Varicocele and Male Fertility

What is a varicocele?

Most people have heard of varicose veins, but many are less familiar with varicocele. You may be surprised to learn that approximately 15-20% of men actually have a varicocele.

A varicocele is similar to a varicose vein, but it occurs in the scrotum (sac of skin that holds the testicles). The veins in this region are called the pampiniform plexus. They’re responsible for draining blood from the testicles and acting as a heat exchanger to keep the testicles cooler than the body. When the veins in the pampiniform plexus become enlarged, it’s called a varicocele.

How does varicocele relate to male fertility?

A varicocele can lead to low sperm count and quality and is commonly found in males with infertility. It’s important to note that most people who have varicoceles do not have fertility problems, but its prevalence in males with infertility is notable. In a study of 816 men with infertility, almost 1/3 had a varicocele. Sometimes a varicocele may even be discovered as part of a fertility evaluation.

In addition to male infertility, are there other problems associated with varicocele?

In addition to impaired fertility, varicoceles can also cause other symptoms, like low testosterone production and discomfort in the scrotum.

Do you think you have a varicocele?

If you suspect that you may have a varicocele, it’s important to speak with your healthcare provider. They can perform a physical examination and advise you on the best next steps depending on what they discover. If a physical exam is inconclusive, your provider may order tests like a scrotal ultrasound to ensure there isn’t another reason for your symptoms.

Is there treatment for varicocele?

In some cases, varicocele treatment may not be necessary. In other situations, treatment is needed. Varicocele may be repaired by open surgery, laparoscopic surgery, or a process called percutaneous embolization in which a catheter is inserted into the vein and materials are injected to seal the enlarged vein.

It’s always important to discuss fertility goals with your medical provider, who can make specific recommendations based on your case.

How does treatment impact male fertility?

There is some debate on whether or not the treatment of varicocele improves fertility. A 2012 meta-analysis analyzed data on whether surgery or embolization of varicoceles in subfertile men increased fertility. The researchers found some evidence that treatment may improve fertility, but that more research is still needed needed.

A 2012 literature review found that repairing a varicocele may reverse some of its effects on fertility, but that the effects on sperm parameters and pregnancy were variable. Again, more evidence and research may be warranted.