A varicocele is the enlargement of the veins (the pampiniform plexus) that carry blood away from the testicle — similar to varicose veins in the legs. It occurs in a significant proportion of men and is the most common correctable cause of male infertility.
Relation to infertility
The enlarged veins can raise the temperature around the testicle and impair blood flow, negatively affecting sperm production and quality. However, not every man with a varicocele develops infertility; the effect varies from person to person.
What are the symptoms?
- Often it causes no symptoms and is noticed by chance
- Heaviness or a dull ache in the scrotum — especially at the end of the day
- A "bag of worms"-like tangle of veins that can be felt by hand
- In some cases, shrinkage of the testicle
- Difficulty having children (low sperm values)
How is it diagnosed?
Diagnosis is made with a physical examination; when needed, it is confirmed with a scrotal color Doppler ultrasound. In the infertility work-up, semen analysis (spermiogram) holds an important place.
A varicocele does not always require treatment. The decision is made by assessing the sperm values, pain, testicle size and desire for children together.
Treatment: varicocelectomy
In situations that require treatment, a varicocelectomy — based on tying off the enlarged veins — is performed. In particular, varicocelectomy done with the microsurgical method is preferred for its low complication rate and good results. In suitable patients, an improvement in sperm values and an increase in the chance of pregnancy can be seen after surgery.
When does treatment come into play?
Treatment is considered in situations such as impaired sperm values together with a desire for children, bothersome pain, or affected testicular development in young people. Varicoceles that are asymptomatic and have normal sperm values are often only monitored.