A varicocele is a varicose vein of the scrotum. They are incredibly common occurring in 15% of all men and 40% of men who visit infertility clinics. However, although common, they are not always a cause of infertility.
Varicoceles can disrupt spermatogenesis (sperm creation). Sperm from a patient with varicoceles are usually low in number, do not swim well, and look abnormal under the microscope (called oligoasthenoteratospermia). The cause of these abnormalities is not clear, but it is possible that because varicoceles elevate temperatures in the scrotum, they could disrupt normal spermatogenesis.
To diagnose whether a varicocele is causing abnormalities in spermatogenesis, we don’t rely only on a semen analysis. Instead we focus on an FSH, which is a test showing an endocrine marker of how stressed a man’s sperm production factory. Many men may have abnormalities on their semen analysis that are totally unrelated to their varicocele.
Surgery for Varicoceles: Varicocelectomy
We usually only perform surgery for varicoceles when patients have the following:
- Abnormalities on their semen analysis
- An elevated FSH showing that the varicocele is causing some stress on the sperm production factory
- A sperm count where surgical repair of the varicocele could alter their chances of conceiving
Although varicoceles can be fixed by different surgical approaches, we recommend that patients undergo a sub-inguinal microscopic varicocelectomy as it has the lowest complication rate and the highest chance of success. We do refer patients to interventional radiology if they have already failed one ligation of the varicocele through the sub-inguinal microsurgical approach.
Learn more about varicocelectomy.