Varicocele and Male Fertility


The most common treatment for varicocele is a varicocelectomy, an outpatient procedure that doesn't require a hospital stay.
The most common treatment for varicocele is a varicocelectomy, an outpatient procedure that doesn't require a hospital stay.
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When was the last time you were in or around a group of men and the topic of their health was front and center? Let's face it: Men don't really like to talk about their health. We all think we're Atlas in some way, strong and indestructible.

All that talk about having to force a man to go to the doctor if he's ill -- is it just an old wives' tale? Doubly difficult to talk about is men's health in regards to the reproductive organs. Take it from this guy, it's not something we readily share with our pals.

Along those lines, infertility can be a tough thing to discuss, and it doesn't rest squarely on the shoulders of the woman. In fact, in about 40 percent of cases of infertility among couples, the man is the sole source or a contributing factor [source: ASRM].

One issue often linked to infertility in men is varicocele, a widening of the veins in the spermatic cords that connect the testicles to the body. When the valves in these veins don't work properly, blood flow is reduced, causing the widening. The condition is similar to varicose veins that occur in legs [source: PubMed Health].

A varicocele typically develops over time and is often found in young men, particularly those ages 15 to 25 [source: PubMed Health]. However, men of any age can develop the condition. Interestingly, almost all instances of varicocele happen on the left spermatic cord, accounting for roughly 78 to 93 percent of reported cases [source: Kantartzi]. Experts think this has to do with anatomical structure. Due to differences in where the left and right veins drain into, more pressure is put on the left spermatic vein, which could lead to varicocele [source: Cornell University].

There are no known factors that could point to a heightened risk of varicocele, genetic or otherwise, and the condition isn't linked to any known syndrome [source: Cornell University]. So could you have the condition? Next we'll take a look at diagnosing varicocele and its implications.

Diagnosing Varicocele

If you've experienced potential infertility, you may be wondering, "Could I have varicocele?"

First things first: Self-diagnosis won't necessarily work. You'd need to see a health care professional.

Back to the stereotype of men not going to doctors. Unfortunately it's based on reality: In a given year, men are 24 percent less likely than women to seek a doctor's help [source: AHRQ]. As a general piece of advice to men, go against the grain and visit your doctor when you think something's going on.

Varicocele is two to three times more likely to be diagnosed in men seeking fertility treatment, meaning they would be screened for the condition by a professional [source: Kantartzi]. This of course doesn't mean men without fertility issues couldn't have the condition. It just breaks down to which men are actually being checked for varicocele.

It's not impossible to tell on your own if you have a varicocele, but there are varying stages of severity. In what are considered grades I and II of the condition, the veins are small to medium in size and not easily visible on inspection. An ultrasound or other imaging technique can be used to better diagnose a grade I or II varicocele [source: Cornell University].

A grade III varicocele is much larger and noticeable to the human eye. Again, the vein runs along the spermatic cord, holding the testicle to the body. If a varicocele is at grade III, it may feel like a bag of worms in the scrotum [source: PubMed Health]. Gross sounding, yes, but not as serious as it may seem.

In fact, a varicocele is usually not considered dangerous and can be left untreated. But if it causes discomfort, or if infertility has been a problem, a man could consider treatment to correct the problem.

On the next page we'll take a look at treatment options and their effect on fertility.

Do varicocele treatments improve fertility?

Infertility is a huge hurdle for couples trying to conceive and add to their family. It's an issue for roughly 10 to 15 percent of couples in the U.S. [source: Mayo Clinic].

But there is hope. In about 85 to 90 percent of cases, infertility is successfully treated through conventional therapies like surgery or medicine [source: ASRM].

The most common treatment for varicocele is a varicocelectomy, an outpatient procedure that doesn't require any hospital stay. A surgeon makes an incision, usually in the lower abdomen, and ties off the spermatic vein causing the condition. Other veins in the scrotum then take over, rerouting the blood flow [source: PubMed Health].

A similar but less invasive treatment is varicocele embolization. With this process, a smaller incision is made to insert a tiny catheter into the problem vein, using either a coil or special fluid to divert the blood flow away from the vein [source: PubMed Health].

Unfortunately, there isn't enough proof to show that these treatments are guaranteed to improve fertility in men, especially in regard to sperm count. According to one analysis of previous studies, a lack of control groups discounts any findings of increased sperm count after the surgical repair [source: Kantartzi]. Basically, sperm count can rise or fall despite the correction of a varicocele, based on other factors. However, it has been generally noted that sperm count does rise in men who have a varicocelectomy, though only slightly [source: Kantartzi].

The difficulty lies in isolating varicocele as the cause of infertility, as opposed to other conditions that could coincide with it, like oligospermia (low sperm count) or azoospermia (zero sperm count) [source: ASRM]. A varicocele slows blood flow out of the testicles, which in turns raises their temperature. High temperature can destroy the creation of and DNA in sperm, so there could be a correlation. But again, medical professionals have been divided on whether a varicocele directly leads to infertility [source: Kantartzi].

Related Articles

Sources

  • Agency for Healthcare Research and Quality. "Healthy Men." 2012. (June 19, 2012) http://www.ahrq.gov/healthymen/
  • American Society for Reproductive Medicine. "Frequently Asked Questions About Infertility." 2012. (June 20, 2012) http://www.reproductivefacts.org/awards/index.aspx?id=3012
  • American Society for Reproductive Medicine. "Quick Facts About Infertility." 2012. (June 18, 2012) http://www.asrm.org/detail.aspx?id=2322
  • Cornell University's Weill Cornell Medical College, Department of Urology. "Varicocele." 2012. (June 18, 2012) https://www.cornellurology.com/clinical-conditions/male-infertility/general-information/varicocele/
  • Kantartzi, P.D., C.D. Goulis, G.D. Goulis and I. Papadimas. "Male infertility and varicocele: myths and reality." Hippokrata. July-September 2007. (June 18, 2012) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658802/
  • Mayo Clinic. "Infertility." Jan. 10, 2012. (June 18, 2012) http://www.mayoclinic.com/health/infertility/DS00310
  • Mayo Clinic. "Varicocele." Jan. 10, 2012. (June 18, 2012) http://www.mayoclinic.com/health/Varicocele/DS00618
  • PubMed Health, U.S. National Library of Medicine. "Varicocele." Sept. 16, 2011. (June 18, 2012) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002263/