Hypothesis: intracellular acidification contributes to infertility in varicocele

We suggest that varicocele leads to male factor infertility by a mechanism involving underperfusion of the testis, a shortfall in glucose supply to the tissue, decreased flux through the pentose phosphate pathway, lowering of the reduced nicotinamide-adenine dinucleotide phosphate/oxidized nicotinamide-adenine dinucleotide phosphate ratio and the supply of glutathione to the antioxidant systems, increased levels of reactive oxygen species, peroxidation of spermatozoon membrane lipids, and the consequent generation of acidic degradation products and sequestering of spermine. Acidification of the seminal plasma impairs sperm motility and also inhibits most antioxidant enzymes, exacerbating the accumulation of reactive oxygen species and the resultant lowering of pH.