Varicocele and Male Infertility
What is a Varicocele?
A varicocele is a common cause of male infertility, and can lead to low sperm production and decreased motility and quality. Similar to a varicose vein in the legs, blood pools within veins in the scrotum, resulting in swelling and dilation.
Medical professionals don’t completely understand exactly how a varicocele affects male infertility, but they do know it seems to cause an increase in scrotal temperature, and negatively impacts testicular sperm production. The testis are outside of the body because of the requirement for sperm production to be at two degrees cooler than the body. With a varicocele, the increased temperature in the testicles damages or kills the sperm.
Around 15 percent of men in the general population have a varicocele, and that rate dramatically increases to 40 percent in those men who suffer from primary infertility.
Causes of Varicocele
Varicoceles usually appear in adolescence and are predominately located on the left side. In adolescence, the testicles grow rapidly and need more blood delivered to the area. With more blood going into the testicles, there is also more blood draining out. If the valves inside the veins can’t handle the uphill blood flow, the backup of blood will cause the veins to dilate and widen.
Many men self-diagnose the presence of varicoceles by feeling a mass of dilated veins in the scrotum. They may also have other symptoms, like a smaller testicle on the side of the varicocele or discomfort in that testicle.
A doctor will be able to feel a varicocele while the patient is standing.
There are also more sophisticated forms of testing that can help in diagnosing a varicocele. If a doctor cannot conclusively diagnose one from a physical examination, he or she may order a scrotal ultrasound.
A surgical technique called varicocele repair can be used to improve fertility. It is usually done on an outpatient basis. In this procedure, a small incision is made in the lower abdomen in the inguinal area and the veins are isolated and tied off. Other techniques include laparoscopic ligation–often used in adolescents–and a non-surgical procedure called percutaneous embolization.
Varicocele and Pregnancy
Treatment of varicocele can often improve sperm quality and improve pregnancy rates. But, based on randomized controlled studies, pregnancy outcomes are mixed and may be dependent on baseline semen parameters, the woman’s fertility status and size of the varicocele.
Couples with extremely poor sperm concentrations and increasing female age might consider proceeding directly to IVF with ICSI in order to conceive. But varicocele repair has been shown to improve semen parameters in most men, may improve fertility, and the risks of correction are minimal, so this may be a good choice for couples who want to conceive naturally or via intrauterine insemination (IUI).
Dr. Natan Bar-Chama, Director of the Center of Male Reproductive Health at RMA of New York, is a board certiﬁed Urologist and Male Infertility Specialist. Following his urology residency at the Albert Einstein College of Medicine, he was awarded the New York Academy of Medicine F.C. Valentine Fellowship and sub-specialized in Male Reproductive Medicine and Surgery at The Baylor College of Medicine in Houston, Texas. For the last 20 years, Dr. Bar-Chama has been the Director of Male Reproductive Medicine and Surgery and is on faculty in both the Departments of Urology and Obstetrics/Gynecology and Reproductive Science at The Icahn School of Medicine at Mount Sinai.