Varicocele - Signs , Symptoms, Causes , Treatment And Risk

Men usually do not come to know that they have varicose veins in the scrotum (varicocele) till the time when they are unable to impregnate the female partner and then evaluated for infertility. Infertility may affect 1 in 6 couples, and in approximately 40% of cases, it is due to issues found in male fertility. Moreover, among those 40% cases, varicoceles can occur in 15% of males facing infertility. However, the good news is that there are fertility treatment options to treat infertility caused due to a varicocele.

What Is A Varicocele?

A varicocele is a web of varicose veins (enlarged veins) that develop in the scrotum. The condition usually occurs as a result of the failure of the valves functioning within the veins that are supposed to return blood from the testicles back into the systemic circulation. As a result of this valve failure, the pressure in the abnormal veins rises with the formation of a varicocele.

A varicocele can occur in about 15% of males and in about 40% of infertile men - and it results in reduced quality of sperm. As enlarged veins in a man's scrotum disrupt blood flow to the testicle, this causes the temperature in the testes to increase, and an increase in the temperature can impact sperm production.

What are the Signs and Symptoms of A Varicocele?

A varicocele usually has no signs or symptoms; occasionally, it might cause pain. Moreover, the pain may vary from sharp to a dull discomfort may increase when a person stands or when he exerts himself physically, may worsen over the course of a day. The pain may subside when the person rests while lying on his back.

A man having a varicocele has impaired fertility. With time, varicoceles can enlarge and become more prominent, thus worsening the condition. This condition may cause the testicles to swell, and this happens mostly on the left side.

What Causes Varicocele?

The actual cause of a varicocele is not known, but experts believe that it forms when the valves inside the veins in the spermatic cord which carries blood to and from the testicles prevent the blood from flowing properly. This creates pressure and causes the veins to dilate and damages the testicle and results in impaired fertility.

How Can Varicoceles Cause Infertility?

Varicoceles are known to raise the temperature of the testicle, which, in a way, affects sperm production and its development. Increase in temperature can affect sperm production in two ways firstly it leads to a decrease in the production of testosterone hormone, which is the male hormone required to produce sperm. This decrease in the level of testosterone leads to a decline in the sperm count that is produced and impairs the development of the sperm, thus affecting its motility. The increased scrotal temperature can even lead to a rise in reactive oxygen species, which is known to damage the sperm's DNA. All these factors together are known to harm the health of the sperm, thus affecting fertility.

So as seen there are 4 ways a varicocele can affect male fertility:

Low Testosterone level:

A presence of a varicocele is known to lower testosterone levels and which can affect sexual function in a man.

Low Sperm Count:

Varicoceles can raise the scrotal temperature, which affects reproductive function. It is said that there is a 40% drop in sperm count for every degree rise in temperature in the scrotum and the testis. Low sperm count is the primary cause of infertility, affecting almost 50% of males.

DNA Damage in Sperm:

Varicoceles have been associated with DNA damage in sperm. It causes testicular inflammation, swollen veins in the scrotum, and abnormally developed testicles can produce abnormal sperm with damaged sperm.

Low Semen Quality:

Varicocele can cause hormonal imbalances in the body that affects semen quality. Semen quality should be good for sperm to move around and be alive. In a man who has a varicocele, a fertility specialist frequently will ask to test his semen quality first because it is one of the first factors that is affected by a varicocele.

How To Treat Varicocele Infertility?

In all the cases, a varicocele treatment may not be necessary. Many men who have varicoceles are still able to father a child without the need for any treatment. However, if the varicocele is causing pain, is a reason for testicular atrophy (shrinkage in testicles) or infertility then it might be necessary to consider assisted reproductive techniques, and then undergo a varicocele repair surgery.

The purpose of the surgery is to seal off the affected vein to redirect the flow of blood into normal veins. Hence the treatment of a varicocele might improve or cure infertility or might even improve the quality of sperm if assisted reproductive techniques such as In-vitro fertilisation (IVF) is needed so that a couple can conceive.

Treating varicoceles would result in increased sperm count, improved sperm quality and more motile sperm. Hence the success rates of pregnancy are greatly enhanced when men choose to correct their varicoceles. It has been seen that success rates for pregnancies after the treatment options range from 26% to 50%.

The Treatment Options are:

Varicoceles are treated both through surgical procedures and nonsurgical treatment options. These treatments mainly aim to decrease the pressure that is created in the varicose veins that make up the varicocele. The treatment options are:

Open Varicocelectomy

Varicocelectomy is a surgical procedure that requires tying the veins that are causing the varicocele. So, an open varicocelectomy involves making an incision in the groin area so that the surgeon can reach the blood vessels that are responsible for the varicocele, and then he ties the blood vessels.

Laparoscopic Varicocelectomy

This procedure involves making three small incisions in the abdomen. Through one of the incisions, a laparoscope (scope) is inserted into the abdomen, and through the other two incisions instruments are inserted which are needed to cut and tie off the swollen veins. This procedure is performed under general anaesthesia.

Microsurgical Varicocelectomy

Microsurgical varicocelectomy involves making an incision in the groin area, and the procedure is very much similar to open varicocelectomy, the difference being that the surgeon uses a microscope that makes it easier to see the blood vessels.

Varicocele Embolization

Varicocele embolization is a minimally invasive OPD (outpatient department) procedure that is performed by an interventional radiologist. It involves making a small incision in the groin area so that a catheter and a thin tube can be placed inside the femoral vein. And, then with the help of x-ray technology, the path of the catheter is followed and then the catheter is led into the swollen veins that contain the varicocele. A small coil is then placed inside the veins to block and redirect the blood flow through different blood vessels and relieve the pressure that was created due to the varicocele. When the procedure is complete, the catheter is removed, and the site of incision bandaged.

Are there any Risks and Complications Associated with Varicocele Surgery?

A Varicocele surgery may have some risks and complications associated with it, which may include:

After the Treatment

Infertility might be a problem if you have a varicocele. Hence it is important to converse with your fertility specialist and get a solution regarding which treatment plan to follow if you and your partner are having issues getting pregnant.

The medical procedure is just necessary if the varicocele is causing you pain or in case you're trying for a baby. After the surgery, your fertility specialist would test you in 3-4 months to check the semen quality. It usually takes this much time for new sperm to develop. You'll probably observe enhancements in six months, yet it could even take a year. Your varicocele might return after treatment, but after knowing all this, in most cases, surgery is the best option.

Frequently Asked Questions