7 Questions about Varicoceles and Male Fertility
If you’re like most people, you’ve probably never heard of varicocele, let alone know how to pronounce it. But despite this term’s obscurity, it’s quite common—about 15 to 20 percent of all men have it—that is, an enlargement of the veins in the spermatic cord that could cause male infertility.
Most of these men have no idea that they have a varicocele, as there are generally no outward signs. Some men with varicoceles have no trouble starting a family, yet others find their attempts at conception unsuccessful, which could be due, at least in part, to the presence of the varicocele.
Dr. Paul Shin, a reproductive urologist who sees patients in SGF’s Washington, D.C., K Street; Frederick, MD; and Woodbridge and Fair Oaks, VA offices, often treats men with varicoceles. Today, he answers the most questions his patients pose about varicoceles.
1. What is a varicocele?
In the simplest of terms, a varicocele is a testicular varicose vein.
People commonly associate varicose veins with the legs. But varicose veins can occur elsewhere.
Within the body, blood vessels are divided into two types based on the direction in which blood flows through them:
- Arteries – Carry blood away from the heart
- Veins – Return blood to the heart
Because humans stand upright, veins must fight against the force of gravity. Valves within the veins help in this fight, allowing blood to flow in only one direction. When one of these valves fails, blood flows in the wrong direction, which can lead to a pooling of blood and the creation a varicose vein.
2. What impact does a varicocele have on fertility?
Despite the fact that we’ve known about varicoceles for thousands of years—the condition was described in records dating back to ancient Rome and Egypt—the answer to this question isn’t entirely clear yet.
Some men with varicoceles have no trouble fathering children, while others experience reduced sperm count or limited motility (sperm movement, which makes it difficult for sperm to fertilize an egg).
There is research to suggest that the presence of a varicocele could impact sperm
morphology (shape), and there is research to the contrary.
The generally accepted explanation for why a varicocele impacts male fertility is that the extra blood in the testicle elevates testicular temperature.
Increased temperatures mean sperm are unable to operate at optimal efficiency and therefore conception may become difficult.
Look at it this way: Imagine a group of people working in an office with no air conditioning in the middle of July. Although employees can work in this environment, they certainly won’t be operating at peak efficiency.
3. Does having a varicocele have any other impact on your health?
For the most part, no.
If a varicocele is significant in size, it can cause some discomfort. Some men report a heavier feeling in one testicle or an unusual testicular awareness. But other than these small issues, a varicocele is entirely harmless.
4. How is a varicocele diagnosed?
A diagnosis usually depends on the size of the varicocele.
If the varicocele is large enough, a doctor can feel it while performing a scrotal or testicular evaluation.
If the varicocele is smaller—or if the patient is particularly ticklish or nervous—it may require an ultrasound to be diagnosed.
In either case, a doctor may elect to follow up with an ultrasound to rule out the presence of other testicular tumors or lumps.
5. I’ve fathered a child before. Why am I having trouble now?
When we see a father who is now experiencing semen quality or quantity issues, 80 percent of the time, the man has a varicocele.
Research suggests that varicoceles have a progressive impact on sperm count. While nearly all men will experience a decline in sperm count as they age, men who have varicoceles will likely see their sperm count decline more rapidly, as compared to men without.
Additionally, if the female partner has also aged since the male partner previously fathered children, it may be more difficult for her to become pregnant, making a small deficiency in sperm count or motility a bigger impediment to getting pregnant than it may have been during prior attempts.
6. What are the varicocele treatment options?
When deciding how or if to treat a varicocele, we consider first the age of the female partner. Even if varicocele treatment goes perfectly, it generally takes 6 to 9 months to see a meaningful improvement in sperm count or quality.
If the female partner is 38 to 40, it may be in the couple’s best interest to leave the varicocele untreated for the time being and use more advanced assistive reproductive technologies (ART), such as in vitro fertilization (IVF). Time is the one thing we can never get back, so moving quickly is often essential.
If we decided to treat the varicocele, there are two common treatment options:
- Microsurgery: In this treatment, a reproductive urologist will make an incision in the groin, where the testicle exits the abdomen. Using a specialized ultrasound probe, the urologist will determine which vessel is abnormal and tie it off.
- Embolization: This treatment does not require an incision. Instead, an interventional radiologist will access the area through a larger vein in the neck or legs and selectively block off any abnormal veins.
Because embolization does not require an incision, recovery from this procedure is easier and the patient will likely experience less lasting discomfort.
When dealing with a bilateral varicocele—or a varicocele impacting both sides of the scrotum— microsurgery is often preferred. Because a shorter vein length and a smaller insertion angle make the right side harder to access, it’s often not possible to fully treat a bilateral varicocele using embolization alone.
7. What’s the likelihood that treating a varicocele will resolve male fertility issues?
Between 70 and 80 percent of patients treated for a varicocele will have measurable improvement in their semen analysis results.
Before deciding to treat a varicocele, it’s important to determine your definition of success.
While our ultimate goal would be to allow a couple to naturally conceive a child through intercourse, it’s just not realistic for some couples.
In situations in which the male has a limited sperm count, “success” may mean being able to use intrauterine insemination (IUI) instead of the more invasive IVF. Similarly, for men who have no sperm in their ejaculate, success may mean having a small amount of sperm and being able to avoid surgical options. What success looks like will be up to you and your partner, and dependent on your specific condition.
A Plan for Your Family, TTC with a Varicocele
When deciding which treatment to pursue, we always ask ourselves…
“How do I help this couple build a family?”
“How do I make this man’s sperm count better?”
The answers to the questions above may not be the same.
In some instances, treating a varicocele may be the best course of action. In others, it may be best to leave the condition untreated in the short term and use an alternative reproductive technology technique to help you and your partner achieve a pregnancy.
At SGF, we are committed to helping you realize your family-building dreams. Through the development of a tailored treatment plan, we partner with you and work to help you achieve your goals and build your ideal family unit.
For more information about varicocele or to schedule a consult with Dr. Shin or any of SGF’s reproductive endocrinologists, call 1-877-971-7755 or complete this brief online form.