFas showed a significant increase in patients compared to their preoperative levels, but still significantly lower compared to control levels. The SP sFas increased in oligospermic patients more than in non-oligospermic patients. It could be concluded that varicocele could reduce male fertility via induction of Fas-mediated apoptosis of germ cells and this effect could be ameliorated by varicocelectomy with a more beneficial results in patients with oligospermia