3. Pediatric varicocele

adolescent, varicocele, undescended testes, cryptorchidism, hormone, and assisted

We searched with association like: adolescent and infertility; varicocele and

Some considerations are essential: the literature regarding medically assisted procreation should be considered only from 1990 onward, and, from a strictly epidemiological point of view, also for varicocele some distinctions should be made. Varicocele seems to have a clear phenotypic trend, for which it is possible that in some countries the prevalence of the disease is lower than in others, justifying a paucity of literature on this topic. However, when comparing the origin of scientific publications on pediatric varicocele and cryptorchidism, Europe and North America cover about 70% of the overall publications worldwide, reaching 80% of the published literature about infertility and assisted medical procreation. Asia and Africa, on the contrary, show poor preventive research while favoring the research

1.Most of the literature on the topics of this research was published after the year 2000, with the two maximum rates of 84 and 79% for medically assisted procreation. This can be reasonably associated with the widespread use of the

2. In absolute numbers, the conditions directly associated with infertility are less

10245 4250 (41%) 1/3: p < 0.05

25399 20309 (79%) 1/4: p < 0.05

6701 5635 (84%) 1/8: p < 0.05

776 (55%) 2/5: p < 0.05

comparison per group

procedures after the 1990s. If such figures are correlated to the other percentages found, they also show how the focus of scientific research has slanted toward the treatment of infertility rather than its prevention.

studied than the treatment with medically assisted procreation.

1396 147 (real pediatricadolescent age-range with follow-up)

Group Key Total >2000 % of paper Statistical

1 Infertility-male 46103 26296 (57%) 1/2: p < 0.05 2 Varicocele 5292 2788 (52%) 1/3: p < 0.05

6 Infertility-U 1195 676 (56%) 6/3: p < 0.05 7 Infertility-semen 11289 6556 (58%) 1/7: p > 0.05

9 Infertility-VAR 2429 1349 (55%) 1/9: p < 0.05 Statistical analysis: Statistical analysis was performed using the student t-test. Significance value was set at p < 0.05. Associations: varicocele and pediatric age/adolescence; infertility and undescended testes; infertility and varicocele; statistical comparison between groups: chi-square test comparing number of total paper published and paper

Data from the research: number of papers published per disease and with multiple associations.

A number of papers and number of the most important associations are

The analysis of the data offers some interesting insights:

medical procreation (Table 1).

on assisted medical procreation.

3 Undescended

4 Assisted

5 V-adolescence/ pediatric age

8 Assisted medical procreation

Table 1.

62

published after 2000 per each -group and sub groups.

testes

reproduction

semen, etc.

explained in the table.

Male Reproductive Health

### 3.1 Focus about pediatric varicocele: the first infertility-related and treatable andrological disease

About this specific topic, where varicocele is the first treatable cause of infertility in adulthood, we found that a total of 625 articles was published since 2000, matching the mentioned criteria; after our selection only 147 articles resulted providing innovative topics in the pediatric range. As a first consideration, we can state that most publications concentrate in Europe, Asia, and North America (the USA being by far the most represented in North America). The percentage of pediatric works is 27.0% being above average in Europe and North and South America. Asia has a considerable number of published articles even though the percentage of pediatric ones is far below average. Africa and Oceania have, respectively, 2 and 1 pediatric articles.

Then we analyzed the main topic and secondary topics of the selected articles. Prevalence of different categories in each continent was summarized, and the main subjects for Europe are surgical technique, videolaparoscopy, and diagnosis; for North America, surgical technique, diagnosis, and endocrinology; and for Asia, video laparoscopy, endocrinology, and screening.

South America includes 10 articles discussing mainly about fertility and semen analysis, being the only region in which this topic appears to be central. Africa had only two publications in the pediatric field, centered on diagnosis and nonoperative treatment. The only pediatric publication published in Oceania was centered on video laparoscopy.

Overall prevalence of topics in the discussed articles was considered as well, and we found that in North America and Asia follow-up prevails as a concomitant topic in many articles, together with complications and relapses. Another topic strongly represented in these regions is endocrinology. On the other side, Europe maintains topics that mainly represented surgical technique and videolaparoscopy, accounting for about 50% of all topics, and then diagnosis is still present, showing little difference between main topic and all mentioned topics in the publications.

4. Final considerations

DOI: http://dx.doi.org/10.5772/intechopen.88459

support network?

medical assisted procreation.

Acronyms and abbreviations

AMP Assisted medical procreation ART Assisted reproductive technology

Conflict of interest

65

impair the patient's future fertile potential [18].

among these, varicocele figures as the first [19].

The authors declare no conflict of interest.

the additional risk of failure of medically assisted procreation.

This research is intended as a warning to the countries worldwide: when talking about fertility, it is right to give a couple the chance to access medically assisted procreation; consequently, scientific studies to improve its outcomes are reasonable. International reports are therefore necessary and should foster research with increasing outcomes. More space should also be given to investigate and prevent male fertility diseases starting from the pediatric age, especially when they might

Infertility Worldwide: The Lack of Global Pediatric Andrologists and Prevention

All those involved in the pediatric treatment area should be stimulated to act toward this goal, and each country should bear the responsibility of promoting and financing andrological screening campaigns. At the international level, there are still few opportunities, in terms of funds and staff, for the adolescents to receive andrological counseling. This is then the bottom line: Is medically assisted procreation the cure to one or more diseases, or is it the answer to the lack of a social

When talking about couple infertility, male causes account for about 35–40%,

Thus collective interest, research efforts, and healthcare funding aim to study couple infertility at the time of inability of procreation, correction of varicocele in adult age, and medically assisted procreation. This choice is taken despite the increased risk of chronic irreversible damage of treating varicocele and other pediatric andrological diseases in adult age and despite the costs and risks of MAP with

In conclusion, the research effort and the capital invested in prevention of infertility are not balanced with respect to efforts and investments relied into

Eventually, a study of the topics and their prevalence over years was performed to see the trend of interest. A significant trend in publications could not be evinced, neither overall nor for single continent. Publication numbers by year underwent cyclic changes over the last 20 years with a peak in 2008 including 16 publications about pediatric varicocele.

A natural comment to the number of publication is the fact that pediatric articles, focusing on pure research, account for <1 third of overall articles about varicocele. This could be due to the fact that historically varicocele is considered as an adult pathology; thus not enough interest is found in its pediatric side. Different series of studies report a higher prevalence of varicocele in adult population than in pediatric one. However it must be taken into account the lack, in almost all countries, of pediatric screening programs for varicocele that could give a strong bias about the exact prevalence of the pathology in pediatric population. Moreover the study of varicocele related to infertility is considered more imminent in adult life, when looking for paternity that during adolescence when study of future fertility may seem premature. In fact many studies on varicocele are performed retrospectively when the patient in adult life has not the possibility to become father (see table).

Concerning the major topics of the publications, in the most represented continents, the first interest of research is surgical technique, may it be traditional surgery or videolaparoscopy technique. We can also see that in the first three majorly represented topics and figures either screening or diagnosis this reflects an attention of research to detection and treatment rather than to follow-up or prevention of infertility. Other topics were only minimally represented. It must be stated that healthcare organization of each single country may influence the topics and publications: in fact screening would not be so represented in countries with private healthcare or, on the other hand, countries with increased population density would feel less important the problem of infertility. The prevalence of varicocele according to the literature remains constant in different ethnic groups; thus, differences in publication do not reflect a difference of entity of the disease but rather a different contribution to publications.

In South America the research group for the published articles is the same, and the works represent mainly an evolution of the same study focusing on semen analysis, metabolomics, infertility pathophysiology, and endocrinology.

The three most prevalent topics in North America and Asia underline an attention to study the evolution of the pathology in time even after treatment and to evaluate if the outcomes of surgical treatment meet the standards for good practice. Articles discussing endocrinology often evaluate testicular volume at diagnosis and follow catch-up growth after surgery, trying to give an indication of the best timing to prevent infertility. On the other side, the spectrum of topics in Europe reflects poor attention to prevention of infertility and follow-up after surgery.

Of particular interest is that there is no increasing trend during the years despite an increase in the trend of publications about overall causes of infertility and medically assisted procreation. In fact in delivering a PubMed research, it appears that publications about MAP are more than 30 times higher than those about varicocele.

We must report the fact that Asia appears abundantly below average, but a strong bias is given that the fact that many publications from China were in original language [10–17].

The same applies to the correlation between undescended testes and infertility if compared to the studies on cryptorchidism alone. Both associations between infertility and disease show a progressive percentage increase in the total number of studies. Infertility Worldwide: The Lack of Global Pediatric Andrologists and Prevention DOI: http://dx.doi.org/10.5772/intechopen.88459
