Varicocele –Most Common Cause Of Male Infertility

Varicocele refers to abnormal enlargement or swelling of venous plexus (also known as pampiniform venous plexus) in the spermatic cord. For purpose of understanding, varicocele can be compared to varicose veins of legs (with the mere difference that varicose veins in this case are formed around the testicles).

What Should You Know About Varicocele?

Varicocele is regarded as one of the most common causes of male infertility. According to latest estimates, the prevalence of varicocele in normal male population is 10%. In addition, it is present in about 40% males who are diagnosed with primary male fertility (1). The distinct link between male infertility and it was first recognized by Barfield in the 19^th century. Since then many research studies have been conducted to establish this association and healthcare providers are in consensus that varicocele can greatly reduce the sperm count and overall quality of semen.

Due to anatomical reasons, varicocele is more likely to occur on the left side of the body. According to some estimates, as many as 90% cases of varicoceles are left-sided. However, even if it is unilateral (affecting only one testicles), the hazardous complications can affect both testicles. Varicoceles are classified on the basis of size; such as small, moderate and large. Usually larger varicocele tends to have a greater effect on the sperm production but sometimes even a small varicocele can badly compromise the sperm motility and morphology.

What Cause Sperm Abnormalities In The Setting Of Varicocele?

Several mechanisms have been proposed to explain how varicoceles may affect sperm production. It was suggested that since varicose or swollen veins are less competent at preventing the backward flow of blood, the risk of developing temperature dysregulation (or testicular hyperthermia) increases. If internal environment and temperature of testes is not maintained for a significant period of time, it may negatively affect the production of sperms permanently. Investigators have also proposed

that following mechanisms can also play a role in this deleterious process.

• Increased production of reactive oxygen species (ROS) due to circulatory disturbances
• Injury or damage to tissues due to heat
• Poor availability of oxygen due to impaired tissue circulation
• Damage to tissues caused by pressure

Symptoms And Diagnosis

The symptoms of this disease may vary. It has been observed that in most early cases of varicocele, the patients is generally asymptomatic but on occasional basis, the affected person may experience pain and feeling of heaviness in the scrotum. Varicocele can be detected via physical examination but the final diagnosis is generally made by the ultrasound of scrotum.

How To Manage Varicocele?

Sub-inguinal microsurgical approach is one of the popular surgical options to treat varicocele. Usually the procedure is short (about 45 to 60 minutes in duration). Surgeons usually introduces about one inch long incision and intra-operative imagery is utilized for precision and accuracy. The recovery is generally quick and patient can resume day to day activities after 2-3 days of surgery.

Other methods include; embolization via percutaneous trans-venous route and laparoscopy.

How Effective Is The Surgery To Treat Varicocele?

The outcome and prognosis after surgery is generally good. Data indicates that about 70 to 80% patients have improved semen quality after undergoing surgery. In addition, most patients can successfully impregnate their partners without needing any added procedure. According to a study reported in the British Journal of Urology International (3) suggested that after surgical correction, the average time to impregnate your partner is six to nine months.

Are There Any Risks?

The chances of having complications after surgery is significantly low. There is only 1% chance of infections, bleeding or hydrocele formation. Speak to your doctor if you have any concerns or questions regarding the procedure.

References

1. Nagler HM, Martinis FG. In Lipshultz LI, Howards SS eds, Infertility in the Male, 3rd edn. St Louis: Mosby–Year Book, 1997: 336–59

2. Lewis, D. S., Grimm, L. J., & Kim, C. Y. (2015). Left renal vein compression as cause for varicocele: prevalence and associated findings on contrast-enhanced CT. Abdominal imaging, 40(8), 3147-3151.

3. Ding, H., Tian, J., Du, W., Zhang, L., Wang, H., & Wang, Z. (2012). Open non‐microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta‐analysis of randomized controlled trials. BJU international, 110(10), 1536-1542.

4. Practice Committee of the American Society for Reproductive Medicine. (2014). Report on varicocele and infertility: a committee opinion. Fertility and Sterility, 102(6), 1556-1560.