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Varicoceles: Overlooked

Cause of Men's Infertility

Varicoceles is an often under looked cause of men's infertility

Varicoceles is an often under looked cause of men's infertility

A varicocele is an abnormally enlarged vein in the scrotum, similar to having a varicose vein in the leg. They often form during puberty and grow larger over time. A varicocele usually causes no symptoms, although sometimes it may cause testicular pain.

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The primary function of these veins is to reduce the local scrotum temperature by pumping the blood out of the area. The swollen varicocele veins cause an increase in the temperature of the testicles.

Varicoceles affect fertility in men

Varicoceles are found in 35 percent of men with primary infertility, and over 75 percent of men with secondary infertility. As such, varicocele is often at the top of the list of male infertility causal factors when male infertility is suspected. But having a varicocele does not always imply male infertility. In fact, 20 percent of the men who have a varicocele have no fertility issues.

Varicoceles create pooling of blood, which elevates the temperature in the scrotum. A higher temperature in the scrotum leads to impaired sperm quality and reduced sperm number. Even a one-degree rise in testicular temperature can have an adverse effect on sperm production. There are four ways varicoceles affect male fertility:

  • Low sperm count
  • Lower testosterone
  • DNA damage in sperm
  • Low semen quality

How are varicocele tested in men?

The most frequent treatment for a varicocele is a surgery called varicocelectomy that involves making an incision in the lower abdomen and cutting the vein that is feeding the varicocele. It is a minor surgery usually performed on an outpatient basis using a local anesthetic.

Varicocele surgery, however remains controversial as clinical trials do not consistently show that the surgery improves pregnancy rates. Studies do show that the repair of large varicoceles improve sperm quality and quantity improvement. Undergoing surgery for small varicoceles that are not seen or felt in a physical exam is often not recommended.

The need for surgery is mainly determined based on the degree of semen abnormality and on the observed female fertility factors. If sperm count is less than 5 million per cc or the motility below about 30%, IVF and ICSI will most likely be recommended. Men with slightly low sperm counts (15-20 million) may be more reasonable candidates for varicocele surgery. However, many couples with sperm parameters in this lower range often conceive naturally, especially when the female partner has no observed fertility issues such as blocked fallopian tubes or low ovarian reserve.

Getting pregnant after a varicocelectomy may still take several months as it takes time for the sperm count, quality, and motility to improve.

When to do varicocele surgery in men?

Individual differences in size, shape, number, and location of varicoceles, and their differential effect on sperm quality usually determine the fertility treatment path to be taken. A varicocelectomy may be right if the sperm count or quality is an issue. Varicocele surgery can also bring significant cost savings over an alternative like IVF.

If your partner has a varicocele and you are unsure if you need to take any further tests or undergo a particular fertility treatment, Opionato is here to help you.

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About Opionato:

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