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Varicocele and Male Infertility
A varicocele is similar to varicose veins in your legs. A varicocele forms when veins in the scrotum become enlarged. Blood can no longer flow properly, so the blood backs up and causes swelling and widening of the veins. A varicocele is a common cause of male infertility, since it can lead to low sperm production and decreased sperm quality.
While the exact way in which a varicocele affects male infertility is not completely understood, the varicocele is thought to increase the temperature in the testicles or cause the blood to back up in the veins. This damages or kills the sperm.
Rates of Varicocele
Around 15 percent of men in the general population have a varicocele. When looking at men who suffer from infertility, the rate of varicoceles is around 40 percent.
Varicoceles are very rare in prepubescent boys and usually appear in adolescence. The rate of adolescents with a varicocele is around 15 percent, the same rate as the general population. The presence of a varicocele is much more common on the left side.
Causes of Varicocele
Varicoceles commonly develop during adolescence, a time in which the testicles grow rapidly and need more blood delivered to the area. With more blood going into the testicles, there is also more blood draining out. If the valves inside the veins can’t handle the blood flow, the backup of blood will cause the veins to dilate and widen.
Many men self-diagnose the presence of varicoceles by feeling a mass of dilated veins in the scrotum. They may also have other symptoms like a smaller testicle on the side of the varicocele or discomfort in that testicle.
A varicocele can be discovered during a physical examination. The doctor will be able to feel the varicocele while the man is standing.
There are also more sophisticated forms of testing that can help in diagnosing a varicocele. If the doctor cannot conclusively diagnose a varicocele from a physical examination, he may order a scrotal ultrasound.
A surgical technique called varicocele repair can be used to improve male fertility. It is usually done on an outpatient basis. In this procedure, a small incision is made in the abdomen close to where the testicles originally descended. Once the veins causing the varicocele are identified, they are cut to eliminate the blood flow to the varicocele.
A non-surgical procedure called a percutaneous embolization can also repair a varicocele. In this varicocele treatment, a catheter is inserted through a vein to reach the varicocele, which is then blocked off.
Varicocele and Pregnancy
Treatment of varicocele can improve sperm quality, but randomized and controlled trials do not consistently show that this improves the pregnancy rates. Couples with a sperm count of less than 5 million per cc or a motility less than 30 percent may need IVF with ICSI in order to conceive. However, varicocele repair may be a good choice because it has been shown to improve semen parameters in most men, it may improve fertility, and the risks of treatment are small.