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

Obesity, injury to the scrotum, inactivity and restrictive underwear are some of the factors that can lead to poor blood circulation to the scrotum. When this happens, the veins that transport blood to the scrotum known as varicoceles get enlarged as blood pools there, leading to swelling, similar to the varicose veins in the legs. This swelling may lead to male infertility. The condition is normally painless although some men may report feeling pain and discomfort. It is however reversible through surgical options with success rates of up to 60% conception. Let's look at how varicoceles can cause infertility, the treatment options and when to consider other Assisted Reproductive Technologies (ART).

How Varicoceles Affect Sperm Production 

Varicocele is one of the common causes of male infertility. It is estimated that around 15% of adult males have a varicocele. A European study shows that out of 7, 802 men who were referred for infertility, about 1295 were affected by varicocele. They are also common in  about 20% of adolescents although most of them resolve on their own. At this stage , the varicoceles can interfere with testicular growth, hormone production and the general function of the testes. 

A varicocele largely affects male fertility in that the pooling of blood in the enlarged veins causes an increase in temperature. This temperature increase can impair sperm production and quality leading to low sperm count, reduced morphology and movement of sperm.

Symptoms & Diagnosis of Varicoceles 

Varicoceles largely go unnoticed and so many men are able to sire children without any medical interventions. Additionally, most men do not experience any discomfort or hormonal disorders.  A varicocele is typically characterized by swelling in the scrotum;more often the left testes, that feel like a sac of worms.There may be pain or discomfort but not always. Some men are said to report scrotal pain after standing for long periods or doing strenuous work. Sometimes the blood accumulation may cause clotting and inflammation leading to severe pain that may decrease when the patient is lying down with the legs elevated.

Varicoceles are generally non-life threatening but may be a cause for alarm especially if they form on the right ride. An exam would be necessary to rule out any masses in the abdomen. They should also reduce in size when a patient is lying down else it may be an indication of a more serious issue. Varicoceles may also be associated with diabetes if they cause extremely low levels of testosterone. A varicocele on one side may still affect both testes due to temperature changes.

Their sizes may vary from non-visible to very large that need surgical intervention. A study by Hopkins Medicine grades the different levels of varicoceles as follows: 

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/varicocele

Surgical Treatment Options 

Of importance to note is that varicoceles of all sizes may affect male fertility. Varicocele repair is an outpatient procedure and patients are able to go home on the same day. A male fertility doctor would normally perform a physical exam to determine the grade of the varicocele and prescribe an ultrasound where the grading is at zero. The common surgical procedures that may be considered are:

Laparoscopic Varicocele Ligation

Normally done under general anaesthesia. This is when cameras and surgical equipment are inserted through small incisions made in the abdomen and the veins feeding the varicocele are clipped. Discomforts from the incisions may be managed using pain killers and the patient is usually able to return to normal activities after about 2-4 weeks. 

Microscopic varicocelectomy

Also done under general anaesthesia, this procedure usually takes longer than the laparoscopic option. It is considered the best approach to varicocele treatment due to its efficiency and safety. The fertility specialist will make 2-3 cm wide incisions in the abdomen; the inguinal incision or the sub-inguinal incision as shown below, to reach the engorged veins and tie them off and then redirect the blood to the pelvis and inner thigh. This approach is preferred for its faster and less painful recovery and its high success rate. It is most ideal for treating infertility caused by varicoceles or cases where the condition leads to significant pain. 

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC3739135/

Success Rates of Varicocele Repair & Fertility

Varicocele repair may positively increase the chances of fertility regardless of the semen analysis. Studies show that approximately 66-77% of men who underwent varicocele surgery had elevated levels of sperm count and motility as well as increased testosterone levels. Additionally, conception rates were seen to increase by 40-60%. However, initial improvements in semen analysis outcomes may not be apparent up to about 3-4 months since spermatogenesis takes around 72 days.

When to Consider IVF or Other Assisted Reproductive Technologies

Surgical repairs of varicoceles largely improve sperm quality and fertility.  However some individuals may still be unable to father children even after the procedure. Assisted Reproductive Technologies such as In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) may be considered in cases such as:

• Severe varicocele cases: Some patients may have suffered irreversible testicular damage before accessing treatment. In this case ART may be employed to achieve pregnancy. 
• Failed natural conception after varicocele treatment: Where a couple may have tried to conceive for many months after a varicocele surgery, Assisted fertility options may provide a solution.
• Persistently low sperm count: Sometimes after varicocele repair, sperm production may still be too low for natural conception necessitating the need for ART intervention. 
• Older age and fertility concerns: Fertility naturally declines as one ages, thus even after varicocele repair, a couple may need ART assistance to increase the chances of conception. 

The journey to fatherhood need not be one of blood sweat and tears. The Fertility Associates of Memphis (FAM), provides a wide range of solutions to suit your specific needs. From IVF, ICSI, semen analysis to egg donor services, you are sure to get the much needed boost towards parenthood. The choice between IVF, IUI, or other ART options is largely dependent on individual circumstances. At FAM, we measure success rates in families because tens of thousands of babies are born each year through our interventions. Contact us today and begin your next chapter with confidence.

FAQs:

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

A varicocele is a condition where the veins in the scrotum become enlarged, potentially causing reduced sperm production, diminished sperm quality, and lower testosterone levels.

How is varicocele diagnosed?

Varicoceles are diagnosed through a physical examination or scrotal ultrasound, both of which help assess the presence and severity of the condition.

What are the treatment options for varicocele?

Varicocelectomy, a surgical correction, and embolization, a minimally invasive procedure, are both effective in enhancing sperm quality by improving blood flow and reducing the negative impact of varicoceles.

Does varicocele surgery improve fertility?

Research indicates that varicocelectomy can enhance sperm count and motility, increasing the likelihood of conceiving naturally.

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

Sperm quality and function may show noticeable improvements within 3 to 6 months after surgery,