Reply to Eugenio Ventimiglia, Francesco Montorsi, and Andrea Salonia's Letter to the Editor re: Jakob Damsgaard, Ulla N. Joensen, Elisabeth Carlsen, et al. Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels: A Study of 7035 Healthy Young Men from Six European Countries. Eur Urol 2016;70:1019-29

Autor: Helena E. Virtanen, Birute Zilaitiene, Valentinas Matulevičius, Ulla Nordström Joensen, Andrea Salzbrunn, Jakob Damsgaard, Inge A. Olesen, Antti Perheentupa, Jorma Toppari, Martin Blomberg Jensen, Niels E. Skakkebæk, Juris Erenpreiss, Elisabeth Carlsen, Margus Punab, Anders Juul, Niels Jørgensen
Rok vydání: 2016
Předmět:
Zdroj: European urology. 71(2)
ISSN: 1873-7560
Popis: We thank Drs Ventimiglia, Montorsi, and Salonia for their interest in our publication [1] and for their constructive comments. Ventimiglia et al consider our use of the most recent WHO reference levels [2] to estimate some of the effects of varicocele a subtle limitation. We used standardized, coordinated, and unchanged assessment methods throughout the study based on the WHO 1992 guideline [3] and modified after our study of interlaboratory variation [4]. To make effect estimates useful for most clinicians today, we used 2010 reference ranges to define a category of ‘‘low semen quality’’ by incorporating sperm concentration, motility, and morphology. The ‘‘high semen quality’’ group had semen quality above such levels that were associated with increased time to pregnancy or reduced fertility in the literature [5–8]. While the limits for ‘‘normal’’ semen quality can certainly be discussed, we do not believe that our methods constitute a limitation as such, but rather a choice of interpretation. Neither previous literature nor the current study suggests that varicocele is associated with other causes of impaired spermatogenesis. While we cannot eliminate the possibility of residual confounding from uneven distribution of unknown causes of spermatogenic dysfunction, as pointed out by Ventimiglia et al, our sample size of 7035 men from several European countries and the low prevalence of other known causes of impaired spermatogenesis should minimize this type of bias. We agree that our study implies that varicocele damages testicular function shortly after puberty. Evidently, we must keep in mind that conclusion on changes over time or on the prudence of early varicocele repair [2_TD$DIFF]cannot be drawn fromour study. Some studies indicate a progressive negative effect on testicular volume during adolescence [9], and potentially
Databáze: OpenAIRE
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