Bilaterality of varicocele: The overlooked culprit in male infertility. Case series study.

OBJECTIVES: Varicocele is the most common correctable cause of male infertility that always has been a debatable subject as regards how it affects fertility and the best way to treat it. Proper assessment of the disease bilaterality is crucial not to miss one side and not to jeopardize treatment outcome. This study aimed to objectively assess varicocele bilaterality in infertile men aiming to improve treatment outcome in this cohort of patients. METHODS: This prospective study was conducted between January 2019 and January 2022 including infertile males with varicoceles. Assessment of missed concomitant contralateral varicocele done pre-operatively by Color Doppler Ultrasound and intraoperatively by intraoperative Doppler device and measurement of maximal vein diameter of contralateral side. RESULTS: A total of 329 cases completed the study. A hundred cases (30.4%) were initially referred as unilateral varicoceles and 229 (69.6%) as bilateral varicoceles. After reassessment of the study population, bilaterality of varicocele was found to be as high as 98.5% (324/329). Repeat CDUS strongly correlated with the intraoperative measured varicocele diameter (r = 0.9, p < 0.001). Moreover, sperm parameters showed significant improvement 3 and 6 months post varicocelectomy. Normal pregnancy after 1 year of surgery occurred in 118 cases (35.9%). CONCLUSIONS: Varicocele bilaterality in infertile men is underreported. Thorough assessment by expert radiologists and andrologists is of paramount importance not to miss significant pathology or hazard treatment outcome.

Effects of herbal supplements on milk production quality and specific blood parameters in heat-stressed early lactating cows.

The present study explored the influence of supplemental herbal mixtures on cow milk production, quality, and blood parameters in dairy cows under high ambient temperatures. Thirty Holstein cows were randomly assigned into three experimental groups of 10 each. The first control group was supplied with the commercial basal diet, whereas two treatment groups were provided with the commercial basal diet supplemented with 50 and 100 g/head/day of the herbal mixture, respectively. The results showed that the mixture of herbal supplementation did not influence weekly milk production. Milk total fat, triglyceride, and total protein values were not affected (p < 0.05) in cows fed on basal diets supplemented with herbal mixture; however, milk cholesterol was decreased significantly by 100 mg/head/day of the herbal mixture. On the other hand, lactose has increased significantly by adding 100 mg/head/day of herbal mixture. Furthermore, the total cholesterol level in serum was decreased by adding 100 mg/head/day of the herbal mixture, while plasma prolactin, cortisol, GOT, and GPT were unaffected. Regarding fatty acids (C18, C18:1 (c9), 18:1 (c11), 18:2 (c9, c12), 18:2 (t9, t12), and CLA (c9, t11)), there was no significant variation between the groups. Meanwhile, both C19:00 and 18:3 (c6, c9, and c12) were noticeably higher (p < 0.05) in the group that received 100gm, followed by 50 mg, compared to the control. In conclusion, the supplement with a herbal mixture positively affected milk quality by decreasing total cholesterol and increasing lactose, milk fatty acid profile by increasing unsaturated fatty acids content, and plasma cholesterol levels.