ESCINA-INFERTILIDADE-HOMEM-PHYTOMEDICINE-2010
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ESCINA-INFERTILIDADE-HOMEM-PHYTOMEDICINE-2010


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venous
malfunction, such as hemorrhoids, deep venous varicocele of
lower extremities, valve insuf\ufb01ciency and postoperative edema
(Mouly 1974; Otto and Arfeen 1974; Hefti and Kappeler 1975;
Devin et al. 1976; Pirard et al. 1976; Gualtieri 1978; Pittler and
Ernst 1998; Bielanski and Piotrowski 1999; Frick 2000; Kamischke
and Nieschlag 2001). Thus, the purpose of the present study was
designed to evaluate the ef\ufb01cacy of escin to improve sperm
quality in male patients with varicocele.
was 29 years old (range, 22\u201344) and the mean period of infertility
was improved: an increase in sperm density by 100% was
considered as highly effective, by 30\u2013100% as effective, and by
o30% as not effective. An increase in sperm motility (Grade
a+Grade b) by 100% was considered as highly effective, by
30\u2013100% as effective, and byo30% as not effective. The following
criteria were used to evaluate the improvement in spermatic
varicocele severity: a decrease of the diameter of the internal
spermatic vein detected by color Doppler ultrasonography by
o15% was considered as not effective; by 15\u201335% as effective; and
by 435% as highly effective.
Observation of adverse effect
During the whole study, various adverse effects such as fatigue,
nausea, stomach irritation were monitored before and after
treatment in each group. Vital signs including temperature, pulse,
breath, blood pressure were also monitored. To monitor the blood
counts, liver and renal functions, 5ml venous blood was also
withdrawn from peripheral veins before and after treatment in
each group.
Statistical analysis
Data was analyzed using the chi-square test by SPSS 11.0.
and were analyzed within 1h of collection. In all patients, the
analysis was performed by the computer assisted semen analysis
(CASA) technology, according to the WHO criteria (WHO 1999).
We mainly observed sperm density, sperm motility (Grade
a+Grade b) and sperm morphology.
2.3. Evaluation of ef\ufb01cacy of treatment
age of this group was 30 years old (range, 22\u201346) and the mean
period of infertility was 5.0 years (range, 1\u201314). 83 patients in this
group were diagnosed as left-sided spermatic varicocele and the
left 23 as both sides by palpation.
In the escin group, according to the diameter of spermatic vein
determined by color Doppler ultrasonography, 61 patients were
detected with left-sided spermatic varicocele and 45 with both
sides. The dilated of spermatic veins (61+45\ufffd2 ¼ 151) were
further classi\ufb01ed into three subgroups: 96 mild (2.1\u20133.0mm), 45
moderate (3.1\u20134.0mm) and 10 severe (44.0mm).
Semen collection and analysis
was performed and the composite medicines mentioned above
were also administered after surgery. 48 patients were included in
this group. The mean age of this group was 32 years old (range,
23\u201345) and the mean period of infertility was 4.8 years (range,
2\u201310). 38 patients in this group were diagnosed as left-sided
spermatic varicocele and the left 10 as both sides by palpation.
In the escin group, a daily dose of 300mg (150mg every 12h)
of Aescuven Forte (Cesra, Germany), which is equivalent to a daily
dose of 60mg (30mg every 12h) of escin was administered. In this
group, composite medicines taken by the control group were also
was 4.5 years (range, 1\u201313). 51 patients in this group were
diagnosed as left-sided spermatic varicocele and the left 14 as
both sides by palpation.
Signi\ufb01cance was set at Po0.05.
ARTICLE IN PRESS
Results
There was no statistical signi\ufb01cance in regard to the age of the
patient, as well as the side, the severity or the course of the
disease of spermatic varicocele in each group. Sperm quality
before the treatment was also comparable for all three groups. No
obvious drug side effect was observed in all groups. Since sperm
density is an important index for semen or sperm quality, we \ufb01rst
investigated if escin can improve sperm density in male patients
with varicocele. In control group, after taking composite medi-
cines for 2 months, sperm density improved in only 38.5% of
Discussion
Improving sperm quality is the key to treat male varicocele-
associated infertility, since higher sperm quality is absolutely
important not only to physiological fertility, but also helpful in
patients who opt for FIVET (fertilization in vitro and embryo
transfer) or ICSI (intracytoplasmic sperm injection) procedures.
The purpose of this study is to evaluate the ef\ufb01cacy of escin to
improve sperm quality for Chinese male patients with varicocele-
associated infertility. Despite the lack of consensus on the
usefulness of treating varicocele-associated infertility in the latest
urg
o.
6
7
3
5
Y. Fang et al. / Phytomedicine 17 (2010) 192\u2013196194
patients, but improved in 57.5% and 67.9% of patients in the
surgery group and the escin group, respectively and the
differences in the improvement rates for sperm density in these
two groups were signi\ufb01cant compared to that in control group
(Po0.05), though the improvement rate for sperm density in
these two groups was comparable (Table 1). These results suggest
that escin, as well as surgery improves sperm density in male
patients with varicocele-associated infertility.
Sperm motility is another important index for sperm quality
and thus, was also investigated in all groups. The improvement rate
in sperm motility was signi\ufb01cantly higher (77.1% vs. 46.2%) in the
surgery group, while comparable in the escin group (55.7% vs.
46.2%) when compared to that in the control group (46.2%, Table 2),
suggesting that escin has little effect on the improvement in sperm
motility in male patients with varicocele-associated infertility.
When severity of varicocele was classi\ufb01ed into mild, moderate
or severe degree according to the diameter of the spermatic vein
by ultrasonography, our results showed that the improvement
rate in disease severity was signi\ufb01cantly higher in the mild (41.7%
vs. 20.0%) and moderate severity subgroup (64.4.7% vs. 20.0%)
when compared to that in the severe subgroup (Table 3).
Interestingly, the improvement rate in disease severity was also
signi\ufb01cantly higher in the moderate subgroup than that in the
mild subgroup (64.4% vs. 41.7%, Table 3). These results suggest
that escin signi\ufb01cantly improves the disease severity in patients
with mild and moderate varicocele and it is more effective in
patients with moderate varicocele.
In this study, the adverse effects of escin were carefully
monitored. In the escin group, only 5.7% of patients complain of
stomach irritation, 4.7% of patients complain of fatigue, 3.8% of
patients complain of nausea, 2.8% of patients complain of anorexia,
1.9% of patients complain of vomiting (Table 4). The frequencies of
adverse effects of escin were very low and most adverse effects
were quite similar in the escin group when compared to the control
or the surgery group (Table 4). All these adverse effects were very
mild and most of them resolved without further symptomatic drug
therapy after advising the patients to take escin or other drugs after
meal. Escin has no signi\ufb01cant effect on vital signs, blood counts,
liver or kidney function since these parameters are all normal in
each group before and after treatment. These results indicate that
escin is a safe drug to improve sperm quality in male patients with
varicocele-associated infertility.
Table 1
The improvement of sperm density after escin treatment.
Control group (n ¼ 65) S
No. Percentage (%) N
Highly effective 9 13.8 1
Effective 16 24.6 1
Overall effective 25 38.5 3
Not effective 40 61.5 1
Note: Compared to the control group.
\ufffd Po0.05.
literature due to poor knowledge about the pathogenic mechan-
isms for this disorder (Zucchi et al. 2006; Kim and Goldstein
2008), this study clearly suggests that both escin and surgery can
improve the sperm density, even though escin has little effect on
the improvement in sperm motility. More importantly, this study
suggests that escin is more effective to ameliorate the disease
severity in patients with moderate varicocele. To the best of our
knowledge, this is the \ufb01rst study