Varicocele & Male Fertility: Can Surgery Improve Your Chances of Conception?

Key Takeaways

Varicoceles are a condition where the blood pools in the blood vessels around the testicles in the scrotum rather than flowing through. When varicoceles form, they can impact a man’s fertility by lowering the production of testosterone. This in turn lowers sperm production and can impair the quality of sperm produced. 

Varicoceles thus can contribute to male infertility which makes it challenging when one would like to build a family. That said, there are treatment options for varicoceles which could improve the chances of conception. In this article we shall take a look at how varicoceles impact sperm production, how they are diagnosed, how they are treated and what the fertility outcomes are thereafter.

How Varicoceles Affect Sperm Production

Varicoceles were first diagnosed in the first century and were described as swollen and twisted around the testicle. They cause the testicle around which they have formed to appear smaller in size than the other. Varicoceles affect sperm production because they somewhat ‘squeeze’ the testicle around which they surround. This causes inefficiencies in the production of healthy sperm. 

There are different ways in which varicoceles are thought to impact sperm production. One way has to do with the elevated temperature of the testicles due to increased blood flow as a result of the swollen veins. Another issue has to do with the increased pressure within the testicles due to the varicoceles squeezing the testicle. As well, a lowered supply of oxygen to the scrotum. All these factors impact hormone production and sperm production, both in quantity and quality. 

Symptoms and Diagnosis of Varicoceles

The Symptoms

Before we get into it, it is worth noting that varicoceles are common. They develop over many years beginning right around puberty. They sometimes may cause discomfort, but they often do not progress to further symptoms or complications. There are cases where varicoceles could cause further symptoms such as: 

• Pain or discomfort, particularly during the later part of the day, or if they had been standing for a long time. Another symptom is 
• The development of a mass in the testicle which can sometimes be seen or felt. 
• A person’s testices could also appear visibly different in size, with one appearing much smaller. 
• Last but not least, is infertility caused by poor hormone and sperm production. 

The Diagnosis

There are different ways of diagnosing varicoceles and this depends on how large they are and what symptoms are more pronounced. Varicoceles can be very small such that medical diagnostics equipment would need to be used. At times, they are large enough to be seen on the surface of the testicles, just beneath the surface of the scrotum.

The main ways in which varicoceles are diagnosed are by first evaluating a person’s symptoms. After that the professional healthare provider will likely perform a physical examination of the scrotum. As well, an ultrasound may be required where the varicoceles may be smaller than what can be seen physically. Due to the impact of varicoceles on fertility, a blood test to evaluate hormonal production and a semen analysis to evaluate the quality and quantity of sperm. 

Surgical Treatment Options

They typical way in which varicoceles are treated is through surgical intervention. There are different surgical approaches applied, depending on the size and location of the varicoceles. Surgery for the treatment of varicoceles is referred to as varicocelectomy. These surgeries are typically performed under anesthesia to prevent discomfort and pain during the procedure. 

Minimally Invasive Surgery Options

A Laparascopic Varicocelectomy involves the surgeon making small incisions in the abdomen through which surgical instruments and a laparoscope are passed through for the procedure to be conducted. 

A Microsurgical Varicocelectomy involves the surgeon incising the upper part of a patient’s groin and uses microsurgery instruments and a surgical microscope to perform the procedure. The instruments used in this procedure are smaller than those used in the laparoscopic procedure. 

Open Surgery Options

Inguinal Ligation involves a surgeon creating an incision at the lower part of the groin - called the inguinial canal - then ligating the varicocele.  

Subinguinal Ligation this is similar to the inguinal ligation, the main difference is that the surgeon accesses the varicocele and ligates it by makes the incision in the lower part of the inguinal canal.

Retroperitoneal Ligation involves accessing and ligating the varicocele through the peritoneum, which is the lining that lines the abdomen.

Success Rates of Varicocele Repair & Fertility

The big question where varicoceles are concerned is, whether varicocele repair is typically successful and how it impacts fertility. Studies have shown that where fertility parameters in men were lowered, variocele repair resulted in more positive outcomes. There was improved sperm production particularly where there was a very low sperm count in the semen. As well, varicocelectomy improved sperm retrieval, leading to higher pregnancy and live birth rates. 

When to Consider IVF or Other Assisted Reproductive Technologies 

Assisted reproductive technologies have had a history of success in helping people to build their families. When male infertility factor is involved, sometimes, non-medical interventions may be the first line of treatment. These include dietary and lifestyle adjustments, which have been known to improve sperm parameters. Where lifestyle and dietary adjustments have not resulted in the required change, medicine-based interventions could be recommended. In such cases, a person may take prescribed dietary supplements and medications that are formulated to improve and restore the balance of hormone production. 

Typically ART is recommended in more serious cases of infertility, where lifestyle changes and medicines have not significantly improved fertility. However, as with any medical intervention such as this, the decision is made on a case by case basis. A professional healthcare provider will discuss the benefits as well as the risks of the ART interventions available to the patient.

If you have further questions or concerns about male factor infertility, or you simply would like someone to walk with you on your family building journey, contact San Diego Fertility. The team of experts at our center are ready and willing to offer you the support you need to achieve your family building goals. 

FAQs:

What is a varicocele, and how does it affect fertility?

A varicocele is an enlargement of veins in the scrotum that could lead to low sperm production, poor sperm quality, and decreased testosterone levels.

How is varicocele diagnosed?

Typically, a physical exam or scrotal ultrasound will be used to detect varicoceles.

What are the treatment options for varicocele?

The main treatment options are varicocelectomy, which is a surgical repair of the varicocele, and embolization, which is a minimally invasive technique, both of which can improve sperm parameters.

Does varicocele surgery improve fertility?

Studies show that a varicocelectomy can improve both sperm count and motility, which in turn could potentially lead to natural conception.

How long does it take to see results after varicocele repair?

It takes a sperm cell about 90 days to fully mature and be ready for ejaculation. Following varicocele repair, improved sperm parameters can be observed between three to six months post-surgery.

This blog is for informational purposes only and should not be considered medical advice.  Please consult with your physician or a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment.