A varicocele is an enlarged vein in the scrotum and testicle, usually found on the left side, but possibly found on both sides of the scrotum, and very rarely only the right side. Varicoceles are relatively common, occurring in up to 15% of men. They are the leading cause of male infertility, found in 40% of men with low sperm counts. Varicoceles are treatable, as long as other fertility problems aren’t present for the male or female partner.
Symptoms of Varicocele
Many people are unaware of a varicocele until they experience fertility issues. Doctors usually conduct an abnormal semen analysis, followed by a physical exam to determine varicocele. Some men may experience signs or symptoms besides infertility. These may include:
- A dull ache or feeling of heaviness in the testicle, especially after exercise
- A swelling or mass in the scrotum, sometimes described as feeling like a bag of noodles
- One testicle noticeably smaller than the other
Diagnosis
A varicocele can be diagnosed during a physical exam. If a varicocele is present, it will be visible when the urologist asks you to stand up and bare down. It disappears when you are in a horizontal position. It is possible to have a varicocele that isn’t noticeable during a physical exam and only discovered with the use of ultrasound. However, a varicocele of this size is usually left untreated, as research has not found an association to infertility in these cases.
Varicocele and Infertility
The presence of a varicocele has been associated with lowered sperm count, an increase in DNA damaged sperm, poor sperm morphology (or shape), and poor sperm movement. It isn’t clear why varicoceles causes infertility, but there are some theories. The most popular theory is that the pooled blood raises the overall temperature in the scrotum and testicles. Increased scrotal heat can be damaging to sperm.
It is also believed that poor circulation leads to increased levels of toxins, which in turn leads to poor semen health. Some people also suggest the increased scrotal pressure harms semen health.
Treatment
Treatment of varicocele depends on its size. Whether it causes you pain, there are additional fertility factors at play, and what you and your partner’s recommended fertility treatment plan looks like.
Varicocele treatment options include:
- Microsurgical varicocelectomy – A highly skilled surgery, performed inguinal, or sublinguinal, using a microscope to aid in the repair. This surgical technique has the fewest risks and the shortest recovery time, making it the surgical treatment of choice.
- Laparoscopic varicocelectomy – A surgery where repair is done via the abdomen. Due to the increased risk and longer recovery time, this technique is rarely chosen.
- Percutaneous embolization treatment – A non-surgical technique with fewer risks and pain than either of the above surgical treatments. It involves a radiologist injecting into the problem vein small coils or alcohol to block the vein that is causing the trouble.
Success rates will vary from person to person, but research has found improvement in semen health in more than two-thirds of patients. Also, 30 to 50% of couples will be able to achieve pregnancy naturally after surgery.
All treatments for varicocele carry some degree of risk. Our doctors at KIMS Cuddles will be able to help you with information on risks, success rates, and recovery times.
