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30% – 40% of infertile men are affected by varicoceles.
Source: Gynecology and Obstetrics Research Journal, 2(1). 29-34 (2015)

What is a Varicocele?

A varicocele is a varicose vein of the testicle and scrotum that may cause pain, swelling, and/or infertility. The scrotal veins contain one-way valves that allow blood to flow from the testicles and scrotum back to the heart.  When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum resulting in a varicocele. This may cause pain and swelling.  It is believed that varicoceles contribute to male infertility.

normal-valves
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Who is at Risk of Getting a Varicocele?

Approximately 10 percent of all men have varicoceles.

Among infertile couples, the incidence of varicoceles increases to 40 percent.

Highest occurrence in men aged 15-35.

Varicocele Symptoms

Many males with varicoceles have no symptoms at all.  It is not uncommon for a man to be unaware that he has a varicocele unless it is noticed during a routine physical exam or it causes problems with fertility.  When symptoms do occur, the dilated veins in the scrotum can often be felt or seen, and the testicle may be smaller on the varicocele side.

The varicocele may cause pain, testicular atrophy (shrinkage) or male infertility. Veins contain one-way valves that allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to resulting in a varicocele.

Testicular Pain

Some men with varicocele experience testicular pain when standing or sitting for a long time, or during exercise. The pain may feel like a dull ache, or a feeling of heaviness. The discomfort often goes away when lying down

Infertility

Male infertility has been associated with varicoceles. Some experts believe that the blocked and enlarged veins around the testes cause infertility by raising the temperature in the scrotum and decreasing sperm production

No Symptoms

If you have a varicocele you may be symptom free.  The signs that you may have a varicocele might be that you notice a lump in one of your testicles, or swelling in your scrotum. You may also notice visibly enlarged or twisted “worm-like” veins in the scrotum.

Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm are related to varicoceles.

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What Causes a Varicocele?

Similar to varicose veins, a varicocele develops over time. They often form during puberty and usually occur on the left side most likely related to the position of the left testicular vein.

Many experts believe a varicocele forms when the valves inside the veins of the scrotum malfunction preventing your blood from flowing back towards the systemic circulation. The resulting backup causes the veins to dilate (widen).

With time, a varicocele may enlarge and become more noticeable. These enlarged varicoceles may result in damage to the testicle and play a role in male infertility. Most varicoceles are easy to diagnose and may be discovered during a routine physical exam or a fertility evaluation.

Varicocele Complications & Risks

A varicocele is a collection of abnormally dilated veins in the scrotum, similar to varicose veins. They may cause pain, testicular atrophy (shrinkage) or male infertility. Veins contain one-way valves that work to allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools; this leads to enlargement of the veins around the testicle in the scrotum which results in the development of a varicocele.

It is not always necessary to treat a varicocele. However, if a varicocele causes symptoms such as pain or swelling or problems with fertility, it often can be repaired with varicocele embolization or surgery.

Infertility

Varicoceles are a common cause of decreased sperm production and quality, which often contributes to infertility. It is believed that blocked and enlarged veins around the testes (varicoceles) cause infertility by raising the temperature in the scrotum, affecting sperm formation, movement (motility) and function.

Testicular Atrophy

The bulk of the testicle is comprised of sperm-producing tubules. When damaged, as from a varicocele, the testicle may shrink and soften. It’s not clear what causes the testicle to shrink, but the dysfunctional valves causes’ blood to pool in the veins, which results in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage. Frequently, after the varicocele is repaired, the affected testicle will return to normal size.

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Understanding Varicoceles and Male Infertility.

Diagnosing & Testing

The diagnosis of varicocele is fairly simple via either a physical or diagnostic examination:

During a visual physical exam:

  • 95 percent of varicoceles are found on the left side of the scrotum
  • The scrotum looks like a “bag of worms”
  • The testicles may be shrunken in size (atrophy)

In the case of an inconclusive physical examination:

  • Abnormal blood flow can be detected with a noninvasive imaging exam such as an ultrasound or through a venogram – an x-ray in which a special dye is injected into the veins to highlight blood vessel.

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Varicocele Treatments

You’ve been diagnosed with a varicocele and probably wondering what you can do about it.

Some men will not need treatment for a varicocele, but if you are suffering from pain or infertility, varicocele repair provides your best chance for improvement.

In the past, surgery was the only option for treating a varicocele. Today men have a choice between surgery and minimally invasive varicocele embolization performed by an interventional radiologist.

varicocele-embolization

Varicocele Embolization

Varicocele embolization closes off the blood flow to the affected vein without surgery. Also called catheter-directed embolization, varicocele embolization is a highly effective, widely available technique to treat symptomatic varicoceles.

This outpatient procedure, performed by an interventional radiologist, uses image-guided technology to insert a thin catheter into a vein in your groin or neck after you are sedated.

Vascular coils, which may be used with a sclerosing agent, are inserted through the catheter to block, or embolize, the abnormal veins. In turn, this reduces pressure in the varicocele. By embolizing the vein, blood flow is redirected through other pathways. Essentially blood flow to the incompetent vein is “shut off” by the coils and/0r sclerosant, accomplishing what the surgeon does – without an incision.

Throughout the procedure the patient is relaxed and free of pain. Total time for an embolization procedure is approximately 2 hours from admission to discharge.

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varicocele-incision

Varicocele Surgery

There are several surgical approaches that are used to close off or “ligate” the varicose vein and repair the varicocele. These include open surgery (with a relatively high incidence of varicocele recurrence), microsurgical (a lower recurrence rate, but technically more complex), or the laparoscopic approach (requiring general anesthesia with higher complication rates). These procedures are performed in a hospital.

Although most patients leave the hospital the same day, 24 percent of surgical ligation patients are required to stay at the hospital overnight. Patients of open surgical ligation can expect a two-to-three week recovery period.

If you are considering surgical treatment, we recommend you also get a second opinion from an interventional radiologist to ensure you know all of your treatment options.

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Embolization is equally effective in improving male infertility and costs about the same as surgical ligation. According to the Society of Interventional Radiology, pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy.

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Speak to a Varicocele Embolization Specialist

Say No to Surgery and Schedule an Appointment Today

If you have been diagnosed with varicoceles and are not interested in having varicocele surgery, then varicocele embolization may be right for you. Schedule an appointment to speak with a varicocele specialist in your area and learn more about your varicocele treatment options.

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