Understanding Male Varicocele and Male Infertility

What is Male Varicoele?

A condition that gradually develops over time. It affects the normal growth of testicles which may end up shrinking or failing to develop at all. Due to pooling of blood and rising of temperature in the scrotal sac, it can cause low sperm production and decreased sperm quality. Even a one-degree rise can affect sperm production and testosterone function. 

Varicocele in the male is different from the varicocele we get in our legs. In male varicocele, there is vein enlargement within the scrotum sac. This is found mostly in younger men during puberty (15-25 years). Most of the times, varicocele is observed on the left side of the scrotum (in 80% of cases). It is found in 15% males and 40% of all male infertility cases have a varicocele issue in atleast one testicle. However, it need not affect sperm production in all cases. Varicocele is luckily easy to diagnose the condition and can be treated with surgery. Some types of varicocele might even not call for a treatment.

Varicocele Symptoms

There are no signs and symptoms of varicocele. However, sometimes it can cause pain in the testicles. This pain may:
 

• Be varying from sharp to dull to feelings as heaviness
• Increase with standing, sitting or physical exertion, especially over long periods
• Seem to increase over the course of the day, especially in hot weather
• Be relieved only when you lie on your back
• Sometimes impair fertility
• The testicle would appear smaller on the side of varicocele and sometimes the dilated veins can be often seen or felt.

Varicocele Diagnosis

A doctor generally detects varicocele by a routine physical exam where he feels the testicles when the patient is in the standing position. If the varicocele has not developed enough, it would require further testing using Doppler ultrasonography (ultrasound designed to detect the sound of backflow of the blood through the valve) and thermography (infrared sensing technology to detect pockets of heat created by the pooled blood).
 
Repairing Varicocele can help correct the following

• The size of the testicle can get corrected in an adolescent
• The scrotal pain can be reduced
• Sperm production and quality will get normal
• Raise the mildly low testosterone levels

Reasons for Varicocele Repair :  The reasons to fix a varicocele include:

• An adolescent with a large varicocele and evidence of a smaller testis on the side of the varicocele.
• For varicocele-induced scrotal pain
• For correction of male factor infertility
• To raise mildly low testosterone levels

Treatment 

The treatment goal in varicocele is to stop the backward flow of blood from the body to the testicles and therefore cooling them to their required temperature.

There are 3 ways of repairing this condition

Incisional or surgical method

This can be performed through an incision in the upper scrotum (sub-inguinal), groin area (inguinal) or lower abdomen (retroperitoneal). It is an open surgery done on an outpatient basis. The patient will be given a general or local anesthesia. The surgeon locates the veins of interest, dissects the spermatic cord microsurgically. Doppler ultrasound is used by the surgeon to identify the right artery and vein and all the surrounding veins are tied to prevent blood flow.

Laparoscopic surgery

This procedure is performed by making a small incision in the abdomen and passing a tiny instrument through the incision to see and to repair the varicocele. In this type of surgery, the patient is given a general anesthesia.

Percutaneous embolization (non-surgical procedure) 

This procedure is performed by an interventional radiologist who inserts a tube through your groin or neck to pass a tiny instrument. It is an image-guided process in which a catheter is passed through the groin area to reach the treatment site. A small amount of X-ray dyes are injected to pinpoint the affected vein clearly. The surgeon then releases a coil or solution that blocks the affected vein. This tops the backflow of blood into the testicles and the blood is diverted to healthy veins that exit the testicles through normal pathways. At the end of the procedure, the catheter is removed and the pressure is applied to stop any bleeding. The skin incision is then covered with a dressing. The recovery time is shorter in this case than an open surgery.

What to Expect After Surgery

You will be allowed to go home the same day of the procedure. One may experience mild to moderate scrotal pain for several days or weeks. The doctor administers pain medication for some time and you will be able to resume work in about 3 days’ time. It is advised to avoid strenuous activities at least for one week after surgery. New sperms generally take 3 months to develop. So the follow-up semen analysis report is conducted after 3-4 months to check the improvement in the sperm quality. The success rates of this surgery are high as it also improves the production of male hormone testosterone. Approx. half of men who undergo this are able to father a child within the first year.