Accumulation of cadmium and iron in the hydrocele fluid of infertile men with primary varicocele; a possible role in male infertility

ABSTRACT

Varicoceles are a common cause of male infertility, but despite data from human studies the pathophysiology remains unclear. Seminal plasma cadmium concentrations were found to be increased in infertile men. In addition, increases in blood plasma cadmium concentrations in infertile men have been associated with terat-ozoospermia. Cadmium contributes to infertility by induction of apoptosis in testicular tissue. An ejaculate and blood sample were collected immediately before surgery followed by aspiration of hydrocele fluid from the tunica vaginalis at the time of subinguinal varicocelectomy. In each specimen, cadmium and iron levels were determined by atomic absorption and the effect of hydrocele fluid on the sperm velocity was determined by examining aliquots of sperms suspended in hydrocele fluid compared to those suspended in seminal plasma. The cadmium and iron levels were higher in the hydrocele fluid than the peripheral blood in 72% and 46% of patients with bilateral varicocele respectively. Hydrocele fluid added to the sperms, initially increased the motility for 10 to 15 minutes then the velocity diminished gradually and eventually all the sperms became immotile in 30 minutes. 1-The hydrocele fluid in patients with varicocele has a deleterious effect on the sperm vitality. 2- The increased cadmium and iron concentrations in the hydrocele fluid are probably derived from the increased transvascular fluid exchange which occurs with vaticocele. 3- These metal ions may diffuse from the hydrocele fluid to the sperms during their maturation in the epididymis and induce their acrosmal insufficiency effect. 4- Impregnation rate was higher after surgical correction of varicocele and removal of hydrocele fluid in those patients who presented with high preoperative levels of cadmium and iron