Many of us have heard of it, but what exactly is a varicocele? Basically, it is a swollen vein in the scrotum, which is the loose pouch of skin that contains the testicles. The veins in the scrotum carry blood which has less oxygen from the testicles to the main testicular veins. A varicocele is formed when the blood stays in the veins rather than being transported out of the scrotum. This causes the veins to become enlarged leading to blood reflux into the testicles.A semen analysis lab can help diagnose the impact of a varicocele on sperm health and fertility.
Varicoceles can affect fertility by both the quality and quantity of sperm produced. They can also cause a reduction in the testicular size and lead to hypogonadism – low testosterone levels which decrease the activity of the testes. The testes require a certain body temperature for the best sperm production and function. The body heat in the scrotum is lower than that of the pelvis and it is the veins that cool the blood before it enters the testicles. When the veins dilate (as in varicocele), it results in increase in temperature, which can negatively affect sperm production.
Varicocele is present from birth but is revealed during puberty. It is recommended that regular tests be done once boys pass this phase. A varicocele usually occurs on the left side of the scrotum though, rarely, they can exist on both sides. The left testicular vein has a different path from the right, which results in more blood flow problems on the left than the right. Many adult men have varicocele and since it is more common in first-degree relatives, it could be hereditary. Often there are no signs or symptoms, though sometimes there could be:
- Pain or discomfort in the scrotal region,
- Difference in testicle size, as the affected one will be smaller,
- If the varicocele is large, it can be seen above the testicle, described as “a bag of worms”. A small varicocele may not be visible but can be detected by touch.
Varicocele does not cause infertility though, in some cases, it could contribute to problems with fertility. Some studies show that 35% of men who are struggling to father a child have varicocele. For those who already have a child and are trying for more, the percentage is much higher.
Varicocele is usually diagnosed by a physical examination by the urologist. It is known as a Valsalva maneuver, where the patient takes a deep breath, holds it and bears down while the urologist examines the scrotum. If enlarged veins are found, then a scrotal ultrasound for more details can also be done.
In many cases, no treatment is needed for varicoceles. It is usually offered if there are problems with fertility, pain, difference in growth of the testicles or abnormal semen analysis. Surgical and radiological treatments are offered. The latter blocks the blood vessels using embolization or sclerotherapy methods. The 2 most common surgeries are microscopic varicocelectomy or laparoscopic varicocelectomy. As with all surgeries, risks are there, but such problems are rare. The aim of the treatments is to stop blood reflux in the testicular vein. Once the venous reflux is inhibited, fertility issues and semen parameters are likely to improve. It is better to have the treatment done early, as varicocele can get worse with time, causing a negative impact on fertility. Aso, untreated varicocele can reduce testosterone levels which in turn can affect sexual function and quality of life.
At Andrology Center, we offer not only the semen analysis test, but the more detailed sperm DFI (DNA fragmentation index) test as well. We are the sole accredited laboratory in India that conducts the official SCSA (sperm chromatin structure assay) test. By employing top class equipment and specialised technology, we ensure precise outcomes, thereby aiding fertility specialists and patients in making informed decisions regarding the most advantageous medical interventions.
