VARICOCELE AND INFERTILITY
A varicocele is dilated veins in the scrotum, often described as a “bag of worms”. These veins carry blood from the testicle and scrotal structures back to the heart.
The scrotum contains the testicle which is where the sperm is made. Sperm are constantly being made in the testis. Sperm, once made in the testis, travel through a series of tubes called the epididymis and vas deferens, to mix with fluid from the seminal vesicle and prostate to make the semen, which is released at ejaculation.
The testicular artery supplies blood to the testicle and the testicular vein drains blood from the testicle. There maybe a dilation of the testicular vein, which is the same thing as a varicose vein (like people can get in their legs) and this is known as a varicocele.
Varicoceles are present in 15 percent of the normal men and in approximately 40 percent of men presenting with infertility.
Varicoceles that can be felt on exam (palpable) have been documented to be associated with infertility. This is thought to be because the varicocele increases the temperature of the testis.
Diagnosis of varicocele is based on physical exam and at least two semen analyses. Scrotal ultrasound may be ordered to document size of the testicles.
Treatment of the varicocele should be considered when all of the following conditions are met: 1) the varicocele can be felt on physical examination of the scrotum; 2) the couple has known infertility; 3) the female partner has normal fertility or a potentially treatable cause of infertility; and 4) the male partner has an abnormal semen analysis.
Adult men who have a palpable varicocele and abnormal semen analyses but are not currently attempting to conceive should also be offered varicocele repair.
Young men who have a varicocele and normal semen analyses should be followed with semen analyses every one to two years.
Adolescents who have a varicocele and decreased size of the testicle should be offered varicocele repair. Adolescents who have a varicocele but normal testicular size may be followed with annual measurement of testicular size and/or semen analyses.
There are two approaches to varicocele repair: surgery and percutaneous embolization. Surgical repair of a varicocele may be accomplished by various surgical approaches. One of the most common types of surgery is through the groin.
Hazards of surgery include bleeding, infection, recurrent varicocele and fluid collection in the scrotum (hydrocele). Semen analysis may be checked at periodic intervals to assess treatment outcomes.
Written by: Jennifer L. Young MD, The Urology Group. Copyright 2011.
Reference: Infertility: Report of Varicocele and Infertility. An American Urologic Best Practice Policy. Copyright © 2001 American Urological Association, Inc.® and American Society for Reproductive Medicine.
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