Varicocele is the dilatation of the network of many small veins found in the male spermatic cord around the testis. It is the most frequently encountered mass of the spermatic cord.
How common is varicocele?
The estimated incidence is at ~15% of the general male population and ~40% of sub fertile and infertile men. It is more common cause in men when trying for the second baby.
How is varicocele diagnosed?
Varicoceles can be asymptomatic. If symptomatic, men may present with scrotal mass/swelling, scrotal pain- constant dragging pain and low sperm parameters.
How varicocele causes male subfertility?
The network of many small veins found in the male spermatic cord around the testisnormally act as heat exchangers, important in the thermoregulation of the testes which is vital for spermatogenesis. A varicocele disturbs this balance and causes heating up of the testis to the normal core body temperature and affects sperm parameters.
What are the types of varicocele?
A varicocele can be classified as primary or secondary.
Primary varicocele:Most varicoceles are primary and result from incompetent or congenitally-absent valves in the testicular vein. The left testicle is affected much more commonly than the right. Bilateral varicoceles are not uncommon, but isolated right varicocele is rare and should prompt evaluation for a secondary varicocele.
Secondary varicocele: Secondary varicoceles are much less common and result from some pathology or abnormality.
This is among one of the surgically-correctable causes of male infertility. Management options include:
Varicocele Ligation: Selection of cases for varicocele ligation is important to expect improvement following surgery. Young age couple, shorter duration of infertility, not severe oligospermia, grade 2 and grade 3 varicocele and normal female factors will ideally improve sperm parameters following surgery.
If the varicocele is of significant size (Grade II or Grade III), about two thirds of men undergoing the surgery will see some improvement in sperm quality. The reported pregnancy rates following surgery are in the range of 40%, but most pregnancies occur 6-9 months following surgery. The age of the female partner needs to be a major consideration.
Improvements in the semen parameters are seen approximately in 40-50% of patients after varicocele surgery. This may take 3-6 months after surgery to see improvements in semen parameters.
If the initial sperm count and sperm motility are in the severe male factor infertility category, the couple might have to consider other options such as sperm retrieval and IVF / ICSI.