title: Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels: A Study of 7035 Healthy Young Men from Six European Countries.
abstract: Present knowledge on the impact of varicoceles on testicular function is largely based on studies of subfertile and infertile men, making it difficult to extrapolate the impact of varicocele on the general population.
  
  
  
  To describe associations between varicocele and testicular function assessed by semen analysis and reproductive hormones in men from the general population.
  
  
  
  A cross-sectional multicentre study of 7035 young men, median age 19 yr, from the general population in six European countries (Denmark, Finland, Germany, Estonia, Latvia, and Lithuania) were investigated from 1996 to 2010.
  
  
  
  We analysed results from physical examination, conventional semen variables, and serum reproductive hormones using multivariable regression analyses.
  
  
  
  A total of 1102 (15.7%) had grade 1-3 varicocele. Increasing varicocele grade was associated with poorer semen quality, even in grade 1 varicocele. In grade 3 varicocele, sperm concentration was less than half of that in men with no varicocele. Presence of varicocele was also associated with higher serum levels of follicle-stimulating hormone, lower inhibin B, and higher levels of luteinising hormone; testosterone and free testosterone were not significantly different between men with and without varicocele. This study cannot draw a conclusion on the progressiveness of varicocele or the effect of treatment.
  
  
  
  We demonstrated an adverse effect of increasing grade of varicocele on testicular function in men not selected due to fertility status.
  
  
  
  The presence and increasing grade of varicocele is adversely associated with semen quality and reproductive hormone levels in young men from the general population.
authors.affiliation: University Department of Growth and Reproduction, Rigshospitalet, and International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Damsgaard
authors.affiliation: University Department of Growth and Reproduction, Rigshospitalet, and International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ulla N
authors.initials: UN
authors.lastname: Joensen
authors.affiliation: Department of Fertility, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Carlsen
authors.affiliation: Biomedicine Study and Research Center, Riga, Latvia.
authors.forename: Juris
authors.initials: J
authors.lastname: Erenpreiss
authors.affiliation: University Department of Growth and Reproduction, Rigshospitalet, and International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Blomberg Jensen
authors.affiliation: Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Valentinas
authors.initials: V
authors.lastname: Matulevicius
authors.affiliation: Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Birute
authors.initials: B
authors.lastname: Zilaitiene
authors.affiliation: University Department of Growth and Reproduction, Rigshospitalet, and International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Inge A
authors.initials: IA
authors.lastname: Olesen
authors.affiliation: Institute of Biomedicine, Department of Physiology, University of Turku, and Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Perheentupa
authors.affiliation: Andrology Unit, Tartu University Hospital, Tartu, Estonia.
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.affiliation: Department of Andrology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salzbrunn
authors.affiliation: Department of Physiology, Institute of Biomedicine, University of Turku, and Department of Paediatrics, Turku University Hospital, Turku, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Toppari
authors.affiliation: Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland.
authors.forename: Helena E
authors.initials: HE
authors.lastname: Virtanen
authors.affiliation: University Department of Growth and Reproduction, Rigshospitalet, and International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Juul
authors.affiliation: University Department of Growth and Reproduction, Rigshospitalet, and International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Niels E
authors.initials: NE
authors.lastname: Skakkebæk
authors.affiliation: University Department of Growth and Reproduction, Rigshospitalet, and International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: Niels.Joergensen@regionh.dk.
authors.forename: Niels
authors.initials: N
authors.lastname: Jørgensen
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003718:Denmark; D004957:Estonia; D005387:Finland; D005640:Follicle Stimulating Hormone / Q000097:blood*; D005858:Germany; D064368:Healthy Volunteers; D006801:Humans; D007248:Infertility, Male / Q000453:epidemiology*; D007265:Inhibins / Q000097:blood*; D007844:Latvia; D008097:Lithuania; D007986:Luteinizing Hormone / Q000097:blood*; D008297:Male; D015999:Multivariate Analysis; D055101:Semen Analysis; D013739:Testosterone / Q000097:blood*; D014646:Varicocele / Q000453:epidemiology*; D055815:Young Adult
chemical_list: C422364:inhibin B; D013739:Testosterone; D007265:Inhibins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
keywords: Fecundity; Reproductive hormones; Semen quality; Varicocele