Varicocele

More Common Than You’d Think

Approximately 25 – 35% of men who have primary male factor infertility (they’ve never fathered a child) have a varicocele, as do 80% of men who have secondary male infertility (fathered previously and now struggle to conceive). So varicocele is prevalent in men with male factor issues, but that doesn’t mean it’s always causative of male factor issues.

What Is Varicocele?

Varicocele is an enlargement of the veins in the scrotum as a result of a breakdown in the blood drainage system in the testicles. If a varicocele does play a role in male factor infertility, it’s likely because the varicocele helps drive up the heat and pressure damage in the testes, which impinges sperm production.

Diagnosing Varicocele

Urologists diagnose a varicocele in a pretty rudimentary fashion. If the doctor can feel the varicocele by pressing on the skin, the varicocele is considered “clinical” and the doctor may want to begin treatment. About 85% of varicoceles are on the left side of the body. For men who are obese, or have a small scrotum, an ultrasound is often needed to detect the varicocele.

Candidates for Surgical Varicocele Repair

Varicocele is present in many male factor patients and, after years of treatment, the field has established that only treating certain types of varicoceles improves semen analysis parameters or live birth rates.

Generally speaking, here are the criteria whereby a urologist should consider treating the varicocele:

  • Clinical: The varicocele is large enough in size & severity to be felt upon examination. Men with large varicoceles tend to benefit most from any intervention.
  • Symptomatic: Semen quality is impaired, the man is experiencing scrotal pain, or there’s evidence of atrophy (more common in children).

Nature of Varicocele Surgery

There are two types of varicocele surgeries, and both involve closing the veins where blood is pooling. Both treatments have relatively short recovery times and modest rates of adverse events. We generally hear from patients they managed to get both covered by insurance, though men who have already been given an infertility diagnosis may face more challenges than men that have yet to be given a fertility diagnosis. As with most aspects of this field, there is conflicting data on which of the two surgical approaches is better.

  • Varicocelectomy is a surgery performed by a urologist that takes 15 – 30 minutes and involves tying off the veins below the varicocele. Most believe a microscopic approach offers better outcomes while inflicting less damage to the arteries. Around 90% of patients who have surgery on their varicocele have a varicocelectomy. This may be because the urologist does this form of varicocele surgery and is reluctant to send the patient to a different doctor to have the varicocele treated.

  • Embolization is a less invasive form of varicocele surgery and is performed by an interventional radiologist. It involves placing an artificial blockage in the problematic vein. The principal fear is that patients treated with embolization have a higher likelihood that the varicocele reappears than patients treated with varicocelectomy.
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