|Year : 2014 | Volume
| Issue : 10 | Page : 532-535
Prevalence of varicocele among primary and secondary infertile men: Association with occupation, smoking and drinking alcohol
Hamid Shafi1, Seddigheh Esmaeilzadeh2, Mouloud Agajani Delavar3, Fatemeh Hosseinpour Haydari2, Neda Mahdinejad2, Sharare Abedi2
1 Department of Urology, Fatemezahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
2 Department of Obstetrics and Gynecology, Fatemezahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
3 Department of Midwifery, Fatemezahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
|Date of Web Publication||20-Oct-2014|
Mouloud Agajani Delavar
Department of Midwifery, Fatemezahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol
Source of Support: Financial support was provided by Babol University
of Medical Sciences, Iran., Conflict of Interest: None
Background: Existing data suggests that varicocele plays a central role in progressive infertility. Aims: This study was designed to assess the occupational and lifestyle factors of development of varicocele among male infertile, for a better prevention and management of the varicocele. Materials and Methods: All males with infertility, who presented at Fatemezahra Infertility and Reproductive Health Research Center between April 2010 and February 2011, were examined. Their occupations, smoking, and drinking alcohol, presence or absence of varicocele were evaluated. The lifestyle factors associated with varicocele were analyzed. Results: The data of 816 men, aged 21-71 years, were included in the study. Two hundred and sixty-one men (32%) with varicocele and 555 (68%) without varicocele were found. Percentage of varicocele was significantly higher in smokers compared with non-smokers (P = 0.035). The adjusted OR for varicocele in smokerswas significantly higher than that in non-smoker (OR = 2.420; 95% CI = 1.04, 5.61). No significant differences were seen between varicocele and occupation or alcohol drinking for the prevalence of varicocele. Conclusions: The findings of the present study indicated that a high frequency of varicocele was indentified among male infertile. Therefore, it is necessary for those male cigarette-smokers to evaluate their possibilities of infertility and varicocele.
Keywords: Alcohol drinking, Infertility, Male, Occupations, Smoking, Varicocele
|How to cite this article:|
Shafi H, Esmaeilzadeh S, Delavar MA, Haydari FH, Mahdinejad N, Abedi S. Prevalence of varicocele among primary and secondary infertile men: Association with occupation, smoking and drinking alcohol. North Am J Med Sci 2014;6:532-5
|How to cite this URL:|
Shafi H, Esmaeilzadeh S, Delavar MA, Haydari FH, Mahdinejad N, Abedi S. Prevalence of varicocele among primary and secondary infertile men: Association with occupation, smoking and drinking alcohol. North Am J Med Sci [serial online] 2014 [cited 2019 Dec 13];6:532-5. Available from: http://www.najms.org/text.asp?2014/6/10/532/143285
| Introduction|| |
Varicocele is a condition involving spermatogenesis and a major cause of male infertility.  Prevalence of varicocele is varied considerably between general population and infertile men. , It is important to note that not all men who have varicocele are infertile, but varicocele is more common in the men attending the infertility clinics. , In addition, varicocele is more frequent in man with primary infertile than with secondary infertility.  The pathogenesis and etiology of varicocele is mulifactorial. 
A number of studies discussed the relationships between anthropometric parameters and varicocele. ,, Some literatures have emphasized that occupational exposure, cigarette smoking and drinking are associated with infertility, ,,,,,, while other studies have excluded these associations with infertility. , Some of lifestyle factors may be linked to varicocele in infertile men, such as smoking, alcohol consumption, and occupational exposure, these are associated with varicocele and increase the risk of infertility.  Therefore, further research is needed in order to elucidate the associations of smoking, occupation, and drinking with development of varicocele in male infertile.
| Materials and Methods|| |
The research design of this study was a retrospective cross-section. The study was based on secondary data from the Infertility and Reproductive Health Center. Inclusion criteria for the study were men with infertility who presented to our center between April 2010 and February 2011. A total of 816 patients were selected and reviewed based on inclusion criteria. Demographic data, including age, education level, residence, occupation, type of infertility, age at marriage, duration of infertility and data about smoking habits and alcohol consumption was summarized in [Table 1].
|Table 1: Chracteristics of male infertile in groups with and without varicocele|
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All subjects were classified as presence or absence of varicocele. Varicocele was diagnosed in the center during physical examination in the upright position, and confirmed using the scrotal ultrasonography.
The Ethical Committee of Medical Faculty of Babol University of Medical Sciences approved the study. Informed consent was obtained from all subjects.
SPSS software version 16.0 (SPSS Inc, Chicago, USA) was used for statistical analyses. Descriptive statistics were used to describe baseline demographic. The final multivariate model that included varicocele as dependent variables were related to the outcome (P = 0.2 in bivariate analyses). Adjusted regression analysis was used to test associations between categorical occupations, smoking, and drinking with varicocele . All independent variables that met the above criteria were included in the multiple logistic regression. A P-value less than 0.05 was significantly considered.
| Results|| |
A total of 816 infertile men were referred to the center. 74.6% of the patients had primary infertility and 25.4% secondary infertility. The overall prevalence of varicocele accounted for 32.0% (CI 95%; 28.1, 36.0) among the infertile men. Moreover, varicocele accounted for 32.2% (CI 95%, 29.3, 37.1) of patients with primary infertile, and 28.5% (CI 95%; 26.5; 30.5) with secondary infertile. No significant differences were seen between the type of infertility and varicocele.
The mean age was 31.6 ± 6.4 years old (21-71 years). The mean age in the group with varicocele (30.9-years old) was significantly younger than that without varicocele (31.9-years old) (P = 0.019). The mean age at current marriage was 25.6 ± 4.9 for varicocele and 26.4 ± 5.7 for non-varicocele, there was a significant difference between them (P = 0.02). The mean body mass index (BMI) and infertility duration had no significantly difference in those with or without varicocele. 61.3% of male infertile was urban residence. There was no significant relations between varicocele prevalence and resident location. Overall, male with varicocele was more frequently current smokers than those without varicocele. Chi-square test showed no significant difference between the alcohol drinking and varicocele. More than 68% of male infertile had an elementary educational level. Chi-square test showed no significant relation between the varicocele group and education level.
[Table 2] presents the estimated adjusted odds ratio (with 95% CI) for varicocele in relation of occupation, smoking habits, and drinking alcohol in male infertile. The adjusted OR in smokers was higher than those in the non-cigarette-smoking individuals (OR = 2.42, 95% CI = 1.04, 5.61). In No significant association was seen between the occupation and drinking alcohol in those with varicocele and without varicocele.
|Table 2: Adjusted ratio (OR) for varicocele according to occupation, smoking habits, and drinking of the subject (n = 816)|
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| Discussion|| |
Most of the studies have showed a higher prevalence of primary infertility compared with secondary infertility. , However, men with the secondary infertile have an opportunity for future fertility, because varicocele is more frequently common in secondary infertile men. , In this study, approximately 75% of infertile men had primary infertility and over 25% had secondary infertility; around 32% of infertile men had varicocele. However, Nielson reported 15%-20% of men with infertility had varicocele.  A possible explanation for relatively higher prevalence of varicocele in infertile men in our study may be due to the various somatometrics parametric and environmental factors.  In addition, those individuals with mild varicocele should not be missed in physical examination.
Despite a large number of researches regarding the effect of smoking on male infertility, the relationship between varicocele and smoking is still in debate. ,,, It is suggested that smoking may have a greater adverse influence on the varicocele.  In the present study, we also found that smoking increased the risk of varicocele. Cigarette smoking increase an accumulation of cadmium in testes, and may cause testicular damage in men with varicocele. , Men with varicocele seem more frequently to suffer from infertility than the men without varicocele. A large size of prospective study is, therefore, needed in order to clarify the importance of smoking in relation to varicocele risk factors among infertile men.
Some recent studies, which focused on the impact of occupation and alcohol on infertility, showed that alcohol intake and occupational factors influenced the reproductive system. , A number of findings have demonstrated the relationship between occupation and risk of infertility.  Industrial and construction workers or agriculture worker may have an increased prevalent of infertility. , Although the role of alcohol intake and occupation on varicocele is unclear, our results do not support the hypothesis that the alcohol intake and occupational factors such as industrial and agriculture workers is closely related to varicocele in infertile men. Therefore, a further prospective study is proposed to elucidate the association of alcohol and occupation with varicocele risk factor in male infertile.
The present study examined a convenience sample, the studies in the future should use population-based random sample, which may provide stronger evidence with the associations between varicocele and infertility. In addition, the unavailability of some information, such as exact nature of men occupation, and amount of drinking and smoking caused an decrease in the number of variables in our present study. Finally, this study did not assess the causality, whereas a case-control study could represent more appropriate in assessing the causes or risk factor associated with varicocele.
| Conclusions|| |
Varicocele alone constituted for 32.0% of infertile men, and was associated with smoking. This percentage was nearly comparable with the findings from other studies. Despite the limitation, the prospective study demonstrated a strong association between infertile and varicocele. Therefore, further studies are needed to make a recommendation or guideline for a better prevention and management of varicocele.
| Acknowledgments|| |
The authors gratefully acknowledge the assistance of Babol University of Medical Sciences and the assistance of the health care providers in this study.
| References|| |
|1.||Miyaoka R, Esteves SC. A critical appraisal on the role of varicocele in male infertility. Adv Urol 2012;2012:597495. |
|2.||Tarhan S, Ucer O, Sahin MO, Gumus B. Long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow. J Androl 2011;32:33-9. |
|3.||Fode M, Sonksen J. Varicoceles. Ugeskr Laeger 2009;171: 3424-9. |
|4.||Jarow JP. Effects of varicocele on male fertility. Hum Reprod Update 2001;7:59-64. |
|5.||Naughton CK, Nangia AK, Agarwal A. Pathophysiology of varicoceles in male infertility. Hum Reprod Update 2001;7:473-81. |
|6.||Ahmed A, Bello A, Mbibu NH, Maitama HY, Kalayi GD. Epidemiological and aetiological factors of male infertility in northern Nigeria. Niger J Clin Pract 2010;13:205-9. |
|7.||Delaney DP, Carr MC, Kolon TF, Snyder HM 3rd, Zderic SA. The physical characteristics of young males with varicocele. BJU Int 2004;94:624-6. |
|8.||Nielsen ME, Zderic S, Freedland SJ, Jarow JP. Insight on pathogenesis of varicoceles: Relationship of varicocele and body mass index. Urology 2006;68:392-6. |
|9.||Handel LN, Shetty R, Sigman M. The relationship between varicoceles and obesity. J Urol 2006;176:2138-40. |
|10.||Inhorn MC, King L, Nriagu JO, Kobeissi L, Hammoud N, Awwad J, et al. Occupational and environmental exposures to heavy metals: Risk factors for male infertility in Lebanon? Reprod Toxicol 2008;25:203-12. |
|11.||Gaur DS, Talekar M, Pathak VP. Effect of cigarette smoking on semen quality of infertile men. Singapore Med J 2007;48:119-23. |
|12.||Okonofua F, Menakaya U, Onemu SO, Omo-Aghoja LO, Bergstrom S. A case-control study of risk factors for male infertility in Nigeria. Asian J Androl 2005;7:351-61. |
|13.||Martini AC, Molina RI, Estofán D, Senestrari D, Fiol de Cuneo M, Ruiz RD. Effects of alcohol and cigarette consumption on human seminal quality. Fertil Steril 2004;82:374-7. |
|14.||Kunzle R, Mueller MD, Hanggi W, Birkhauser MH, Drescher H, Bersinger NA. Semen quality of male smokers and nonsmokers in infertile couples. Fertil Steril 2003;79:287-91. |
|15.||El-Melegy NT, Ali ME. Apoptotic markers in semen of infertile men: Association with cigarette smoking. Int Braz J Urol 2011;37:495-506. |
|16.||Collodel G, Capitani S, Pammolli A, Giannerini V, Geminiani M, Moretti E. Semen quality of male idiopathic infertile smokers and nonsmokers: An ultrastructural study. J Androl 2010;31:108-13. |
|17.||Jensen TK, Jorgensen N, Punab M, Haugen TB, Suominen J, Zilaitiene B, et al. Association of in utero exposure to maternal smoking with reduced semen quality and testis size in adulthood: A cross-sectional study of 1,770 young men from the general population in five European countries. Am J Epidemiol 2004;159:49-58. |
|18.||Gracia CR, Sammel MD, Coutifaris C, Guzick DS, Barnhart KT. Occupational exposures and male infertility. Am J Epidemiol 2005;162:729-33. |
|19.||Collodel G, Capitani S, Iacoponi F, Federico MG, Pascarelli NA, Moretti E. Retrospective Assessment of Potential Negative Synergistic Effects of Varicocele and Tobacco Use on Ultrastructural Sperm Morphology. Urology 2009;74:794-9. |
|20.||Elussein EA, Magid YM, Omer MM, Adam I. Clinical patterns and major causes of infertility among Sudanese couples. Trop Doct 2008;38:243-4. |
|21.||Kantartzi PD, Goulis Ch D, Goulis GD, Papadimas I. Male infertility and varicocele: Myths and reality. Hippokratia 2007;11:99-104. |
|22.||Wagner L, Tostain J; Comite Andrologie de l'Association Française d'Urologie. Varicocele and male infertility: AFU 2006 guidelines. Prog Urol 2007;17:12-7. |
|23.||Prabakaran S, Kumanov P, Tomova A, Hubaveshki S, Agarwal A. Adolescent varicocele: Association with somatometric parameters. Urol Int 2006;77:114-7. |
|24.||Viloria T, Meseguer M, Martínez-Conejero JA, O'Connor JE, Remohí J, Pellicer A, et al. Cigarette smoking affects specific sperm oxidative defenses but does not cause oxidative DNA damage in infertile men. Fertil Steril 2010;94:631-7. |
|25.||Sepaniak S, Forges T, Gerard H, Foliguet B, Bene MC, Monnier-Barbarino P. The influence of cigarette smoking on human sperm quality and DNA fragmentation. Toxicology 2006;223:54-60. |
|26.||Künzle R, Mueller MD, Hänggi W, Birkhäuser MH, Drescher H, Bersinger NA. Semen quality of male smokers and nonsmokers in infertile couples. Fertil Steril 2003;79: 287-91. |
|27.||Taha EA, Ezz-Aldin AM, Sayed SK, Ghandour NM, Mostafa T. Smoking influence on sperm vitality, DNA fragmentation, reactive oxygen species and zinc in oligoasthenoteratozoospermic men with varicocele. Andrologia 2014;46:687-91. |
|28.||Fariello RM, Pariz JR, Spaine DM, Gozzo FC, Pilau EJ, Fraietta R, et al. Effect of smoking on the functional aspects of sperm and seminal plasma protein profiles in patients with varicocele. Hum Reprod 2012;27:3140-9. |
|29.||Benoff SH, Millan C, Hurley IR, Napolitano B, Marmar JL. Bilateral increased apoptosis and bilateral accumulation of cadmium in infertile men with left varicocele. Hum Reprod 2004;19:616-27. |
|30.||Okonofua FE, Shittu SO, Oronsaye F, Ogunsakin D, Ogbomwan S, Zayyan M. Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria. Acta Obstet Gynecol Scand 2005;84: 270-80. |
|31.||Joo KJ, Kwon YW, Myung SC, Kim TH. The effects of smoking and alcohol intake on sperm quality: Light and transmission electron microscopy findings. J Int Med Res 2012;40: 2327-35. |
|32.||Queiroz EK, Waissmann W. Occupational exposure and effects on the male reproductive system. Cad Saude Publica 2006;22:485-93. |
|33.||Jensen TK, Bonde JP, Joffe M. The inﬂuence of occupational exposure on male reproductive function. Occup Med (Lond) 2006;56:544-53. |
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