HOW VARICOCELES AFFECT MALE FERTILITY

What are varicoceles and what causes them? Learn how they can be treated to improve male fertility

A varicocele develops when veins that leave the testis become enlarged and elongated. This network of veins is called the pampiniform plexus and it facilitates the flow of blood away from the testis. A varicocele prevents this and blood builds up. Varicoceles affect approximately 15% of men and they develop slowly over time.

The effects of varicoceles on fertility

Varicoceles are a common cause of decreased sperm quality and low sperm production, leading to infertility. In some cases, varicoceles can lead to azoospermia.

Approximately 40% of men with fertility problems have varicoceles^[1]“American Society for Reproductive Medicine (2008). Report on varicocele and infertility. Fertility and Sterility, Volume 90, Issue 3, (pp. 247–49.)”.

However, not all varicoceles negatively affect fertility. Approximately 80% of men with varicoceles can still conceive without medical intervention.

Varicocele symptoms

Men suffering from a varicocele may not necessarily have any noticeable symptoms or signs, especially in early stages of development. As the varicocele develops some common symptoms include:

• A dull or sharp pain in the testes
• Sensation of heaviness
• Increased pain during physical exertion or long periods of standing or sitting
• Increasing discomfort towards the end of the day, which is often alleviated once lying down

Usually men are aware of varicoceles when they are more fully developed.

Causes of varicoceles

A disruption in the function of the valves that occur along the spermatic cord causes a backflow of blood. This increases pressure and causes vein dilation that ultimately damages testicular tissue. Generally 80% of varicoceles develop on the left side in conjunction with the left-testicular vein.

Diagnostics

Generally varicoceles are easy to diagnose on physical examination. The doctor can often feel the mass of blocked veins. In some cases, patents may be asked to take a deep breath and bear down (valsalva manoeuvre) to increase dilation and improve detection.

If physical examination is inconclusive, more detailed assessments are necessary to determine elongated and enlarged veins. This may include an ultrasound, magnetic resonance imaging, venography, scintigraphy and CAT scan, or thermography. A venography is one of the most effective diagnostic tests. However, it is invasive and requires catheterization of leg veins to access the pampiniform plexus. One advantage of this procedure is that it can be combined with embolisation to treat the problem. Doppler ultrasounds are less invasive and can detect the flow within the varicocele.

Treatment options

In many cases varicoceles don’t require treatment. However, if there is testicle shrinkage, pain, or infertility problems, surgery may be necessary. Surgery can seal dilated veins to redirect the flow of blood through healthy veins. Depending on the individual situation, incisions may be performed in the groin area (inguinal), the upper scrotum (subinguinal), or the lower abdomen (retroperitoneal).

A laparoscopy or venography and embolisation are other options. Embolisation involves injecting small metal coils or a special liquid into the vein to block it and prevent blood from accumulating. It is often performed under local anaesthesia.

Generally, all procedures have the same results. The different approaches depend on other issues. Surgical procedures directly preformed on the scrotum or groin often have the lowest recurrence rate due to the improved precision.

It’s important to understand that if varicocele treatment is performed to treat infertility, it still may not resolve problems associated with sperm count and quality.

Duration

Varicocele repair can take anywhere from half-an-hour to several hours depending on the type of procedure being used. Microsurgical varicocelectomy requires general anaesthesia. Patients much not drink or eat for eight hours prior to the procedure. It’s important not to take aspirin or similar medication for at least ten days prior to surgery as this can cause excess bleeding during and after the surgery.

Always tell your doctor what medications you are on prior to scheduling surgery to avoid any complications. Generally most patients return home the same day after a short recover period. Most patients can return to normal duties within a couple of days.

Success rate

Varicocele repair can enhance semen parameters significantly. However, in some cases there can be other causes contributing to infertility. Therefore there is no guarantee that a varicocelectomy will result in improved fertility. Nevertheless, research has shown that pregnancy rates can improve by up to 50% following varicocele repair^[2]“Cayan, S. et.al. (2002). Can varicocelectomy significantly change the way couples use assisted reproductive technologies? Journal of Urology, Volume 167, Issue 4, (pp. 1749-52).”, ^[3]“French, D. et.al. (2008). Varicocele repair: does it still have a role in infertility treatment? Current Opinion in Obstetrics and Gynecology, Volume 20, (pp. 269-74).”.

Costs

The cost of repairing varicoceles will vary depending on your location, the method of treatment, and whether you choose to use the public or private health system.

Generally varicocele embolisation costs around £1,400 under the NHS system. Privately it can cost approximately £2,300. Depending on health insurance and individual circumstances, some costs may be covered.

Cost may vary significantly depending on your location.

Learn more about the cost of treatment in your region

Please consult your local fertility specialist for the most cost effective route for treatment. 

Side effects

After a varicocelectomy it’s normal to experience some discomfort such as bruising and swelling around the scrotum and the incision site. There may also be very light fluid drainage around the incision. These side effects will go away within a couple of days. If you have had general anaesthesia it’s normal to feel body aches, nausea and a sore throat. These symptoms will also dissipate within a couple of days.

It’s important to contact your doctor if you experience fever, excessive swelling, and/or vomiting within the two weeks post surgery.

In some cases, varicoceles may reoccur.