Varicocele and infertility: when it is necessary to intervene

Who I am
Philippe Gloaguen
@philippegloaguen
Author and references
Fonte: shutterstock

In this article

  • What is it
  • Causes and symptoms
  • Consequences on fertility
  • Diagnosis
  • Surgical intervention
  • The scleroembolization
  • When therapy doesn't work

What is varicocele?

The Ministry of Health defines the varicocele how "an abnormal dilation of the veins of the testicle which, becoming incontinent, allow a pathological reflux of venous blood from the abdomen to the testicle, with consequent stagnation of blood, an increase in temperature, accumulation of potentially harmful substances and poor oxygenation ".





Simply put, it is an enlargement of the veins present in the skin sac that encloses the testicles. It's a pathology that affects the reproductive system and affects on average between 10 and 20% of the male population. This condition usually manifests itself towards the age of pubertal development, between 11 and 16 years. In some cases, particularly when human fertility is compromised, surgery is required.

Causes and symptoms of varicocele

To date, the causes of varicocele are not yet fully known, but it tends to be traced back to one congenital weakness of the venous walls. Very often it is a pathology that does not bring with it symptoms, but sometimes it is accompanied by a sense of discomfort and heaviness at the level of the testicle, especially after sports or intense physical exertion. Another alarm bell concerns the size of the testicle: the one with the varicocele tends to be smaller.



Consequences on fertility

Varicocele causes the temperature of the testicle to rise, reducing its level of oxygenation. All this entails an alteration of spermatogenesis with also important consequences on the quality and quantity of sperm. The outcome of these changes can be male infertility.



In 95% of cases it almost always affects the left testicle, but sperm production in both may be affected.

Read also: The causes of male infertility

The diagnosis

Often, as we have seen, varicocele produces no symptoms, so it can be discovered during a follow-up visit or with a specialist visit to evaluate fertility.

The diagnosis is made with an andrological visit in which the specialist verifies the presence or absence of varicocele. If the pathology is confirmed, it will then be essential to perform a testicular echocolordoppler and a spermiogram that allow to know the level of the varicocele (from 1st to 4th degree) and to evaluate the quality of the seminal fluid. It is necessary to make an important clarification: the presence of varicocele does not necessarily mean that there are fertility problems, for this reason it is useful to undergo the tests mentioned.

Surgical intervention

The purpose of the treatment is to improve spermatogenesis or prevent its deterioration in the future. Surgical intervention (varicocelectomy) is performed only in some cases:

  •  If varicocele is associated with pain or discomfort
  •  If the testicle affected by varicocele is smaller
  •  If the varicocele is of high degree (3rd or 4th degree)
  •  When, after puberty, there is an alteration in fertility

Surgery closes the affected vein so that blood flow is redirected to normal veins. Microsurgery has proven particularly useful in this regard, with positive results on improving the quality of seminal fluid, thus solving numerous cases of male infertility. In this sense, the intervention offers a good chance of restoring spontaneous fertility, but it can be considered in cases of 1st level medically assisted procreation (intrauterine insemination). The operation may also be effective for the recovery of spermatozoa in situations of azoospermia (absence of spermatozoa) related to varicocele.

After the operation, it will be necessary to repeat the ecocolordoppler in order to evaluate the success of the operation and to prevent any recurrences.

The scleroembolization

Finally, varicocele can also be treated in another way, with a more recent approach. It is about scleroembolization, a radiological technique that is performed under local anesthesia and which therefore has the advantage of being less invasive than surgery. In this case, a liquid is injected into the dilated veins which allows them to be occluded.

When therapy doesn't work

The correction of varicocele allows a complete recovery of fertility in 35% of cases, while for another 35% there is an important improvement in the quality of the sperm. Unfortunately, however, it remains a 30% chance that the treatment will not produce the desired effect. In this case, the couple will have to evaluate the option of in vitro fertilization, that is, the union of the maternal egg and sperm in order to generate fertilized embryos to be transferred into the woman's uterus.

References

Ministry of Health, Varicocele 

National Institute of Health, Varicocele: ailments, causes and treatment 

Del Paesena Society of Andrology and Sexuality Medicine, Varicocele 

TAG:
  • fertility
  • male fertility
  • spermatozoa
  • infertility
add a comment of Varicocele and infertility: when it is necessary to intervene
Comment sent successfully! We will review it in the next few hours.