Poor Sperm Delivery

Varicoceles and male infertility

There are several conditions that might affect male fertility. One of them is called varicoceles. While it is quite common and usually doesn’t require treatment, for some patients it can play a role in fertility success.

What are varicoceles?

There are veins in the scrotum that control blood flow into and out of the testicles. Varicoceles occur when one or more of these veins bulge, allowing blood to pool inside the scrotum. To imagine them, think of the varicose veins that we typically see in the legs, but instead inside the scrotum.

Sometimes varicoceles are described as looking like a bag of worms, though not all men with this condition have such obvious cases. In fact, most men with varicoceles have no signs or symptoms. A small percentage experience pressure or pain when they stand or sit for a long period of time due to the excessive blood pooled in the scrotum.

Most men with varicoceles don’t need treatment. The condition can, however, cause the testicles to shrink (or overheat) and can be associated with male infertility issues.

How are varicoceles diagnosed?

If a fertility doctor suspects that varicoceles are affecting a man’s fertility, the patient will be referred to a urologist for diagnosis. In most cases, the patient is asked to stand for a physical examination. The doctor asks the patient to bear down – as with preparing for a bowel movement – while still standing. The increase of blood flow to the scrotum through this exercise allows the doctor to feel any bulging veins. The bulging usually disappears when the man lies down. Ultrasound may also be used to detect varicoceles.

How can varicoceles affect fertility?

While only 15% of the general male population has varicoceles, 40% of men seeking treatment for infertility have the condition. This leads experts to believe that there may be a link between varicoceles and infertility issues.

One theory is that the pooled blood caused by the varicoceles raises the temperature in the scrotum. In turn, higher temperatures in the testicles damage sperm and reduce the amount of new, healthy sperm produced. In this way, varicoceles might negatively affect both the quantity and quality of sperm the man produces.

Another way that varicoceles can reduce fertility is through its effect on testicles over time. Men with prolonged cases of varicoceles might also experience testicular atrophy. This means that the testicles shrink and stop effectively producing healthy sperm.

Despite these potential problems, however, it’s important to note that not all men who have varicoceles will have fertility issues. Likewise, not all male infertility is associated with varicoceles.

What fertility treatment is available for varicoceles?

Most men with varicoceles don’t require treatment. If the condition causes pain, testicular atrophy or infertility, however, some men might consider treatment.

In order to determine if treatment could improve fertility, your fertility doctor might order a laboratory test such as a semen analysis for men with varicoceles that are experiencing infertility issues. Based on these results, they might decide that treatment is a reasonable option for the patient.

In these cases, a urologist will do a surgical repair where they tie off the bulging veins, ensuring that blood will only flow through the normally-sized veins. This is an outpatient procedure done with local or general anesthesia. In most cases the surgeon accesses the veins through the groin.

A fertility doctor will likely do a sperm analysis after the procedure to measure its effect. Evidence shows that almost 70% of men with varicoceles that were affecting their fertility improve their semen quality and have improved results on semen analysis after the surgery.

If you are concerned about varicoceles or other potential fertility issues, please make an appointment for a consultation.