Male infertility is as valid an activity in fertility treatment as female infertility. In fact, in the case of couples, both members must undergo tests to thoroughly investigate infertility problems. Of what are believed to be the most common problems related to male infertility having to do with sperm production, low sperm count, problems with sperm motility, erectile dysfunction, hormonal dysfunction related to LH levels or testosterone, or even retrograde ejaculation (where the ejaculate returns to the bladder instead of the normal route), in some cases, vigilant physicians should also investigate the possibility of varicocele.

Varicocele refers to the widening and dilation of the veins around the spermatic cord within the scrotum, usually on the left side. The incidence of varicocele is that it affects about 15-20% of the general male population. Contrary to what some have been led to believe, the truth is that the majority of affected men are fertile when their sperm is analyzed with a normal semen analyzer, however, it can affect 20 to 40% of infertile men , if they are smokers.

Presentation and Diagnosis of Varicocele

The average age men first notice a varicocele is between 15 and 25 years old. Although the condition may be asymptomatic, in some cases it can be uncomfortable. This is because those affected may experience a dull ache, heaviness in the scrotum that may be worse during any given day, and there may also be sensations of a lump or swelling in the scrotum. These are also considered the symptoms of varicocele, as well as its presentation to the examination by the doctor. Experienced doctors also point out that the diagnosis of varicocele is when the veins are twisted or congested and sometimes described as a bag of worms. Keep in mind that men who self-examine their testicles, as all men should do for signs of testicular cancer, a serious problem, should always see a doctor if there is cause for concern, and should never assume this article that lumps in your scrotum are simply a varicocele. Leave the diagnosis to a professional. However, this article is about varicocele, as it can occur in some cases of male infertility.

The clinical diagnosis of varicocele is often made by the physician through a physical examination, with the patient standing, and using the Valsalva maneuver. If the diagnosis of varicocele is not yet definitive, the doctor may request an ultrasound of the scrotum.

Causes of varicocele

Varicocele is due to abnormal valve function within the veins of the scrotum, causing blood to back up and causing swelling and widening of the veins. Among older geriatric men, it may be due to a kidney tumor, but that is extremely rare. Treatment considerations regarding varicocele are important in cases where men have infertility and are also smokers. As there may be some cases of testicular atrophy due to the accumulation of toxins. There was also research showing that varicocele increases the temperature of the scrotum and intratesticular pressure reduces blood flow. These findings were thought to possibly lead to hypoxia and reflux of toxic metabolites from the adrenal gland. This influenced the DNA in the sperm head. However, these studies were inconclusive because there was no significant difference between fertile men with varicoceles and infertile men with varicoceles.

Treatment recommendations for varicocele in men with infertility

First of all, in many cases of varicocele, it is harmless. No additional treatment may be needed. However, there are things that should be done to help ease the discomfort of a varicocele, and these may include wearing special underwear or lying down when the discomfort is pronounced. And surgery might be considered. However, the option of surgery should not be seen as a quick and easy solution, as it is not something that is recommended, except in cases where there is extreme pain due to the varicocele, or when men who smoke have definitive varicocele and infertility.

There were studies that showed that the effects of surgery on varicocele improved sperm motility and pregnancy rates; however, subsequent meta-analyses of these studies did not show the same significantly higher rates of pregnancy after surgery. If surgery is to be considered among the cases described (extreme pain and among those with varicocele and infertility, who are also smokers), there are several surgical options that can be considered. Namely: (a). open surgery as an outpatient operation, under general or local anesthesia through a small incision in the groin; (b). microsurgery where a microscope may be used; (against). laparoscopic surgery; this requires general anesthesia. In addition, percutaneous embolization can also be done, where this can be done under local anesthesia, but this is not actually surgical.

Due to the oft-cited research, many doctors will fairly readily recommend surgery, however, it should only be considered in cases of male infertility where the varicocele is present if the man is a smoker, in addition to considering other factors. These other contraindicating factors that require due diligence on the part of the physician should include: duration of infertility; very low sperm count and very low motility (in such cases, surgery is unlikely to improve the count enough to result in pregnancy compared with IUI or ICSI); the presence of other factors that affect the woman’s fertility (in the case of couples) such as advanced maternal age, tubal obstruction, anovulation, ovarian reserve problem. In the presence of such problems; surgery is not recommended. Furthermore, varicocele that is not detected clinically, but has only been diagnosed by Doppler ultrasound, should not be operated on, as its benefit has not been demonstrated. Finally, after surgery, if couples have not achieved pregnancy within 6 to 9 months, then IUI or ICSI should be considered.

In conclusion, varicocele is a valid condition if it is clinically present to be considered by the clinician in cases of infertility, if there are no certain contraindications and if the man has extreme pain and/or is a smoker.