If you have been trying to have a baby without success, it is important for the man to get a thorough medical evaluation and physical examination. This is often how a varicocele is found (pronounced VAR-ih-koe-seel). It may be a possible cause of male infertility.
A varicocele is like varicose veins that are common in the legs. The one way valves in the veins are not working properly, and blood pools in the scrotum, causing the veins to enlarge.
Usually a man does not even realize he has a varicocele. If the scrotum is felt carefully, there will be a clumpy mass described as a â€œbag of wormsâ€. One testicle may be smaller. There may be a dull, achy pain in one or both testicles. See your doctor if you have any pain or swelling in your scrotum, feel any mass, or if your testicles are different sizes. Several conditions could cause these, and some require immediate treatment.
Varicoceles are found in 15% (range of 4-30%) of all men, and usually develop during adolescence. Statistics show that 40% (range 17-41%) of men with infertility have varicoceles. It is possible that men evaluated for fertility problems are examined more carefully, and the incidence is actually not significantly higher. We do know that most men with varicoceles are able to father children.
Why varicoceles may affect fertility is not known, but there are several theories. Infertility may be due to a decrease in the quantity and quality of sperm. This may be related to ineffective cooling of the testes, oxidative stress, and/or DNA damage. It may be due to abnormal growth of the testes, which can also affect the production of testosterone. There may be increased waste products in the testicle because the veins do not drain as efficiently.
The best way to diagnose a varicocele is with a physical examination by a well-trained physician who understands techniques to make it easier to detect. Occasionally imaging studies are used, with Doppler ultrasound being the least invasive and very effective.
Is treatment necessary or helpful? Remember, the majority of men with varicoceles are fertile and have no symptoms. Clearly treatment is usually unnecessary. Always do at least 3 semen analyses to evaluate the quality and quantity of sperm. You can have a varicocele with normal sperm, which eliminates this as a cause of infertility. And you can have a varicocele with abnormal sperm, but the varicocele is not necessarily the cause.
The known facts and statistics should be understood before considering a surgical procedure to attempt to correct a varicocele for fertility reasons. This is the classic risk/benefit question. The risks include infection, injury to the testicular structures, such as damage to the arteries or to the lymphatics (which may cause fluid to collect in the testicle). Also, shrinking of the testicle may occur and recurrence of the varicocele. And any surgery has risks associated with sedation or anesthesia.
The actual potential benefits of surgical treatment of a varicocele are unclear, and real improvement in fertility has been questioned. Statistics are based on semen parameters and not pregnancy rates, and studies lack appropriate control groups. Surgical treatment of a varicocele is one of the most debatable issues in the field of male infertility. Do your own research and remember that a surgeon may be biased. The decision about how to proceed should be made by the well informed couple.