Varicocele

A varicocele is the enlargement of the veins inside the scrotum. These veins are found along the cord that holds up a man’s testicles (spermatic cord) and their widening can affect a patient’s fertility due to a raise in the testicles’ temperature.

Contrary to popular belief, surgery is not strictly necessary to improve sperm quality in patients with varicocele. In-Vitro Fertilization combined with intracytoplasmic sperm injection ( IVF + ICSI) offers the highest pregnancy rates in patients with varicocele making possible to select and inject a single viable sperm directly into the egg.

What is varicocele?

A varicocele is the swelling of the veins inside the scrotum.

About 15 percent of men suffer from this disease, and although this is not a problem for some of them, nearly 40 percent of infertile men present varicocele.

The Varicocele raises testicular temperature, affecting the patient’s fertility in some ways:

  1. It causes oligozoospermia (low sperm concentration in the ejaculate)
  2. Decreases sperm motility ( astenozoospermia ) which prevents them from reaching the egg
  3. Generates changes in sperm morphology (teratozoospermia)

Varicocele main symptoms

Although varicocele may be asymptomatic, its symptoms usually manifest through:

  • Presence of enlarged/twisted veins in the scrotum
  • Scrotal swelling
  • Presence of painless testicular tumors
  • Testicle pain or heaviness, especially when standing
  • Different size between both testicles
  • Infertility

It’s important to note that the presence of varicocele on the left testicle is much more common (in about 80 percent of the cases).

Causes of varicocele

The veins in your testicles (just like the ones in your legs) have valves that help blood to flow to your heart. If these valves fail, the blood accumulates in the veins and causes them to dilate.

Usually the varicocele develops slowly, being more common in men from 15 to 25 years old.

Usually the varicocele develops slowly, being more common in men from 15 to 25 years old.

In addition to a medical history analysis, a genital examination needs to be performed. This painless procedure takes a just few minutes and can reveal the presence of enlarged veins or other varicocele symptoms.

It is also advisable to perform a spermiogram (or semen analysis) to rule out problems in sperm concentration, motility and/or morphology.

Treatments to achieve pregnancy in patients with varicocele

Treatments to achieve pregnancy when suffering from varicocele include:

  1. Artificial insemination, where a previously capacitated couple or donor sperm sample is introduced into the woman’s uterus just at the time of ovulation. This method is only recommended in women under 35 and only when there are no other infertility causes detected. 
  2. In-Vitro Fertilization (IVF), which allows to join the patient’s eggs with an improved quality sperm sample in a special laboratory dish under controlled conditions to increase the likelihood of a successful fertilization.
  3. In-Vitro Fertilization (IVF) and Intracytoplasmic Sperm Microinjection (IVF + ICSI). In this specialized procedure a single sperm is carefully introduced directly into the cytoplasm of a mature egg using a microscopic needle via micromanipulation. This technique offers the highest pregnancy rates by disregarding sperm motility as a necessity to fertilize the egg.

In case the ejaculate presents no sperms, it is still possible to recover them in some cases by Epididymal Aspiration or testicular biopsy.

It is also important to clarify that varicocele correction surgery is not recommended, since it does not reverse the damage generated by the varicocele in the first place.