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Hypospermia and Its Relationship to Varicocele and Intrascrotal Temperature
Hyposperrnia and Its Relationship to Varicocele and Intrascrotal Tern perature JACKIE D. STEPHENSON, MAJ. (MC), and EDWARD J. O'SHAUGHNESSY, COL. (MC)
THAT HYPOSPERMIA may result from exposure of the testicles to slight increases in temperature has been suggested for many years. During the past 15 years, the relationship of varicocele to infertility has been studied extensively in England and to a lesser extent in the United States. 1 , 9 Elevation of the testicular temperature by the varicocele has been proposed as the etiology of this phenomenon. 2 , 3, 8, 10 In this report an effort is made to clarify the relationship of varicocele, testicular temperature, and hypospermia.
HISTORY In 1550, Ambrose Pare defined a varicocele as a compact group of vessels filled with "melancholic" blood. 11 For nearly 400 years, little additional information was published on varicocele. In 1918, Ivanissivich described the venous drainage of the testicle and scrotum. 4 Pain was the primary consideration in the treatment of varicocele until 1952, when Tullock proposed a relationship between varicocele and infertility and reported restoration of fertility following varicocele ligation. 10 , 11 He reported the cases of 82 patients with counts below 20 million per cubic centimeter. Within 6 months, 83.7% were judged fertile, and in 48 of 57 patients with less than 10% motility before treatment, this rating was increased to over 50% after ligation. Subsequent reports!' 5, 7, 8, 12 substantiated the increased incidence of subfertility associated with varicocele. It was also observed that a varicocele that persists in men older than 30 years is more likely to be associated with subfertility.6 From the Urology Serviee, Department of Surgery, TripIer Army Medical Center, Honolulu, Hawaii. Presented at the 23rd AnnJlal Meeting of the American Fertility Society, Apr. 14.-16, 1967, Washington, D. C.
110
VOL.
19, No.1, 1968
HYPOSPERMIA
111
Young proposed two possible mechanisms by which varicocele may induce hypospermia: (1) venous congestion giving rise to anoxia with lack of nutrition of the delicate germinal epithelium; (2) elevation of testicular temperature. In 1956 Hanley reported that normal temperature of the scrotal septum is approximately 2.5 C. lower than that of the rectum. 2 ,3 A large varicocele, he believed, reduced this differential to approximately 1 0 C. The removal of a moderate-sized varicocele generally lowered the intrascrotal temperature by about 1 0 C. He also reported 5 cases in which varicocele ligation produced no demonstrable change in scrotal temperature although the patients experienced marked improvement in fertility; these experiences suggested that a factor other than temperature is involved in hypospermia. Hanley's work was essentially undisputed until 1966, when Tessler and Krahn attempted to duplicate his data. 9 They inserted a needle thermocouple directly into each testicle and into the thigh percutaneously. In their series the differential between intratesticular and thigh temperatures was only slightly greater than 1 0 C. in both normal patients and those with varicoceles. Also, variations in testicular temperature in the supine and erect positions were less than 1 0 C. 0
CLINICAL OBSERVATION
From January 1965 to January 1967, 40 men were surgically treated for varicocele. The operation in all cases was high ligation of the left spermatic vein through a transverse muscle-splitting incision at the level of the anterior superior iliac spine. The chief complaint in 35 cases was pain; the remaining 5 patients had been referred for infertility evaluation. Sperm counts were obtained from all patients as part of the preoperative evaluation. The number of patients with sperm counts below 20 million is striking (Tables 1 and 2). Seventy per cent of these patients were subfertile, and only 4 patients (10%) had sperm counts greater than 50 million per cubic centimeter (Fig. 1). An attempt to obtain a 3-month postoperation sperm count was successful in 9 patients (Table 2). The counts in 6 patients were within fertile levels (a sperm count of 20 million or greater, and a motility of 60% or greater). Two patients' sperm counts improved, but not to fertile levels. One patient's sperm count did not improve. Another patient had no followup spenn count; however, his wife became pregnant twice in less than 2 years.
112
STEPHENSON
& O'SHAUGHNESSY
FERTILITY
& STERILITY
TABLE 1. Preoperative Sperm Counts in 30 Patients with Varicoceles Patient
Age
Sperm count (per cc.)
Motility (%)
G.T. D.C. W.A. J.A. M.O. H.D. D.D. A.F. J.F. R H. D.J. C.L. S.L. C.McC. R McC. J.McD. RM. J.M. C.M. RR Y.S. RM. A.L. S. v. H.C. G.H. C.W. G.B. K. S. RI.
27 19 48 24 24 21 24 18 20 17 19 27 18 25 23 25 22
450,000 35,750,000
80 80-85
None seen
7,100,000 5,950,000 90,909 126,000,000 22,400,000 60,700,000 54,400,000 30,000,000 17,750,000 4,300,000 3,200,000 8,500,000 85,300,000 8,250,000
24
None seen
20 22 24 24 21 21 22 29 20 20 25 24
28,800,000 35,200,000 8,900,000 2/HPF 9,2oo,ooU 22,200,000 3,300,000 48,000,000 23,600,000 3,000,000 1,150,000
30 80 45 85 70 50 70 85 40 50 20 30 50 70 65 70 40 85-9v 85-90 35-45 90 4045 85-90 20
None seen
METHOD
In view of the conflicting reports concerning the existence of a significant reduction by the varicocele, of the differential between intrascrotal and body temperature, a study was undertaken in an attempt to reproduce Hanley's data. A thermistor needle telethermometer probe was inserted into the scrotal septum for the full length of the needle, and a rectal telethermometer was used to record body temperature. The scrotal septal and rectal temperatures of patients having elective circumcisions were measured as controls. Varicocele patients were tilted feet downward to approximately 30°, or until their varicoceles were obviously distended. Initially, all measurements were made under spinal anesthesia, and the patients were
VOL.
19, No.1, 1968
11:3
HYPOSPERMIA
TABLE 2. Preoperative and Postoperative Sperm Counts in 10 Patients with Varicoceles 3 months after operation
Before operation Name
Age
Sperm count (per cc.)
V.V. D.W. T.M. O.B. R. F. D.J. M.N. C. C. J.W. W.S.
33 24 23 26 20 24 24 21 36 32
8,500,000 None seen None seen 150,000 12,700,000 3,200,000 5,500,000 19,600,000 150,000 14,000,000
* No follow-up
Sperm count (per cc.)
Motility (%)
Motility (%)
85-90 60
22,050,000 38,500,000 None seen 12,200,000 50,000,000 37,600,000 34,700,000 57,000,000 5,500,000
40-50 50-60 85 10-20 80 85 50
80 25-30 70 60
75 50
-*
count, but 2 children in 2 years.
70 % r60 % Fig. 1. Preoperative spenn counts of patients with varicoceles (millions per cubic centimeter).
V)
-
50%0 -
:SI
~~: :}1
f-
Z40 %fUJ f-
~30%or-
~fJ,R J
20 % -
Jj
10%o 0%0
S
11
12
0
o-5
5-20
8
4
20·50 ABOVE 50
"prepped" for 10 min. with PhisoHex* and water at room temperature. With this regimen, a wide range of temperature differentials was noted in both groups. This method may have resulted in cooling the scrotal contents. Thereafter, PhisoHex and water were used at 37° C., and the temperature differential became stabilized. However, this method conceivably could increase the temperature of the scrotal contents. To reduce the effects of these variables to the minimum, all subsequent temperatures were recorded *Winthrop Laboratories, New York, N. Y.
114
STEPHENSON
&
O'SHAUGHNESSY
FERTILITY
& STERILITY
with no surgical preparation and no anesthesia other than for a tiny skin wheal where the probe entered the scrotum. RESULTS
Measurement of intrascrotal and rectal temperatures without surgical preparation or anesthesia in 3 patients with varicoceles revealed the average intrascrotal temperature to be 0.9 0 C. less than that of the rectum (Table 3). For 13 control patients without varicoceles, the average intrascrotal temperature was 0.6 0 C. less than body temperature (Table 3, Fig. 2). TABLE 3. Intrascrotal and Rectal Temperatures (OC.) Temperature Name
Rectal
Scrotal
Difference
PATIENTS WITH VARICOCELES
M.D.*
J.
S.t
R.I.
A.L. R.M.
37.3 37.3 37.0 36.6 36.3 36.0 36.0 36.0 37.0 37.0 36.6 36.6 36.8 Rfi.R
30.3 30.3 30.8 32.5 33.8 35.3 36.0 34.6 35.0 35.0 36.0 36.0 36.5 36.6
7.0 7.0 6.2 4.1 2.5 0.7 0.0 1.4 2.0 2.0 0.6 0.6 0.3 0.2
PATIENTS WITHOUT VARICOCELES
E. C.* W.D.*
B.
S.t
P.F. H. K.
::l7.0 36.6 36.6 37.8 37.4 37.3 37.3 37.3 37.1 36.3 36.3 37.0 37.0
33.8 34.6 33.0 33.0 31.6 32.5 37.3 37.6 37.3 34.6 34.6 37.0 36.9
3.2 2.0 3.6 4.8 5.8 4.8 0.0 0.3 0.2 1.7 1.7 0.0 0.1
VOL.
19, No.1, 1968
115
HYPOSPERMIA
TABLE 3. (Continued) Temperature Name
Rectal
Scrotal
J. G.
37.1 37.0 37.7 37.7 36.8 36.8 37.0 37.7 37.0 37.7 37.0 36.9 37.9 37.8 36.4 36.5 35.7 35.7 36.4 36.4 37.3 37.3
37.3 37.0 37.0 37.0 34.3 35.0 36.3 36.3 37.7 37.7 37.0 37.3 37.0 37.1 35.0 36.5 35.6 35.7 37.0 37.0 37.2 37.2
G.P. H.H. C. R.
J. V. J.McG. M.S. L.M. K. C. N.B.
R.G.
Difference
0.2 0.0 0.7 0.7 2.5 1.8
0.7 0.4 0.7 0.0 0.0 -0.4 0.9 0.7 1.4 0.0 0.1 0.0 -0.6 -0.6 0.1 0.1
* Spinal anesthesia and preparation at room temperature. t Spinal anesthesia and preparation at 37° C. 38 .37
(J
e-
O
e-
0
LI.I
...
:;) 34
0
x
35
A::
+
CC A:: 33
+eO
0
z 36
e+
x
e-
0
-9-
+e
+
oS
e-
-e +
+
X
x
e+
e+
e-
+
-e +
-9-
+ +
+
o - VARICOCELE - RECTAL TEMP
LI.I
x - VARICOCELE - SCROTAL SEPTAL TEMP
a.
:E 32
-9--
LI.I
CONTROL - RECTAL TEMP
+ - CONTROL - SCROTAL SEPTAL TEMP
... 31 x
30
A
C
Fig. 2. Intrascrotal and rectal temperatures in patients with varicoceles and in controls. A indicate spinal anesthesia and room-temperature preparation; B, spinal anesthesia and 37° C. preparation; C, no anesthesia and no preparation.
116
STEPHENSON & O'SHAUGHNESSY
FERTILITY & STERILITY
DISCUSSION
Previous experiments have yielded conflicting results concerning the effect of varicocele on testicular temperature. In the present study of 14 controls and 5 patients with varicoceles, the rectal and scrotal septal temperatures were carefully measured with the elimination of essentially all variables except for presence or absence of a varicocele. The average intrascrotal temperature was only 0.6 0 C. less than that of the rectum. In patients with varicoceles, the average intrascrotal temperature was 0.9 0 C. less than that of the rectum. Data in this study confirm a definite association of hypospermia with varicocele. However, temperature measurements obtained on controls, as well as on patients with varicoceles, fail to substantiate the statement that varicoceles elevate scrotal temperatures above normal. Thus, the role of the relatively elevated scrotal temperatures associated with varicoceles as the cause of hypospermia cannot be confirmed by this study. SUMMARY
There is a frequently observed, definite relationship between varicocele and hypospermia. The average normal intrascrotal temperature is 0.6 0 C. less than rectal temperature. In the presence of a varicocele, the intrascrotal temperature is 0.9 0 C. less than that of the rectum. \Ve have been unable to demonstrate that normal testicular temperature is significantly Jess than in the presence of a varicocele. How a varicocele is able to suppress spermatogenesis remains unsolved and is a challenging problem for further investigation. 8th Field Hospital Nha Trang, Viet Nam APO 96240, San Francisco, Calif.
REFERENCES 1. DAVIDSON, H. A. Treatment of male subfertility: Testicular temperature and varicoceles. Practitioner 173:703, 1954. 2. HANLEY, H. G. "Surgical correction of errors of testicular temperature regulation." In World Congress on Fertility and Sterility (Proc. 2nd Congr). 1956, p. 953. 3. HANLEY, H. G., and HARRISON, R. G. The nature and surgical treatment of varicocele. Brit] Surg .56:64, 1962. 4. OLSON, R. P., and STONE, E. P. Varicocele: Symptomatic and surgical concepts.
New England] Med 240:877, 1949. 5. RUSSELL, J. K. Varicocele in groups of fertile and subfertile males. Brit M ] i: 1231, 1954. 6. RUSSELL, J. K. Varicocele, a~e, fertility. Lancet ii:222, 1957. 7. SCOTT, L. S. Varicocele, a treatable cause of subfertility. Brit M ] 1:788, 1961.
VOL. 19, No.1, 1968
HYPOSPERMIA
117
8. SCOTT, L. S., and YOUNG, D. H. Varicocele: A study of its effects on human 9.
10. 11. 12.
spermatogenesis, and the results produced by spermatic vein ligation. Pertil Steril 13:325, 1962. TESSLER, A. N., and KRAHN, H. P. Varicocele and testicular temperature. Pertil Steril 17:201, 1966. TULLOCH, W. S. Varicocele in subfertility. Brit M J ii:356, 1955. TULLOCH, W. S. Varicocele. ProG Roy SOG Med 55:1046,1962. YOUNG, D. H. The influence of varicocele on human spermatogenesis. Brit J Urol 28:426, 1956.
American Association of Planned Parenthood Physicians The Sixth Annual Meeting of the American Association of Planned Parenthood Physicians will be held in the Gunter Hotel, San Antonio, Texas, Apr. 16 and 17, 1968. For further information, please contact the Executive Secretary, GEORGE J. LANGMYHR, M.D., Planned Parenthood Federation, 515 Madison Ave., New York, N. Y. 10022.
THAT HYPOSPERMIA may result from exposure of the testicles to slight increases in temperature has been suggested for many years. During the past 15 years, the relationship of varicocele to infertility has been studied extensively in England and to a lesser extent in the United States. 1 , 9 Elevation of the testicular temperature by the varicocele has been proposed as the etiology of this phenomenon. 2 , 3, 8, 10 In this report an effort is made to clarify the relationship of varicocele, testicular temperature, and hypospermia.
HISTORY In 1550, Ambrose Pare defined a varicocele as a compact group of vessels filled with "melancholic" blood. 11 For nearly 400 years, little additional information was published on varicocele. In 1918, Ivanissivich described the venous drainage of the testicle and scrotum. 4 Pain was the primary consideration in the treatment of varicocele until 1952, when Tullock proposed a relationship between varicocele and infertility and reported restoration of fertility following varicocele ligation. 10 , 11 He reported the cases of 82 patients with counts below 20 million per cubic centimeter. Within 6 months, 83.7% were judged fertile, and in 48 of 57 patients with less than 10% motility before treatment, this rating was increased to over 50% after ligation. Subsequent reports!' 5, 7, 8, 12 substantiated the increased incidence of subfertility associated with varicocele. It was also observed that a varicocele that persists in men older than 30 years is more likely to be associated with subfertility.6 From the Urology Serviee, Department of Surgery, TripIer Army Medical Center, Honolulu, Hawaii. Presented at the 23rd AnnJlal Meeting of the American Fertility Society, Apr. 14.-16, 1967, Washington, D. C.
110
VOL.
19, No.1, 1968
HYPOSPERMIA
111
Young proposed two possible mechanisms by which varicocele may induce hypospermia: (1) venous congestion giving rise to anoxia with lack of nutrition of the delicate germinal epithelium; (2) elevation of testicular temperature. In 1956 Hanley reported that normal temperature of the scrotal septum is approximately 2.5 C. lower than that of the rectum. 2 ,3 A large varicocele, he believed, reduced this differential to approximately 1 0 C. The removal of a moderate-sized varicocele generally lowered the intrascrotal temperature by about 1 0 C. He also reported 5 cases in which varicocele ligation produced no demonstrable change in scrotal temperature although the patients experienced marked improvement in fertility; these experiences suggested that a factor other than temperature is involved in hypospermia. Hanley's work was essentially undisputed until 1966, when Tessler and Krahn attempted to duplicate his data. 9 They inserted a needle thermocouple directly into each testicle and into the thigh percutaneously. In their series the differential between intratesticular and thigh temperatures was only slightly greater than 1 0 C. in both normal patients and those with varicoceles. Also, variations in testicular temperature in the supine and erect positions were less than 1 0 C. 0
CLINICAL OBSERVATION
From January 1965 to January 1967, 40 men were surgically treated for varicocele. The operation in all cases was high ligation of the left spermatic vein through a transverse muscle-splitting incision at the level of the anterior superior iliac spine. The chief complaint in 35 cases was pain; the remaining 5 patients had been referred for infertility evaluation. Sperm counts were obtained from all patients as part of the preoperative evaluation. The number of patients with sperm counts below 20 million is striking (Tables 1 and 2). Seventy per cent of these patients were subfertile, and only 4 patients (10%) had sperm counts greater than 50 million per cubic centimeter (Fig. 1). An attempt to obtain a 3-month postoperation sperm count was successful in 9 patients (Table 2). The counts in 6 patients were within fertile levels (a sperm count of 20 million or greater, and a motility of 60% or greater). Two patients' sperm counts improved, but not to fertile levels. One patient's sperm count did not improve. Another patient had no followup spenn count; however, his wife became pregnant twice in less than 2 years.
112
STEPHENSON
& O'SHAUGHNESSY
FERTILITY
& STERILITY
TABLE 1. Preoperative Sperm Counts in 30 Patients with Varicoceles Patient
Age
Sperm count (per cc.)
Motility (%)
G.T. D.C. W.A. J.A. M.O. H.D. D.D. A.F. J.F. R H. D.J. C.L. S.L. C.McC. R McC. J.McD. RM. J.M. C.M. RR Y.S. RM. A.L. S. v. H.C. G.H. C.W. G.B. K. S. RI.
27 19 48 24 24 21 24 18 20 17 19 27 18 25 23 25 22
450,000 35,750,000
80 80-85
None seen
7,100,000 5,950,000 90,909 126,000,000 22,400,000 60,700,000 54,400,000 30,000,000 17,750,000 4,300,000 3,200,000 8,500,000 85,300,000 8,250,000
24
None seen
20 22 24 24 21 21 22 29 20 20 25 24
28,800,000 35,200,000 8,900,000 2/HPF 9,2oo,ooU 22,200,000 3,300,000 48,000,000 23,600,000 3,000,000 1,150,000
30 80 45 85 70 50 70 85 40 50 20 30 50 70 65 70 40 85-9v 85-90 35-45 90 4045 85-90 20
None seen
METHOD
In view of the conflicting reports concerning the existence of a significant reduction by the varicocele, of the differential between intrascrotal and body temperature, a study was undertaken in an attempt to reproduce Hanley's data. A thermistor needle telethermometer probe was inserted into the scrotal septum for the full length of the needle, and a rectal telethermometer was used to record body temperature. The scrotal septal and rectal temperatures of patients having elective circumcisions were measured as controls. Varicocele patients were tilted feet downward to approximately 30°, or until their varicoceles were obviously distended. Initially, all measurements were made under spinal anesthesia, and the patients were
VOL.
19, No.1, 1968
11:3
HYPOSPERMIA
TABLE 2. Preoperative and Postoperative Sperm Counts in 10 Patients with Varicoceles 3 months after operation
Before operation Name
Age
Sperm count (per cc.)
V.V. D.W. T.M. O.B. R. F. D.J. M.N. C. C. J.W. W.S.
33 24 23 26 20 24 24 21 36 32
8,500,000 None seen None seen 150,000 12,700,000 3,200,000 5,500,000 19,600,000 150,000 14,000,000
* No follow-up
Sperm count (per cc.)
Motility (%)
Motility (%)
85-90 60
22,050,000 38,500,000 None seen 12,200,000 50,000,000 37,600,000 34,700,000 57,000,000 5,500,000
40-50 50-60 85 10-20 80 85 50
80 25-30 70 60
75 50
-*
count, but 2 children in 2 years.
70 % r60 % Fig. 1. Preoperative spenn counts of patients with varicoceles (millions per cubic centimeter).
V)
-
50%0 -
:SI
~~: :}1
f-
Z40 %fUJ f-
~30%or-
~fJ,R J
20 % -
Jj
10%o 0%0
S
11
12
0
o-5
5-20
8
4
20·50 ABOVE 50
"prepped" for 10 min. with PhisoHex* and water at room temperature. With this regimen, a wide range of temperature differentials was noted in both groups. This method may have resulted in cooling the scrotal contents. Thereafter, PhisoHex and water were used at 37° C., and the temperature differential became stabilized. However, this method conceivably could increase the temperature of the scrotal contents. To reduce the effects of these variables to the minimum, all subsequent temperatures were recorded *Winthrop Laboratories, New York, N. Y.
114
STEPHENSON
&
O'SHAUGHNESSY
FERTILITY
& STERILITY
with no surgical preparation and no anesthesia other than for a tiny skin wheal where the probe entered the scrotum. RESULTS
Measurement of intrascrotal and rectal temperatures without surgical preparation or anesthesia in 3 patients with varicoceles revealed the average intrascrotal temperature to be 0.9 0 C. less than that of the rectum (Table 3). For 13 control patients without varicoceles, the average intrascrotal temperature was 0.6 0 C. less than body temperature (Table 3, Fig. 2). TABLE 3. Intrascrotal and Rectal Temperatures (OC.) Temperature Name
Rectal
Scrotal
Difference
PATIENTS WITH VARICOCELES
M.D.*
J.
S.t
R.I.
A.L. R.M.
37.3 37.3 37.0 36.6 36.3 36.0 36.0 36.0 37.0 37.0 36.6 36.6 36.8 Rfi.R
30.3 30.3 30.8 32.5 33.8 35.3 36.0 34.6 35.0 35.0 36.0 36.0 36.5 36.6
7.0 7.0 6.2 4.1 2.5 0.7 0.0 1.4 2.0 2.0 0.6 0.6 0.3 0.2
PATIENTS WITHOUT VARICOCELES
E. C.* W.D.*
B.
S.t
P.F. H. K.
::l7.0 36.6 36.6 37.8 37.4 37.3 37.3 37.3 37.1 36.3 36.3 37.0 37.0
33.8 34.6 33.0 33.0 31.6 32.5 37.3 37.6 37.3 34.6 34.6 37.0 36.9
3.2 2.0 3.6 4.8 5.8 4.8 0.0 0.3 0.2 1.7 1.7 0.0 0.1
VOL.
19, No.1, 1968
115
HYPOSPERMIA
TABLE 3. (Continued) Temperature Name
Rectal
Scrotal
J. G.
37.1 37.0 37.7 37.7 36.8 36.8 37.0 37.7 37.0 37.7 37.0 36.9 37.9 37.8 36.4 36.5 35.7 35.7 36.4 36.4 37.3 37.3
37.3 37.0 37.0 37.0 34.3 35.0 36.3 36.3 37.7 37.7 37.0 37.3 37.0 37.1 35.0 36.5 35.6 35.7 37.0 37.0 37.2 37.2
G.P. H.H. C. R.
J. V. J.McG. M.S. L.M. K. C. N.B.
R.G.
Difference
0.2 0.0 0.7 0.7 2.5 1.8
0.7 0.4 0.7 0.0 0.0 -0.4 0.9 0.7 1.4 0.0 0.1 0.0 -0.6 -0.6 0.1 0.1
* Spinal anesthesia and preparation at room temperature. t Spinal anesthesia and preparation at 37° C. 38 .37
(J
e-
O
e-
0
LI.I
...
:;) 34
0
x
35
A::
+
CC A:: 33
+eO
0
z 36
e+
x
e-
0
-9-
+e
+
oS
e-
-e +
+
X
x
e+
e+
e-
+
-e +
-9-
+ +
+
o - VARICOCELE - RECTAL TEMP
LI.I
x - VARICOCELE - SCROTAL SEPTAL TEMP
a.
:E 32
-9--
LI.I
CONTROL - RECTAL TEMP
+ - CONTROL - SCROTAL SEPTAL TEMP
... 31 x
30
A
C
Fig. 2. Intrascrotal and rectal temperatures in patients with varicoceles and in controls. A indicate spinal anesthesia and room-temperature preparation; B, spinal anesthesia and 37° C. preparation; C, no anesthesia and no preparation.
116
STEPHENSON & O'SHAUGHNESSY
FERTILITY & STERILITY
DISCUSSION
Previous experiments have yielded conflicting results concerning the effect of varicocele on testicular temperature. In the present study of 14 controls and 5 patients with varicoceles, the rectal and scrotal septal temperatures were carefully measured with the elimination of essentially all variables except for presence or absence of a varicocele. The average intrascrotal temperature was only 0.6 0 C. less than that of the rectum. In patients with varicoceles, the average intrascrotal temperature was 0.9 0 C. less than that of the rectum. Data in this study confirm a definite association of hypospermia with varicocele. However, temperature measurements obtained on controls, as well as on patients with varicoceles, fail to substantiate the statement that varicoceles elevate scrotal temperatures above normal. Thus, the role of the relatively elevated scrotal temperatures associated with varicoceles as the cause of hypospermia cannot be confirmed by this study. SUMMARY
There is a frequently observed, definite relationship between varicocele and hypospermia. The average normal intrascrotal temperature is 0.6 0 C. less than rectal temperature. In the presence of a varicocele, the intrascrotal temperature is 0.9 0 C. less than that of the rectum. \Ve have been unable to demonstrate that normal testicular temperature is significantly Jess than in the presence of a varicocele. How a varicocele is able to suppress spermatogenesis remains unsolved and is a challenging problem for further investigation. 8th Field Hospital Nha Trang, Viet Nam APO 96240, San Francisco, Calif.
REFERENCES 1. DAVIDSON, H. A. Treatment of male subfertility: Testicular temperature and varicoceles. Practitioner 173:703, 1954. 2. HANLEY, H. G. "Surgical correction of errors of testicular temperature regulation." In World Congress on Fertility and Sterility (Proc. 2nd Congr). 1956, p. 953. 3. HANLEY, H. G., and HARRISON, R. G. The nature and surgical treatment of varicocele. Brit] Surg .56:64, 1962. 4. OLSON, R. P., and STONE, E. P. Varicocele: Symptomatic and surgical concepts.
New England] Med 240:877, 1949. 5. RUSSELL, J. K. Varicocele in groups of fertile and subfertile males. Brit M ] i: 1231, 1954. 6. RUSSELL, J. K. Varicocele, a~e, fertility. Lancet ii:222, 1957. 7. SCOTT, L. S. Varicocele, a treatable cause of subfertility. Brit M ] 1:788, 1961.
VOL. 19, No.1, 1968
HYPOSPERMIA
117
8. SCOTT, L. S., and YOUNG, D. H. Varicocele: A study of its effects on human 9.
10. 11. 12.
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American Association of Planned Parenthood Physicians The Sixth Annual Meeting of the American Association of Planned Parenthood Physicians will be held in the Gunter Hotel, San Antonio, Texas, Apr. 16 and 17, 1968. For further information, please contact the Executive Secretary, GEORGE J. LANGMYHR, M.D., Planned Parenthood Federation, 515 Madison Ave., New York, N. Y. 10022.