What Exactly is a Varicocele?
A varicocele is a little bit of a hidden secret in the male infertility world. It’s simply an abnormally enlarged vein on the scrotum that occurs in 15-20% of all males. Many men who have a varicocele just ignore it, although when speaking of males with infertility issues, close to 40% have this condition. Varicocele can be easily treated with micro-surgery on an outpatient basis.
What can be the impact of a simple enlarged vein? The answer lies in increased blood flow. Heavier flow through this vein raises the temperature levels around the testicles which contributes to fertility problems affecting sperm count, sperm motility, sperm structure and chromosomal structure, and reducing the odds for fertilization.
Varicocele is usually seen in the 20 to 30 age group and is more common on the left side for physiological reasons. Occurance and severity can often be attributed to lifestyle factors like diet, digestive health, testicular temperature, smoking, and alcohol. While playing a major role in male infertility, generally a varicocele is not painful and not troublesome, yet there are other health issues that can result if left untreated.
And when there are symptoms?
Varicocele is not symptomatic in all patients. But due to proximity to the testicles there is often sensitivity or a heavy aching pain which can range from mild to moderate severity. Pain will usually increase after prolonged periods of sitting or standing. Pains may often feel more intense at night before bed, and be alleviated by morning. The enlarging of the veins may become more evident over time.
Development is very similar to a varicose vein commonly seen in the lower legs. As the varicocele progresses, symptoms such as pain and swelling of the veins are felt more intensely and one or more testicles may become smaller.
What causes varicocele?
Varicocele result from blood flow restriction in the veins carrying blood to the testes, and usually starts to be apparent during adolescence. Science is still uncertain why the vascular valves malfunction, but when the valve doesn’t act efficiently and blood flow is disrupted, the veins start to expand. Generally, varicoceles occur on the left side of the scrotum but even if the varicocele affects a single teste, the sperm production in both testicles will likely be compromised.
Infertility And Varicocele
Varicocele is one of the main causes of male factor infertility and is found in a significant percentage of men who seek medical help with infertility problems. A temperature increase in the scrotum due to the heavier blood flow coupled with testicular atrophy will affect sperm production negatively. Testosterone production is reduced. Resulting sperm will not have the capacity to fertilize the ovum.
Diagnosis & Treatment
Diagnosis of varicocele is usually made by simple physical examination. If the physician finds a physical examination insufficient for a conclusive diagnosis, he may ask for scrotal x-rays but this is not ideal, for other reasons.
Although some still question whether treatment for varicocele will actually improve a man’s fertility, it is undisputed that the number of sperm is measurably greater when tested three months after the varicocele has been treated, and sperm quality also seems to be improved.
Treatment varies according to symptoms and the patients’ condition. If the varicocele is asymptomatic, usually no intervention is done. Supportive underwear might be all that is recommended.
When varicoceles develop during adolescence, they could inhibit normal development and prevent the teste(s) from reaching full length. Annual checkups will help the doctor monitor such a condition.
When a varicocele does require treatment, there are several methods available.
One non-surgical treatment has been to prevent enlargement of the veins by binding. Treatment may also be effected by endovascular embolization, a minimally invasive procedure which involves injecting a small amount of a substance to close off the blood flow. Both methods have proven to be very effective treatments and the advantages and disadvantages of these methods should be discussed with the doctor.
If there is significant pain and the other treatments are not deemed applicable, micro-surgical intervention can be applied. This treatment method is usually employed when infertility is suspected.
Generally done on an out-patient basis, only local anesthesia is administered during varicocele micro-surgery. Via a small incision the the blood flow to the problematic veins is cut off and the incision stitched up.
Post surgery, the patient will usually be able to walk and return home within a few hours. There will be temporary pain due to the sensitivity of the area and the patient should not participate in any intense physical activity for 1-2 days following the operation. One week after surgery, the patient will be fully healed and able to return to all normal activities.
More than 50% of males post-surgery have seen higher sperm levels and improvement in sperm quality and many couples have indeed seen fertility success post-surgery… yet medical science to date is unwilling to state that fertility is affected by varicocele treatment.