Varicocele

What is Varicocele and what impact does this have on Fertility?

A varicocele is some enlarged or dilated veins in the scrotum (ball sack), caused by back pressure in faulty veins draining blood away from the testicles. They most commonly occur on the left side, but can be on both sides.

Varicoceles can cause an aching pain in scrotum. They are also associated with low sperm count and quality. In addition, varicocele can be a cause of low testosterone.

Varicoceles are present in 10-15% of all men and generally cause no problems. 40% of sub-fertile men have a varicocele. Also couples who have successfully had a child, but are having a difficulty conceiving a second time, the presence of varicoceles can be as high as 81%.

We know that varicocele is associated with reduced male fertility, but the exact reason is not completely clear, the cause is thought to be increased temperature of the testes and poor blood flow. The testicles need to a be a bit cooler than the body for normal sperm and testosterone production. This is why they are outside of the body in the scrotum and can move up and down, allowing regulation of their temperature.

The pooling of blood in a varicocele warms the testicles, reducing the number and quality of sperm produced.
In addition, the pooling of blood means waste products of metabolism are less efficiently cleared from the scrotum, which may also affect sperm and testosterone production.

When present from adolescence, a varicocele may cause one testicle to be smaller. Smaller testicles produce fewer sperm.
Early treatment of varicocele can allow a small testicle to grow to normal size.

Varicocele treatment improves fertility in around 50-60% of couples. Studies have shown 83% of patients have an increase in sperm production with embolization (versus 63% with surgical operation.)

Clearly reduced fertility has many causes, treating a varicocele eliminates one of the possible causes.

Varicocele Embolisation

Varicocele Embolization is a non-surgical, image guided, minimally invasive procedure to block the back pressure in the testicular veins, relieving pain, improving sperm production and increasing testosterone.

The procedure is performed under ultrasound and low-dose real-time X-ray imaging.

A small tube (less 2mm) is inserted into a vein in the side of the neck, from this position the testicular veins are blocked with a combination of tiny platinum coils and sclerosant liquid which sticks shut the veins, thereby stopping the back-flow. It is performed as a day-case procedure under local anaesthetic and twilight sedation, so you can go home 2 hours after the procedure.
Most patients go back to work the next day.

The traditional surgical alternate involves an incision in the scrotum or groin and tying off of the problematic veins, usually under general anaesthetic.

VARICOCELE LIGATION (Surgical repair)

The traditional surgical varicocele repair is performed under general anaesthetic, an incision is made in the upper scrotum or groin and the veins are tied off to stop the back flow. Patients may go home the same day or the following morning. Depending on your job, the return to work is 2-4 days. There is small a risk of infection in the wound, also collection of fluid around the testicle called a hydrocele.