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Varicocele

A fairly common infertility problem resulting in male fertility problems, varicocele refers to the presence of varicose veins in the testicles. This condition is thought to affect 15% of the general male population but as much as 40% of all infertile males. Varicoceles tends to occur more often in men experiencing secondary infertility.

 

Definition

A varicocele is an enlargement of the veins within the scrotum, the loose bag of skin that holds your testicles. A varicocele is similar to a varicose vein that can occur in your leg.

About one in six men have a varicocele. For males who are infertile, the figure is higher � about 40 percent. Varicoceles are the most common cause of low sperm production and decreased sperm quality, although not all varicoceles affect sperm production.

Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and, if they cause symptoms, can be repaired surgically.

A varicocele is a dilation of the pampiniform plexus - the veins that drain blood from the testicle. Due to anatomical differences, varicoceles are more common on the left side although they may also occur on both sides simultaneously. As the varicose veins dilate, the valves within the veins become incompetent and no longer function. This allows blood flow to reverse within the veins which causes abnormal blood flow around the testicle. It is this change in blood flow which leads to poor testicular function by causing overheating of the testicle.

How Does Varicocele Affect Fertility?

As with most other varicose veins, varicoceles occurs when blood in the testicles does not circulate out properly. As a result, this excess blood causes the temperature in the testicles to rise leading to abnormal testosterone levels. This increased temperature in the scrotum then prevents the proper production and maturation of sperm thereby lowering a man�s fertility.

Although it is possible for varicocele to affect both testicles, about 90% of the time it is just the left side that is affected. While experts aren�t exactly sure why it is almost always the left testicle that develops the varicose veins, the fact that there are 40% fewer valves in the left spermatic vein, which is also as much as 8 to 10 centimeters longer than the spermatic cord in the right testicle, is one possible reason. Additionally, the left spermatic vein has more pressure placed on it than the right, which may cause it to be more prone to blockages.

Varicoceles Symptoms

Often times, men affected by varicocele will not produce any visible signs. On occasion, though, a man may experience one or more of the symptoms associated with varicocele, which can include:

  • Testicular pain or discomfort

  • Noticeable shrinkage of the testicle(s)

  • A heavy feeling in the testicle

  • Infertility

  • An enlarged vein that can be found by touch or sight

Causes

The spermatic cord, which supplies blood to and returns blood from the testicle, houses the vas deferens, which carries sperm from the testicles. The pampiniform plexus is a group of veins within the scrotum and above the testicles. The pampiniform plexus drains blood from the testicles. Enlargement of these veins often occurs during puberty.

It's not certain what causes varicoceles, but many experts believe abnormal valves within the veins prevent normal blood flow. The resulting backup causes the veins to widen (dilate).

Varicoceles usually occur in the region of the left testicle, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles.

Veins that have become significantly enlarged will likely be visible. However, small or medium sized veins may only be identifiable through touch.

How does a varicocele cause infertility?

We are certain that varicoceles decrease fertility but we have not yet categorically determined why this is so. There are several theories:

A) Increased temperature of the testicles

The testicles are located in the scrotum, which effectively regulates their temperature. They are maintained at a temperature slightly below body temperature. (This is probably why they are located outside the body rather than inside the body where they clearly would be better protected.) In cold weather you may notice that a man's testicles move close into his body as the cremasteric muscles, the muscles in the scrotum wall, tighten. In warm weather the cremasteric muscles relax and lengthen allowing the testicles to hang away from a man's body and cool down.

Some babies are born without their testicles having descended into their scrotum. They are trapped somewhere in their bodies and constantly exposed to body temperature. This is so harmful for the testicles that if they remain there past puberty they will stop producing sperm altogether and have a higher chance of developing cancer. Therefore if a boy's testicles do not descend into the scrotum by the time he is 12 months old, they should be surgically brought down and placed into the scrotum.

Varicoceles are a group of dilated veins filled with blood, which surround the testicles. The blood is at body temperature and if the testes are near these veins they will be kept at a higher temperature than is beneficial for them. Even if a man has a varicocele only on one side, the whole scrotum is warmed by the blood and both testicles can be negatively affected.

In general, larger testicles make more sperm than smaller testicles. Often however, you see men who have a large one-sided varicocele that has damaged the testis on one side making it smaller. The small teste makes significantly less sperm than the normal one. However even in the "normal" one the sperm quality is often very low. The varicocele is not only damaging the teste on the side where it is found but also suppressing the sperm production on the opposite (better) side.

When a varicocele is repaired the blood is no longer able to flow back into the scrotum. This affects not only the testes on that side, but also the opposite side with this normalization of temperature, there may be some dramatic improvement in sperm production. This improvement is most likely mostly coming from improved production in the larger better testicle.

B) Increased waste products back-flowing into the testicle

The veins draining the testicles connect into larger veins. On the left side, they drain into the kidney vein, which is draining blood from the kidney. The blood from the kidney carries waste products, which may then drain backwards into the scrotum and collect there. This may negatively effect sperm production.

Diagnosing Varicocele

Many incidents of varicocele are diagnosed during physical examinations. However, in cases where varicoceles is suspected but none can be found by sight or touch, an ultrasound or venography (whereby dye is injected into the vein and then x-rayed) diagnostic test may be performed.

In some cases, a sperm analysis may also alert your fertility specialist to the presence of varicose veins in your testicles. Upon examination, a semen analysis can reveal sperm that is immature, damaged, has abnormal morphology or motility, is dying, or dead. It can also indicate decreased sperm count, another effect of varicocele.

Facts about Varicocele

A varicocele is a collection of enlarged, varicose veins that develops in the spermatic cord. Caused by a defective or damage valve that regulates blood flow into the main circulatory system. Blood flow is hampered and enlargement of the vein occurs.

  • A varicocele can occur in one or both testicles

  • Most common in the left testicle (85% more common)

  • More common in men between the ages of 15 and 25 years old (10-20% higher).

  • Varicocele, a Common Cause of Infertility

  • About 40% of infertile men have a varicocele.

  • About 80% of men with secondary infertility, who have fathered one child but are unable to do so again, have a varicocele.

  • Infertility is common because the blood carried in the dilated vein makes the testes warmer. It is this warmth damaging sperm that is believed to be the cause of infertility.

How does a varicocele affect semen quality?

A. The most common theory to explain how a varicocele affects semen quality has to do with overheating of the testicle. It is felt that the dilated veins allow warm blood from the abdominal cavity to flow around the testicle. This causes overheating of the testicle which then impairs its function. Commonly, a low sperm count, low motility, and abnormally shaped sperm (stress pattern) are found in men with varicoceles. A varicocele surrounding 1 testicle may affect the testicle on the opposite side of the body. A varicocele may also lead to testicular atrophy (impaired growth) and thus the testicle on the side of a varicocele may be smaller than its contralateral mate.

Nonsurgical Treatment for Male Infertility Caused by Varicoceles

Highly Effective, Widely Available Treatment is Underutilized

A varicocele is a varicose vein of the testicle and scrotum that may cause pain, testicular atrophy (shrinkage) or fertility problems. Veins contain one-way valves that work to allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele. Open surgical ligation, performed by a urologist, is the most common treatment for symptomatic varicoceles. Varicocele embolization, a nonsurgical treatment performed by an herbal physician, is as effective as surgery with less risk, less pain and less recovery time.

Prevalence

  • Approximately 10 percent of all men have varicoceles - among infertile couples, the incidence of varicoceles increases to 30 percent

  • Highest occurrence in men aged 15-35

  • As many as 70-80,000 men in America may undergo surgical correction of varicocele annually.

Treatment

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