title: Grade 3 varicocele in fertile men: a different entity.
abstract: OBJECTIVE
  Although varicocele size has an inverse relationship with baseline semen parameters and a direct relationship with seminal reactive oxygen species in infertile patients, to our knowledge the effect of varicocele grade in fertile men is unknown. We evaluated the impact of varicocele grade on seminal parameters, testicular size and seminal reactive oxygen species in fertile men.
  
  
  METHODS
  We prospectively evaluated 194 men from July 2004 to April 2010. Of the men 156 were fertile and classified by presence of varicocele. A total of 38 infertile patients with varicocele as the only identifiable cause of infertility comprised the control group. Physical examination, semen parameters and seminal reactive oxygen species were compared between the groups.
  
  
  RESULTS
  Of 156 fertile men 43 (24.3%) had clinical varicocele, which was grade 1 to 3 in 22, 11 and 10, respectively. The remaining 113 men (72.7%) had no varicocele. Infertile men had smaller testes, decreased semen parameters and higher seminal reactive oxygen species than the fertile groups. Testicular size, reactive oxygen species and semen parameters did not differ between fertile men with vs without varicocele. Fertile men with varicocele grade 3 had higher seminal reactive oxygen species than those with lower grade varicocele. As varicocele grade increased, seminal reactive oxygen species increased and sperm concentration decreased.
  
  
  CONCLUSIONS
  Although fertile men have more efficient defense mechanisms to protect against the consequences of varicocele on testicular function, these mechanisms may not be sufficient in those with varicocele grade 3. Further research is needed to clarify whether they are at increased risk for future infertility.
authors.affiliation: Department of Urology, University of São Paulo, São Paulo, Brazil. mcocuzza@uol.com.br
authors.forename: Marcello
authors.initials: M
authors.lastname: Cocuzza
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Athayde
authors.forename: Conrado
authors.initials: C
authors.lastname: Alvarenga
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.forename: Jorge
authors.initials: J
authors.lastname: Hallak
mesh_terms: D000328:Adult; D005298:Fertility; D006801:Humans; D008297:Male; D009929:Organ Size; D011446:Prospective Studies; D017382:Reactive Oxygen Species / Q000032:analysis*; D012661:Semen / Q000737:chemistry*; D055101:Semen Analysis; D013737:Testis / Q000473:pathology*; D014646:Varicocele / Q000145:classification
chemical_list: D017382:Reactive Oxygen Species