EXCESSIVE SOCCER PRACTICE MAY LEAD TO MALE INFERTILITY.

Byline: Angela La Voie Medical Tribune News Service

Rigorous physical activity may produce subtle damage to the genitals of adolescent boys that could potentially threaten their future fertility, Italian researchers report.

In a new study of about 200 boys ages 10 to 14, more than a quarter of those who played soccer for 10 or more hours a week had a varicocele - a varicose vein around one of the two spermatic cords, which sperm travel through from the testicles.

By comparison, none of the sedentary boys in the study had varicoceles, according to the report, published last week in the international medical journal the Lancet.

And in the boys who trained 10 or more hours a week and had a varicocele, the testicle with the varicocele was slightly smaller than the unaffected testicle, the study showed.

Varicoceles may impede the oxygen-rich blood supply to the testicles, causing them to shrink and possibly leading to infertility in later life, said the researchers, led by Dr. Andrea Scaramuzza of the division of pediatrics at the Azienda Institute Hospital in Cremona, Italy.

``Sports training might cause varicoceles by some mechanical effects of exercise,'' they wrote.

``This is the first time the presence of varicoceles has been reported in a particular group of athletes,'' said Dr. Larry Lipshultz, a professor of urology at the Baylor College of Medicine in Houston.

The report merits further examination to determine whether an association exists between the presence of varicoceles and participation in other sports, he said.

In the study, varicoceles were found in 29 percent of boys who trained 10 or more hours a week, 22 percent of those who trained seven to nine hours a week, 14 percent of those who trained four to six hours a week and 10.5 percent of those who trained one to three hours a week.

Varicoceles are present in approximately 15 percent of the general male population, and most boys who grow up with varicoceles are fertile, pointed out Dr. Eli Lizza, director of the division of male reproductive medicine at the New Jersey Medical School, part of the University of Medicine and Dentistry of New Jersey in Newark.

While doctors look for varicoceles as part of a routine physical examination, the irregular veins are often missed in adolescents because they are too small, he said.

If the varicocele is relatively large, and particularly if it is accompanied by a difference in size between the two testicles, doctors may operate because the longer a varicocele is present, the more likely a man is of becoming infertile, according to Lizza.

If an infertile man undergoes surgery for a previously undiagnosed varicocele, he has a 50 percent to 70 percent chance of regaining his fertility, he added.

Lipshultz speculated that the preponderance of varicoceles in the new study may be associated with long periods of running and standing.

But Lizza hypothesized that the increased incidence of varicoceles may have been caused by an increase in abdominal pressure associated with rigorous physical training. If this is the case, an increased incidence of varicoceles would also be found in weight lifters and males who do many sit-ups, because the normal valve mechanism regulating blood flow from the testicles to the abdominal interior is likely to be burdened during such exercise, he explained.

But the new study does not offer enough evidence to explain the cause or even prove that varicoceles are linked with any particular type of activity, both Lizza and Lipshultz noted.

Based on the findings, the Italian researchers suggested that doctors examine athletic adolescent boys for the presence of varicoceles.

Lizza and Lipshultz agreed that doctors should be careful to look for varicoceles in performing routine physicals.