The link between male infertility and varicoceles

The link between male infertility and varicoceles

When we think of infertility, traditionally it is presumed to be a woman’s issue.  Yet, about one out of every three cases of infertility is due to the man alone.  Failure to conceive is defined as clinical infertility if pregnancy is not achieved after 12 months or more of regular unprotected sexual intercourse. 

Male infertility can be due to several different reasons including drug abuse, toxic environments, heat, chronic disease, obesity, or stress.  But another reason that affects up to 3 million men a year is a condition called varicoceles. 

Varicoceles are veins that become enlarged inside the scrotum of men – comparable to developing a varicose vein in a leg.  The scrotum is a sac that holds the testicles and is part of the male reproductive system that makes, stores, and moves sperm.  The testicles make sperm and the hormone testosterone.  Sperm that are in the process of maturing will move through the epididymis, a coiled tube behind each testicle.

In men with varicocele veins within the scrotum may experience pain, swelling, atrophy or shrinkage and/or infertility.  More than one vein can be affected and may appear bunched together like a “bag of worms.”

What causes varicoceles?

Veins within the scrotum contain one-way valves that allow blood to flow from the testicles and scrotum back to the heart.  When these valves fail, blood pools and the increased pressure enlarges the veins around the testicle in the scrotum – resulting in the development of a varicocele.

How do varicoceles cause infertility?

There are several ways in which a man with varicoceles could have his ability to father a child be affected:

·      Lower sperm count

In order for sperm to develop and for spermatogenesis to proceed normally, scrotal temperature is about 2 degrees Fahrenheit lower than in the rest of the body.  But in men with varicoceles, the varicoceles cause blood to pool in the scrotum resulting in a rise in testicular temperature and a decrease in sperm production. There is a 40 percent reduction in sperm count for every degree of elevated temperature in the scrotum and testes. 

·      Low testosterone

Varicoceles may cause low testosterone levels in the testicles, which could cause a chain reaction resulting in lower fertility.

·      DNA damage in sperm

Varicoceles have been attributed to DNA damage in sperm.  Studies have suggested that men with varicocele have more damaged sperm than men who do not suffer from the problem.

Symptoms of varicoceles

Generally, most men do not have any symptoms associated with varicoceles.  However, some men may experience one or more of the following:

·      Pain – Men may experience testicular pain when standing or sitting for a long time or during exercise.  It has also been described as a dull ache or feeling of heaviness or discomfort that disappears when a man lies down.

·      Testicle size – Atrophy or shrinkage of the testicle may occur.

·      Appearance of a vein – Veins in the scrotum may appear larger than normal, twisted or worm-like.

·      Infertility – Difficulty in being able to conceive a child.

Treatment of varicoceles

In most cases, varicoceles are left untreated as there are no medications to treat or prevent them.  But treatment may be offered to man who are having fertility problems, pain or if the left testicle is growing more slowly than the right in a child who has varicoceles. If a man is having pain then pain killers such as acetaminophen or ibuprofen may be offered.

It is believed that boys with a smaller testicle may have a higher risk of fertility problems when they are older.

There are two main options for treatment that a man can discuss with his doctor:

·      Surgery – Varicocele surgery could include open surgery, laparoscopy or microsurgery by a urologist. With each option, the veins affected are permanently tied off to prevent continued abnormal blood flow. 

·      Embolization – An alternative surgery, this minimally invasive, image-guided procedure is performed by an interventional radiologist.  Embolization is as effective as surgery with less pain, risk and recovery time.