Male Infertility: Varicocele

One of the most common causes of infertility among men is a condition known as varicocele. Varicocele affects approximately 15% of the male population and can significantly affect the male reproductive system and male fertility. Among men diagnosed with infertility, about 40% of cases are due to varicocele.

What is Varicocele?

Varicocele is a condition in which varicose veins develop in the testicles. This takes place as a result of improper blood circulation within the testes, and can significantly affect male fertility since the presence of excess blood leads to higher temperatures in the testicles. This in turn leads to abnormal testosterone levels and hinders the production and maturation of sperm.

Varicocele Symptoms and Male Fertility

Varicocele most often occurs in the left testicle. This may be due to physiological differences between the left and right spermatic veins, such as the length of the vein as well as a difference in the number of spermatic valves present. The left vein is typically shorter and contains less valves than the right, in addition to being more prone to pressure and blockage.

Some typical symptoms of varicocele that may cause difficulty getting pregnant include the following:

  • pain, aches or discomfort in the testicles and scrotum
  • heaviness or dragging feeling in testicles
  • shrinkage of the testicles
  • visible or enlarged vein in the testicles
  • infertility

In many cases, there are no clear physical symptoms of varicocele, and fertility testing may be required in order to achieve diagnosis. In some cases, the symptoms of varicocele may become more prominent as a result of physical exertion.

Fertility Testing and Diagnosis

Fertility testing for varicocele may be as simple as detection during a physical examination. However, if your doctor cannot detect the varicose veins during this initial exam, you may need to undergo a scrotal ultrasound.

In some cases, a venography may be used in which dye will be injected into the vein prior to receiving an x-ray. A sperm analysis may also be performed to assess sperm maturation, sperm damage, and motility, all of which may be affected by varicocele. These tests may also be used to determine whether the cause of infertility is a similar condition, such as a tumor affecting the spermatic vein.

Varicocele Treatment

In many cases, varicocele involves very little treatment or else relatively non-invasive infertility treatment procedures. These can range from wearing more close-fitting underwear, to taking over- the-counter pain killer medications.

The most typical non-surgical treatment of varicocele is embolization, in which a small coil is inserted into the testicles to relieve pressure on the veins. This helps minimize dilation as well as restoring blood flow.

In some cases, surgery may be required and a surgical ligation or laparoscopy may be performed.