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If you’ve been diagnosed with varicocele or suspect you have this condition, your first thoughts may be about your future family planning. Let’s take a look at this common issue and what it could mean for your fertility.
Pronunciation: ver-a-ko-seal. (If you get it wrong, don’t worry—you’re not alone.)
Varicocele is an enlargement of the veins within the scrotum, the loose skin that houses the testicles. It’s similar to varicose veins in the legs, and it’s relatively common, occurring in roughly one in six (over 15%) people assigned male at birth.
Researchers believe that varicocele is caused by defects in the valve(s) that regulate the blood flow to and from the testicles. When the valves have a fault, blood can back up within the veins, causing bulging and stretching.
In most cases, this happens during puberty, when changes to the sex organs increase blood flow. Interestingly enough, it happens most often—around 90% of the time—in the left testicle, but can also occur in the right testicle or in both (known as bilateral varicocele).
Varicocele doesn’t usually cause any symptoms, and most people with this condition don’t even notice. If there are symptoms, they often manifest as:
Having varicocele doesn’t automatically mean it’s affecting sperm health. However, varicocele is associated with infertility; according to UCLA Health, about 40 percent of males experiencing infertility also had varicocele in at least one testicle.
Varicocele can also cause the affected side to shrink. Medical professionals aren’t entirely sure of the relationship between damaged veins and shrinkage of the testicle, but it could be due to increased pressure or exposure to toxins in the blood.
Since most people with testicles may not even realize they have varicocele, diagnosis happens through a physical exam. A doctor examining the testicle could notice visible veins and confirm through a small physical exam.
Smaller varicoceles can be diagnosed with Doppler ultrasonography, a technique that listens for backflow through the valves. Doctors may also use thermography, an infrared process that senses pockets of heat created by the pools of blood in the enlarged veins.
There has been ongoing debate about the effects of varicocele on fertility, but the most recent literature strongly suggests a link. A massive literature review published in 2011 found that, despite conflicting studies, some research found significant improvements in fertility after varicocele repair.
Varicocele doesn’t cause blanket infertility, but it may be associated with altered semen parameters. Why? Some potential mechanisms:
According to a study from March of this year, varicocele patients have a significant reduction in average semen parameters and an increase in sperm DNA fragmentation, damage to the genetic material carried by sperm. The study examined 84 varicocele patients and 85 healthy patients. Researchers suspected that chronic inflammation caused by varicocele, and the associated oxidative stress, reduced overall semen parameters.
Additionally studies provide further evidence connecting varicocele and sperm DNA fragmentation. A 2006 study found a higher percentage of class III and class IV DNA fragmentation (meaning, high levels of damage) in adolescents with at least one varicocele-affected testicle. Another study pointed to chronic inflammation as a potential source of sperm disruption.
Varicocele doesn’t always require treatment. If there’s no ongoing pain or discomfort, or no fertility issues, treatment—especially surgery—isn’t an automatic path. However, for those experiencing either challenge, there are surgical and nonsurgical treatment options.
If it’s causing pain or discomfort, treatment can reduce those symptoms. For those of you considering future family planning, it can help to make an informed decision about seeking treatment.
Treatment can be as simple as anti-inflammatory medications, or wearing snug underwear or a jockstrap to provide support for the testicles. These treatments reduce discomfort, but may not reverse any effect of the varicocele on male fertility.
Embolization is also a nonsurgical treatment option. During embolization, a catheter is used to place a coil or other obstacle into the damaged vein to block it and redirect blood flow. Embolization is less invasive than surgery, and is an outpatient procedure with a shorter healing period. However, embolization may have a higher rate of failure than surgical varicocele repair.
Similar to embolization, surgery can help redirect the flow of blood to reduce pockets and fix any valve issues causing the flow issues in the first place. The surgeon ties off the unhealthy vein while preserving the overall vein and artery structure. This process is known as “varicocelectomy.”
Studies show a strong link between varicocele repair surgery and both improved sperm parameters and increased rates of pregnancy. Some studies also estimate that embolization, if successful, will produce a similar improvement.
If you find out you have varicocele, the first step should be to get a deeper picture of your sperm health through at-home semen analysis. Then, you and your doctor will be able to make an informed decision for your fertility and your health.
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