Abstract
Varicocele is one of the major causes of infertility in men.Although there are different theories related to the pathophysiology of the varicocele, the exact pathophysiologic mechanism remains unknown.Sperm DNA damage may be the cause of undiagnosed infertility problems.The standard semen examination may not be sufficient to determine the etiology of infertility.For this reason, extra tests are needed to identify sperm DNA damage.Despite conflicting reports, many studies have shown that varicocele repair improves the quality of sperm DNA.Another mechanism related to the association between varicoceles and male infertility is increased oxidative stress (OS) [21,22].Varicoceles may increase reactive oxygen species (ROS) production and decrease antioxidant capacity.Thus, varicoceles can cause OS [23][24][25].A number of studies have demonstrated an increase of OS in serum, semen, and testicular tissues of patients with a clinical diagnosis of varicocele.This suggests that the impairment of sperm parameters found in men with varicocele may be related to oxidative stress [26][27][28][29][30][31].Furthermore, OS may cause mtDNA deletions in human spermatozoa and mtDNA mutations can cause impairment of sperm functions [32].In addition, an abnormal amount of ROS and antioxidants is connected to sperm motility defects and sperm quality [33,34].Other pathologies that could affect the spermatogenesis in patients with varicocele are Y chromosome micro deletions, acrosome reaction disorders, protamine deficiency, and endocrinological changes.Whereas Y chromosome micro deletions are found in 0.3-7% of infertile men, the rate goes up to approximately 18% in varicocele cases with poor semen parameters and testicular hypotrophy [35,36].