By Neus Ferrando Gilabert BSc, MSc (embryologist).
Last Update: 10/29/2014

Varicocele is an inflammation of the spermatic cord veins that drain the testicles. They become curved and elongated. The blood vessels that irrigate the testicle have their origin in the abdomen and as they descend, they form the spermatic cord. The blood vessels’ flow is controlled by a series of valves that prevent the blood reflux. This reflux rises the testicles temperature and has a negative impact on spermatogenesis, which is the process of sperm formation.

Varicocele presence

Treatment

15% of males and 40% of males with infertility suffer from varicocele. It’s more likely to happen in the left testicle. An exhaustive medical and reproductive history must be included and a physical test, and two sperm analysis performed, when examining an infertile male with varicocele.

The man must be offered the treatment when he wishes to have children and meets the following conditions:

  • Palpable varicocele
  • His female partner is fertile or if infertile, it must be easily solvable.
  • Documented male infertility
  • The man must have one or more sperm analysis with normal parameters.

According to specialists, the treatment should also be offered to those males who don’t wish to have children, have to endure varicocele and have an abnormal sperm analysis. Young males suffering from varicocele but with a normal sperm analysis will be regularly examined and a sperm analysis will be performed every year or every two years.

Varicocele can be treated with surgery if the man’s seminal quality is insufficient and his partner doesn’t have fertility problems. Currently, there are two techniques available: open surgery (retroperitoneal, inguinal and subinguinal) or laparoscopic surgery. The chosen technique will depend on the expertise and ability of the specialist performing it.

Men with varicocele

The intervention lasts a bit longer than half hour and usually epidural anaesthesia is used. After the intervention, the patient must rest for one or two days, and after a week the patient can get back to his normal routine.

There’s another surgical procedure named percutaneous embolisation that can be performed to treat varicocele in those blood vessels with reflux. It consists in the insertion of a small catheter in a large vein located on the inner thigh area, which is inserted until it gets to the varicocele and then the vein is blocked by physical means. It’s an effective treatment in those cases in which surgery has been performed to treat varicocele and after the intervention the varicocele has formed again.

90% of the treatments result in success and most of the studies prove that fertility is improved from 33% to 60%. Surgical treatment is offered due to the following reasons:

  • Low index of complications.
  • Fertility improvement.
  • Improvement of the results in the sperm analysis of the treated males.

Evaluation

Once the treatment is performed, tests must be carried out to ensure that the results have been optimal. An internal gonadal venography can be performed to locate the place where there might be reflux and treat it. Sperm analysis must be carried out every three months after the intervention, until a year from the date of the intervention has gone by or pregnancy is achieved.

Some specialists consider that the surgical treatment is not as effective as the infertility treatments. Varicocele is the main cause of male infertility and thus must be taken into account, researched, diagnosed and properly treated.

Authors and contributors

 Neus Ferrando Gilabert
BSc, MSc
Embryologist
Bachelor's Degree in Biology from the University of Valencia (UV). Postgraduate Course in Biotechnology of Human Assisted Reproduction from the Miguel Hernández University of Elche (UMH). Experience managing Embryology and Andrology Labs at Centro Médico Manzanera (Logroño, Spain). More information