Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production.
Varicoceles can also cause testicles to fail to develop normally or shrink.
Symptoms:
- Vary from sharp to dull discomfort
- Increase with standing or physical exertion, especially over long periods
- Worsen over the course of a day
- Be relieved when you lie on your back
- Impaired fertility
- A lump in one of your testicles
- Swelling in your scrotum
- Visibly enlarged or twisted veins in your scrotum, which are often described as looking like a bag of worms
- A dull, recurring pain in your scrotum
Causes:
A Spermatic cord holds up each testicle. The cords also contain the veins, arteries, and nerves that support these glands. In healthy veins inside the scrotum, one-way valves move the blood from the testicles to the scrotum, and then they send it back to the heart. when the valves inside the veins in the cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate). This might cause damage to the testicle and result in worsened fertility. Varicoceles often form during puberty. Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein.
Complications:
- Shrinkage of the affected testicle (atrophy). The bulk of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It’s not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.
- Infertility. Varicoceles might keep the local temperature in or around the testicle too high, affecting sperm formation, movement (motility) and function.
- Primary infertility is generally used to refer to a couple that hasn’t conceived a child after at least one year of trying. Secondary infertility describes couples that have conceived at least once but aren’t able to again.
Diagnosis:
A varicocele can’t always be felt or seen when you’re lying down. Scrotal ultrasound helps to measure the spermatic veins and allows your doctor to get a detailed, accurate picture of the condition.Once the varicocele is diagnosed, your doctor will classify it with one of three clinical grades. They’re labeled grades 1 through 3, according to the size of the lump in your testicle. Grade 1 is the smallest and grade 3 the largest.
The size doesn’t necessarily affect the overall treatment because you may not require treatment. Treatment options are based on the degree of discomfort or infertility issues you have.
Treatment:
Varicocele treatment might not be necessary. Many men with varicoceles are able to father a child without any treatment. However, if your varicocele causes pain, testicular atrophy or infertility or if you are considering assisted reproductive techniques, you might want to undergo varicocele repair.
The purpose of surgery is to seal off the affected vein to redirect the blood flow into normal veins. In cases of male infertility, treatment of a varicocele might improve or cure the infertility or improve the quality of sperm if techniques such as in vitro fertilization (IVF) are to be used.
Clear indications to repair a varicocele in adolescence include progressive testicular atrophy, pain or abnormal semen analysis results. Although treatment of a varicocele generally improves sperm characteristics, it’s not clear if an untreated varicocele leads to progressive worsening of sperm quality over time.
Varicocele repair presents relatively few risks, which might include:
Buildup of fluid around the testicles (hydrocele)
Recurrence of varicoceles
Infection
Damage to an artery
Repair methods include:
Open surgery. This treatment usually is done on an outpatient basis, during general or local anesthetic. Commonly, your surgeon will approach the vein through your groin (inguinal or subinguinal), but it’s also possible to make an incision in your abdomen or below your groin.
Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.
You might be able to return to normal, nonstrenuous activities after two days. As long as you’re not uncomfortable, you might return to more strenuous activity, such as exercising, after two weeks.
Pain from this surgery generally is mild but might continue for several days or weeks. Your doctor might prescribe pain medication for a limited period after surgery. After that, your doctor might advise you to take over-the-counter painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve discomfort.
Laparoscopic surgery. Your surgeon makes a small incision in your abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.
Percutaneous embolization. A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure isn’t as widely used as surgery.After embolization, you can often return to work after two days, and begin exercising after seven to 10 days.
