Leydig Cell Function in Oligospermicmen with Varicocele

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Abstract
The evaluation of Leydig cell function in 16 young men with sperm counts less than 10 million/ml and with various degrees of unilateral or bilateral varicocele was presented. An in vitro technique of incubation of testicular tissue with radiolabeled precursors was used for evaluation of Leydig cell androgen synthesis. A significant suppression of in vitro testosterone formation was observed in almost 90% of the patients. Circulating testosterone and luteinizing hormone levels were within the normal range. However, when the patients were grouped according to the in vitro testosterone synthesis data a correlation between the circulating testosterone and gonadotropin levels was observed. Sperm motility was highest for patients with highest testosterone synthesis rates. No correlation among the ages of the patients, size of varicocele, degree of oligospermia or histologic appearance of the seminiferous epithelium could be demonstrated. An increased Leydig cell number was observed in testes with highest in vitro testosterone formation. Since testicular volume was lowest in this group, this finding could represent a relative rather than an absolute increase in Levdig cell density. No improvement in sperm count or motility was observed after varicocelectomy and no pregnancies occurred. A disturbance of androgen biosynthesis in testes of men with varicocele and sperm counts < 10 million per ml was shown. Consequently, Leydig cell function should be evaluated carefully in all oligospermic patients regardless of the presence of varicocele. Plasma testosterone levels are not sufficiently sensitive tests of testicular function. If Leydig cell dysfunction is diagnosed in men with varicocele, medical treatment in addition to varicocelectomy should be considered.