Male Fertility

 

Understanding Varicoceles and Infertility


Production of sperm within the testis is a highly specialized process. Even one minor disruption in the steps can cause larger problems in trying to conceive. Blood flow to and from the testicles is a vital part of sperm production and temperature regulation. When the system fails to work properly, as occurs in varicoceles, sperm production may be altered.


What is a varicocele?


An enlargement of the veins within the scrotum, a varicocele is similar in nature to a varicose vein. Though the cause is not entirely clear, most fertility specialists believe that a varicocele forms due to failure of the valves located within the vein. This failure creates dilation and enlargement of the veins.


What are the risk factors for varicoceles?


Most varicoceles occur over time and frequently develop in puberty. No clear risk factors exist to indicate that a man will be at higher risk for development of a varicocele. Men who are obese, however, may be at a slightly increased risk.


Diagnosis of a varicocele


Depending on semen analysis results, Dr. Gehlbach may suspect a varicocele. Because blood flow is abnormal in the testicles with the presence of a varicocele, temperature regulation can be affected, a vital factor in normal sperm production. Changes in sperm parameters, such as motility or morphology, may suggest the possibility of varicocele.


If Dr. Gehlbach thinks there is a varicocele, he will make a referral to a urologist, who will perform a physical exam to confirm the diagnosis. Varicoceles are typically painless, but may cause some discomfort or a feeling of heaviness in the testicle. On exam, the testicle may reveal a twisted, non-tender mass. Also described as a “bag of worms”, this mass can be reduced by lying down. A testicular ultrasound may be required if the exam is not sufficient for diagnosis.


Treating a varicocele


Some fertility experts believe that as many as 90 percent of varicoceles do not need to be repaired, so treatment of a varicocele is somewhat controversial. Because the effect on fertility is unclear, surgical repair may be recommended and completed by a qualified urologist.


What happens next?


After surgical repair of a varicocele, it will take time to see any possible effects on sperm production. Results may be apparent after three to four months following surgery. Additional testing will be required to assess for anti-sperm antibodies that can form following surgery. The presence of anti-sperm antibodies causes clumping of sperm, preventing free movement and decreasing the chances of

pregnancy.