Andrologia. 2018;e13066. wileyonlinelibrary.com/journal/and | 1 of 5 https://doi.org/10.1111/and.13066 © 2018 Blackwell Verlag GmbH 1 | INTRODUCTION Varicocele is a dilation of pampiniform plexus veins, which drains the testicle (Alsaikhan, Alrabeeah, Delouya, & Zini, 2016). Varicocele had a common association with male infertility with a high preva- lence (~40%) in couples with male factor infertility compared with the general population (≤20%) (Miyaoka & Esteves, 2012). How the varicocele causes male infertility is still debated, whereas no sin- gle factor is believed to be responsible for such negative effects. Instead, the pathogenesis is believed to be multifactorial, with sev- eral proposed mechanisms acting together (Eisenberg & Lipshultz, 2011; Jensen et al., 2017). Several studies have raised that varico- cele has the capacity to generate testicular tissue hypoxia, germ cell apoptosis, oxidative stress, toxic metabolites reflux from renal/ad- renal and testicular hyperthermia (Mostafa, Anis, El-Nashar, Imam, & Othman, 2001; Sedaghatpour & Berookhim, 2017; Zaazaa et al., 2018). In contrast, as not all men with varicocele are infertile, there is a belief that molecular and genetic factors could play roles in the pathogenesis of varicocele-associated infertility (Mostafa et al., 2018; Santana, Miranda-Furtado, de Oliveira-Gennaro, & Dos Reis, 2017). Apoptosis is one of the pathophysiologic mechanisms of tes- ticular dysfunction suggested in varicocele-induced male infertility (Hassan, el-Nashar, & Mostafa, 2009; Lee, Lee, Cheng, & Jeng, 2009). Apoptosis occurs normally during spermatogenesis, which is essen- tial for testicular tissue homoeostasis and removal of abnormal cells Received: 4 April 2018 | Revised: 4 May 2018 | Accepted: 13 May 2018 DOI: 10.1111/and.13066 ORIGINAL ARTICLE Assessment of seminal granulysin in infertile men with varicocele Nancy W. Mikhael 1 | Asmaa M. El-Refaie 1 | Jehan H. Sabry 2 | Essam M. Akl 1 | Amal Y. Habashy 1 | Taymour Mostafa 3 1 Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Benha University, Benha, Egypt 2 Department of Clinical Pathology, Faculty of Medicine, Benha University, Benha, Egypt 3 Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt Correspondence Essam M. Akl, Dermatology Venereology & Andrology Department, Faculty of Medicine, Benha University, Benha 13518, Egypt. Email: esamakl@hotmail.com Abstract Varicocele has a common association with male infertility, but its exact role is still debated. Apoptosis has been suggested as one of the mechanisms of varicocele- associated infertility. Granulysin is a molecule that plays a role in apoptosis with no previous study about its role in male infertility. This case-controlled study aimed to assess seminal plasma granulysin level in infertile patients with varicocele. This study involved 90 men that were allocated into fertile normozoospermic men (n = 20), in- fertile men without varicocele (n = 30) and infertile men with varicocele (n = 40). These men were subjected to history taking, clinical examination, semen analysis and estimation of seminal granulysin. In general, seminal granulysin level was significantly elevated in infertile men compared with fertile men. Infertile men with varicocele showed significantly higher seminal granulysin compared with infertile men without varicocele, in bilateral varicocele cases and in grade III varicocele. Seminal granulysin level was negatively correlated with sperm concentration, sperm motility, sperm nor- mal forms percentage and testicular volumes. It is concluded that increased seminal granulysin has a negative impact on spermatogenesis in infertile men in general and in infertile men associated with varicocele in particular. KEYWORDS apoptosis, granulysin, male infertility, semen, varicocele