The role of internal spermatic vein plasma catecholamine determinations in subfertile men with varicoceles.

Catecholamine concentrations were determined in left spermatic vein blood of 18 patients with varicocele. These values were compared with concentrations of catecholamines in the right femoral vein. Of 18 patients studied, 6 had moderate to marked elevations of spermatic vein catecholamine concentrations. Norepinephrine was the fractioned component that was elevated. In an average 1-year follow-up the group with elevated catecholamine levels had a much better semen improvement percentage and pregnancy rate than the other group. Chronic exposure of testicular vasculature to norepinephrine may account for the spermatogenic dysfunction encountered in varicocele patients. Once this exposure is interrupted, there may be reversibility of function and the fertility prognosis may improve. The presence of other adrenal or renal metabolites detrimental to spermatogenesis must be considered.