Achieving Pregnancy with a Varicocele

By (embryologist) and (invitra staff).
Last Update: 02/04/2021

Testicular varicocele is a male disorder that, in severe cases, can prevent a man from having children, since it can affect sperm production and, therefore, the quality of semen.

Before analyzing in detail how varicocele influences fertility in men, we will recall the definition and other interesting data about this pathology.

Definition of varicocele

The term varicocele refers to the dilation of the veins of the spermatic cord (veins that nourish the testicle). This alteration occurs when the valves in these veins prevent the blood from flowing properly, causing a rise in temperature and swelling of the veins.

This can be detrimental to the process of spermatogenesis (sperm formation), which would lead to a decrease in sperm quality due to alterations in the concentration, motility, and/or morphology of the sperm. For this reason, one of the consequences of varicocele is male infertility.

As Dr. Antonio Alcaide explains:

Varicocele can affect getting pregnant in this way that it affects sperm production and, what’s more, the viability of the sperm.

There are different types of varicocele, depending on the symptoms, severity, and location. Each of the varicocele classifications is discussed below.

Varicocele by origin

We can distinguish between two types of varicocele depending on the derived symptoms and etiology:

Primary or idiopathic Varicocele
is when there is no obvious cause. This type of varicocele usually has no symptoms and is the most common. Normally it appears on the left side.
Secondary or symptomatic Varicocele
is produced by compressing the sperm veins, which prevents the normal flow of blood. This obstruction is usually tumorous in origin. The most common symptoms are a feeling of heaviness and pain in the testicles or groin area.

Both types of varicocele can affect the likelihood that the affected man will have offspring. Therefore, routine urological check-ups are essential.

Severity

Depending on the severity with which the varicocele appears, we distinguish between:

Grade 1
is the mildest level of varicocele.
Grade 2
is the moderate form of varicocele. The doctor detects the dilated veins by palpation.
Grade 3
are more serious cases, known as severe varicocele. This type of varicocele can be seen with the naked eye, without the need for palpation.

As mentioned above, the diagnosis of varicocele is carried out by physical examination. Sometimes it is necessary to perform some complementary test such as an ultrasound scan to confirm the pathology.

Varicocele by location

Another classification of the varicocele can be made taking into account the place where the dilation of the spermatic cord takes place. In this case, we can classify between:

Unilateral Varicocele
if it shows up in one testicle. Most commonly it occurs in the left testicle.
Bilateral Varicocele
The veins in both testicles are swollen.

A distinction is also made between extra-testicular varicocele (most common) and intra-testicular varicocele. Generally, these types of varicoceles are distinguished according to the clinical manifestations present in the male.

Varicocele and male infertility

There are numerous studies that confirm that varicocele can seriously affect a man's fertility. In fact, between 40 and 70% of men with varicocele have a diminished capacity to produce sperm.

In the long term, varicocele, especially grade three, can have some of the effects discussed below:

  • Produce lesions in the testicular tissue.
  • Decrease the size of the testicle.
  • Altering or preventing sperm production due to increased temperature caused by blood reflux.
  • Produce a lesion in the hypothalamus-pituitary-tissue axis that leads to an affectation of both testicles with a decrease in spermatogenesis and testosterone production.
  • Increased oxidative stress, which can affect sperm DNA integrity.

Despite this, there is a percentage of men with mild varicocele who have achieved their partner's natural pregnancy and have been fathers to healthy children without any problems. In these cases, the varicocele has not prevented the production of good quality sperm, that is, sperm with the capacity to fertilize the egg without complications.

Pregnancy

Varicocele surgery is usually considered the first therapeutic option when the man with varicocele presents a suboptimal semen quality. This surgical treatment is successful in 90% of the cases. Also, the following observations have been made after a varicocele surgery:

  • Improved semen analysis in 60-70% of cases.
  • Increased pregnancy rate by about 50%.
  • Deterioration of testicular function is stopped, which improves sperm and testosterone production.
  • It can reverse hypotrophy of the testicle if performed near puberty.

Once the varicocele has been treated surgically, the male should have a semen analysis every 3 months for the first year or until pregnancy is achieved. Once varicocele has been eliminated, the sperm produced in the testicles can be expelled normally in the ejaculate. Therefore, as long as there is no other cause of infertility, there should be no difficulty in achieving pregnancy.

Although the effectiveness of varicocele treatment is high, there are occasions when natural pregnancy does not occur either. In these cases, Assisted Reproductive Technology (ART) should be used to produce offspring.

Reproductive options include artificial insemination (AI) for males with milder forms of varicocele and in vitro fertilization (IVF).

Fertility treatments and costs

As mentioned above, if the man shows a mild varicocele and the woman is under 35, the most appropriate therapeutic option would be artificial insemination (AI). Its cost is around $600-1,000, although there may be differences depending on the fertility clinic.

On the other hand, conventional IVF or IVF-ICSI (intracytoplasmic sperm injection) would be the appropriate treatments when sperm quality is diminished by presenting a more severe form of varicocele, regardless if there are additional female infertility issues or not. This fertility treatment is more expensive than AI. To be more precise, the cost of IVF ranges from $10,000 to 15,000.

As a last option, sperm donation is the solution for extremely serious cases of male infertility. The price of AI with donor sperm is usually between $700-1,000 per vial.

In any case, a recommendation when visiting a fertility clinic is to ask for a detailed and personalized budget for each treatment.

FAQs from users

Can a man with varicocele get a woman pregnant naturally?

By Andrea Rodrigo BSc, MSc (embryologist).

This will depend on the degree of varicocele he has and the characteristics of each male. In principle, if the varicocele is not severe and does not affect sperm production, he should not have any problems getting his partner pregnant. However, if the varicocele is grade two or three and has caused damage to the testicle, male fertility problems may arise.

Are there serious consequences for a baby born from a natural pregnancy if its father has a varicocele?

By Andrea Rodrigo BSc, MSc (embryologist).

No. In principle, children born to fathers with varicocele are healthy babies and do not necessarily have to present anomalies or certain alterations. In any case, this will depend on the severity of the varicocele and its detrimental effect on sperm production.

Does testicular varicocele affect libido?

By Andrea Rodrigo BSc, MSc (embryologist).

In most cases, no. However, should the varicocele affect testosterone production, it may influence male libido.

Is it possible to have children with bilateral varicocele?

By Marta Barranquero Gómez (embryologist).

Varicocele can be a cause of male infertility. However, when this alteration is surgically treated, most men recover their fertility. This therapeutic option improves seminal quality, increases sperm production and increases the possibility of pregnancy.

In the most severe cases of varicocele, it will be necessary to resort to assisted reproduction techniques and even to a sperm donor in order to have offspring.

Suggested for you

We have explained what varicocele means. However, in order to better understand how it affects male fertility and the possibility of pregnancy, it is advisable to know what this disorder consists of. Get more detailed information about it in this article: What is a varicocele?

Varicocele is a cause of infertility due to a testicular factor. In this article, you can find information about other alterations at the testicular level that can be the cause of fertility problems: Testicular factor male infertility.

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References

Author

 Marta Barranquero Gómez
Marta Barranquero Gómez
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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