Overview

What Is a Varicocele?

What Is a Varicocele?

abnormal sperm
Abnormal Sperm

A varicocele is a varicose vein inside the scrotum. They are incredibly common. 15 percent of all men and 40 percent of men who visit infertility clinics have varicoceles. However, although common, they don’t always cause infertility.

Varicoceles can disrupt spermatogenesis (sperm creation). Sperm from men who have varicoceles are usually low in number, do not swim well, and look abnormal under the microscope (called oligoasthenoteratospermia).

What Causes Varicose Veins in Testicles?

Researchers don’t know exactly what causes varicose veins inside the scrotum. But it is possible that varicoceles elevate temperatures in the scrotum, disrupting normal sperm creation.

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Varicoceles Diagnosis

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 that will show an endocrine marker of how stressed a man’s sperm production factory is. Many men may have abnormalities in their semen analysis that are totally unrelated to their varicocele.

Treatment/Surgery for Varicoceles: Varicocelectomy

We usually only perform surgery for varicoceles when patients have the following:

  • Abnormalities in 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 have a sub-inguinal microscopic varicocelectomy because it has the lowest complication rate and the highest chance of success. We refer patients to interventional radiology if they have already failed one ligation of the varicocele through the sub-inguinal microsurgical approach.

Varicocelectomy

Figure 1: Varicocelectomy

Swollen vein in the spermatic cord
A. Swollen vein in the spermatic cord
Ligated venous branches of the spermatic cord
B. Ligated venous branches of the spermatic cord

How Long Does Varicocelectomy Take?

This procedure typically takes 45 minutes, and patients go home from the operating room the same day. Most men have minimal pain after this procedure and often forget to take the pain pills that we provide. Men will have semen analysis at two-month intervals after this procedure to see if the quality of their sperm has improved because of the procedure.

Microscopic Procedure

For the varicocelectomy, we typically make a 1–2 cm incision in the groin and then bring the spermatic cord up to the skin (see Figure 1). Once the spermatic cord is brought up to the skin, we bring in the operating microscope to perform the varicocelectomy at 30–40X magnification.

We then open the external spermatic fascia (outside layer) under the microscope and dissect out and divide each engorged spermatic cord vein. We also use a microscopic Doppler probe to find and preserve your artery.