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Volume 18, Issue 2 (March 2016) 18, 205–212; DOI:10.4103/1008-682X.172642

Specialized sperm function tests in varicocele and the future of andrology laboratory

Ahmad Majzoub, Sandro C Esteves, Jaime Gosálvez, Ashok Agarwal

1Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; 2Androfert, Andrology and Human Reproduction Clinic, Referral Center
for Male Reproduction, Avenue Dr. Heitor Penteado, 1464, Campinas, SP 13075-460, Brazil; 3Genetics Unit, Department of Biology, Universidad Autónoma de Madrid,
Madrid, Spain; 4American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.

Correspondence: Dr. A Majzoub (majzoua@ccf.org)


Varicocele is a common medical condition entangled with many controversies. Though it is highly prevalent in men with infertility,
still it marks its presence in males who do have normal fertility. Determining which patients are negatively affected by varicocele
would enable clinicians to better select those men who benefi tted the most from surgery. Since conventional semen analysis has
been limited in its ability to evaluate the negative effects of varicocele on fertility, a multitude of specialized laboratory tests have
emerged. In this review, we examine the role and signifi cance of specialized sperm function tests with regards to varicocele. Among
the various tests, analysis of sperm DNA fragmentation and measurements of oxidative stress markers provide an independent measure
of fertility in men with varicocele. These diagnostic modalities have both diagnostic and prognostic information complementary to,
but distinct from conventional sperm parameters. Test results can guide management and aid in monitoring intervention outcomes.
Proteomics, metabolomics, and genomics are areas; though still developing, holding promise to revolutionize our understanding
of reproductive physiology, including varicocele.

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