A varicocele is an engorged collection of veins around the testicle. It can be seen in up to 15% of men without any symptoms.
Unfortunately it has been shown to be a cause of decreased testicular function in males with impaired fertility, or can be the cause of chronic testicular pain. A varicocele can be found in about 40% of males with fertility problems and can have a profound effect on several aspects of the semen analysis and testosterone levels. It is also the most surgically correctable condition that causes male fertility impairment.
The veins that drain the testicle are known as the pampinform plexus. They are responsible for the drainage of blood from the testicles back to the heart for redistribution. These veins can sometimes become enlarged much like veins of the leg. In fact, a scrotal varicocele is simply a varicose enlargement of the testicular veins around the testicle.
Several theories have been proposed to explain the harmful effect of the varicocele on sperm quality. These include possible effects of pressure, oxygen deprivation, heat injury, free radicals and toxins. Despite considerable research, none of these theories has been unquestionably proven, although an elevated heat effect caused by impaired circulation appear to be the most reproducible defect. In addition, varicoceles may be a cause of progressive damage to the testes, resulting in shrinkage of the testes or decreased testosterone levels.
Symptoms Associated With Varicoceles
In most cases, varicoceles have no symptoms and the patient is seen primarily for evaluation of impaired fertility. However, in some cases, males complain of pain or heaviness in the scrotum, or testicular pain. Younger males may even report one testicle being smaller than another.
Treatment Options
Once a varicocele is diagnosed, reasons for surgical correction include: testicular discomfort or pain unrelieved by routine symptomatic treatment, loss of testicular size, or the possible contribution to male infertility. There are a variety of approaches to the treatment of a varicocele. In cases of scrotal discomfort, pain medication and scrotal elevation may be helpful. In instances of impaired fertility or a situation where conservative management does not alleviate discomfort, surgery is the treatment of choice. Surgical approaches range from laparoscopic, percutaneous vein embolization and open surgical techniques using loops (magnified glasses), or the use of an operating microscope. All approaches have their own risks and rates of success.
Dr. Avila’s Surgical Approach To The Varicocele
Dr. Avila uses an operating microscope when performing the varicocele surgery. By using the operating microscope he can ensure precise identification of all veins and the testicular arteries that bring blood to the testicle. This ensures improved results and less likelihood of complications. This approach has the highest rates of success and the lowest rate of complications.
Results of Varicocele Surgery
Improvement in semen quality occurs in close to 70% of patients, and the pregnancy rate is as high as 40%. The average pregnancy occurs nine months following surgery. The first semen analysis is obtained in four months, but changes may not be seen for up to 18 months. A varicocele can impact the treatment and ultimate success in achieving a pregnancy and this underscores the important of the male partner evaluation early on in the process of the couple’s fertility evaluation.
