What is a Varicocele and how does it affect Male Fertility?

Varicocele is a common condition characterised by the enlargement of veins within the scrotum (the loose bag of skin that holds the testicles). It is akin to varicose veins that typically affect the legs, but in this case, they occur in the testicular area. Varicoceles can have significant implications for male fertility, potentially leading to low sperm production, poor sperm quality and other fertility issues. This blog explores what varicocele is, its symptoms, and how it impacts male fertility, including available treatment options such as varicocele surgery and embolization.male infertility testing

What is Varicocele?

A varicocele refers to the enlargement of the veins within the scrotum, specifically the veins that drain the testicles (testicular veins). These veins can become dilated, resembling a varicose vein, which impairs blood flow and affects the temperature regulation of the testicles. The majority of varicoceles develop over time and usually occur on the left side (left testicular vein), although they can also affect both sides.

How Does Varicocele Affect Male Fertility?

Varicoceles are a known cause of male infertility, affecting up to 15% of the male population and about 40% of infertile men. They can disrupt sperm production, lower sperm quality, and may lead to reduced testosterone levels. Here’s how varicocele impacts various aspects of male fertility:

  • Sperm Production and Quality: Varicocele affects the testicles’ ability to produce sperm efficiently. This may result in a low sperm count, abnormalities in sperm shape and structure and reduced sperm motility. For many men, it is a leading cause of poor semen quality.
  • Oxidative Stress and Sperm DNA Fragmentation: One of the critical mechanisms by which varicocele impacts fertility is through increased oxidative stress. This leads to higher levels of reactive oxygen species, causing damage to the sperm cells and increasing Sperm DNA Fragmentation test. High levels of DNA fragmentation can adversely affect embryo development and reduce pregnancy rates, making it harder for couples to conceive naturally.
  • Testicular Temperature and Function: Varicocele can raise the temperature of the affected testicle due to impaired blood flow, which is detrimental to sperm production. The increased temperature can also lead to hormonal imbalances and reduced testosterone production, impacting overall testicular function.

Symptoms of Varicocele

Often, varicoceles present no obvious symptoms, and many men only discover the condition during a routine examination or investigation for male factor infertility. However, some symptoms include:

  • Testicular Pain: This may vary from a dull ache to a feeling of heaviness, which worsens with physical exertion, prolonged standing or exposure to heat.
  • Scrotal Swelling or Lump: The affected testicle may appear smaller, and the veins in the scrotum may become visibly enlarged, appearing twisted or swollen.
  • Infertility Issues: Men experiencing difficulties with conception may discover a varicocele as the underlying cause during fertility assessments.

Diagnosing Varicocele

Diagnosis is often achieved through a physical exam, where the doctor feels the scrotum for enlarged veins. In some cases, a scrotal ultrasound may be used for a more accurate assessment. Identifying the grade of varicocele (ranging from Grade 1 to Grade 3) is crucial as it influences the decision regarding treatment options.

Varicocele Treatment Options

Treatment for varicocele isn’t always needed, particularly if there are no symptoms or indications of decreased sperm quality.  However, in cases where it leads to pain, infertility or testicular atrophy, intervention becomes crucial. The primary treatment options include:

1. Varicocele Surgery (Varicocelectomy)

This surgical procedure involves ligating the affected veins to redirect blood flow through healthy veins. It is typically performed under general or local anaesthesia. The surgery can be done using open surgery, laparoscopic techniques or microsurgery, each offering varying benefits and recovery times.

Microsurgical Varicocelectomy: Considered the gold standard, this method has the highest success rates in terms of improving sperm quality and lowering risks of recurrence. Studies show that varicocele repair through surgery significantly improves semen parameters, reduces oxidative stress and enhances overall male fertility.

2. Percutaneous Embolization

This is a minimally invasive procedure where a small coil or solution is inserted through a catheter to block the enlarged veins, diverting blood flow away from the varicocele. Varicocele embolization has the advantage of shorter recovery times and fewer complications compared to traditional surgery, though it may not be as widely available.

3. Non-Surgical Approaches

For those with mild varicoceles that do not cause fertility issues or significant discomfort, doctors may recommend regular monitoring and lifestyle changes, such as reducing physical exertion, avoiding prolonged standing and managing stress levels. In cases where male infertility persists, advanced techniques like intracytoplasmic sperm injection (ICSI) may be considered.

Varicocele and Fertility Outcomes

Addressing varicocele through treatment can substantially improve sperm counts, sperm motility and reduce sperm DFI levels, thereby enhancing pregnancy rates in couples experiencing infertility. Studies suggest that treating varicoceles, especially through surgery, can lead to significant improvements in semen quality and increased chances of achieving pregnancy naturally or with assisted reproductive techniques.

Pregnancy rates tend to improve post-treatment, as the reduced oxidative stress and improved blood flow positively impact sperm DNA integrity and overall semen parameters. For men undergoing fertility treatments like IVF, addressing varicocele may be beneficial in enhancing outcomes.

Conclusion

Varicocele is a common condition that can significantly impact male fertility, leading to low sperm production, poor sperm quality and higher levels of sperm DNA fragmentation. However, with timely diagnosis and appropriate varicocele treatment, such as surgery or embolization, many men can experience improved semen quality and increased chances of conception. It’s important for men experiencing symptoms or struggling with infertility to seek professional advice.

At Andrology Center, we offer diagnostic tests which cover semen analysis (both manual and AI), DFI Test (DNA fragmentation index) for which we are the only authorised lab in India to carry out the  SCSA® test.  Under the same roof, we also conduct relevant other tests such as Blood Tests (hormone assays and serology tests), Semen Culture, ROS Test, Karyotyping, Sperm Aneuploidy Test and Y-chromosome Microdeletion.   Our standardised reports help fertility specialists decide on the best treatment methods.

If you suspect you might have a varicocele or are facing fertility problems, don’t hesitate to contact a specialist for further guidance and treatment options.

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