The term varicocele is used to refer to the dilation of the vessels of the spermatic cord (that irrigate the testicle), and is produced when the valves of these veins prevent the blood from flowing correctly, provoking an increase in the temperature, which is harmful for the process of spermatogenesis (spermatozoa formation), and that results in the swelling of these veins.
In most of the cases, it is due to external factors of the testicles, but there’s also a small percentage due to internal factors of the testicles. It’s generally classified depending on the clinical manifestations that it presents:
There are two types of varicocele:
- Primary or idiopathic: when no evident cause can be found. There aren’t usually any symptoms and it usually appears on the left side.
- Secondary or symptomatic: it appears when the spermatic veins are compressed, preventing the normal blood flow. This obstruction is normally due to a tumour. The most common symptoms are a feeling of heaviness or pain in the testicles or inguinal area, which could be corrected through surgery.
Varicocele and infertility
There are many studies that prove that varicocele can severely harm male fertility. 40%-70% men with varicocele show a reduction in their capacity to produce spermatozoa. In the long term, there can be lesions in the testicle tissue, reduction in the size of the testicles, or damage to the hypothalamus-pituitary gland-testicle axis, which could affect both testicles, hence decreasing the spermatogenesis and the testosterone production. However, there’s a percentage of men with varicocele that have become parents of healthy children, since they are able to produce good quality spermatozoa capable of fertilising the egg without complications.
As long as the man suffers from a not severe varicocele and the woman is younger than 35, the most appropriate option would be artificial insemination. On the other hand, in vitro fertilization (IVF) or ICSI would be the right techniques, if there’s a female problem or the sperm quality is diminished due to varicocele.
Nevertheless, to repair the varicocele is always considered as the first option, as long as the woman doesn’t suffer from any alteration in fertility and the sperm quality of the man is not optimal. The treatment is successful in 90% of the cases, and after this:
- The sperm analysis improves in 60%-70% of the cases.
- The pregnancy rate increases in 50% of the cases approximately.
- The damage to the testicle function stops and the production of testosterone and spermatozoa improves.
- The hypotrophy in the testicles can be reversed if carried out in puberty.
The younger the male is and the bigger the varicocele is, the better the results are. After the surgical intervention, sperm analysis must be performed every three months during the first year, until pregnancy is achieved. Once the varicocele has been eliminated, the spermatozoa produced in the testicles can be expelled with normality when ejaculating. As long as there’s no other cause, there should be no problem when it comes to achieving pregnancy.