varicocele

When it comes to male fertility Varicocele is one of the biggest unknown yet common issues which can seriously impact a man’s chances of conceiving.

Varicocele occurs in 15% of the male population but is present in 40% of men who are struggling to conceive. This increases to 80% when you look at men who are struggling to have their second child (secondary infertility).

What is Varicocele?

Varicocele is in effect a varicose vein that affects the blood supply to the scrotum. It is more common on the left side than the right but can occur on both sides.

Due to poor veinous return blood pools in the veins within the scrotum causing them to become engorged. The pooling of blood that follows causes a rise in scrotal temperature which can be detrimental to sperm health through increased oxidative stress and DNA fragmentation.

How do I know I have one?

Many men will be blissfully unaware that they have a Varicocele, and it often goes undiagnosed as it isn’t routinely checked for.

Certainly, if you’ve received a poor semen analysis or have high level DNA fragmentation Varicocele could be a consideration and is something a Urologist / Andrologist would want to discount or confirm.  

Although less common some men may experience:

• Aching or heaviness in the testicles, especially on the left
  
• Pain
  
• A mass or feeling of a “bag of worms” within the scrotum
  
• Heaviness that is exacerbated by exercise or long periods standing
  

How do I get checked?

Getting assessed for a Varicocele should in theory be quite easy. Your GP should be able to carry out a physical examination and may send you for an ultrasound scan to confirm the diagnosis.

However, as we mentioned this isn’t done routinely and you may have to ask to have it checked. Many men shy away from going to the Doctor for any health issues, but this is a simple check that could make all the difference to your fertility and family plans.

If you have no luck with your GP then you may want to arrange a private consultation with a Urologist / Andrologist.

Once an examination has taken place your Varicocele will be graded. If having an ultrasound scan you will be asked to perform the Valsalva technique to increase the pressure in the veins. This is similar to the way you might push whilst trying to poo. This helps the sonographer assess the level of the Varicocele.

Grading usually follows the below system.

What happens next?

Once you’ve been diagnosed with a Varicocele the treatment pathway isn’t particularly clear especially within the NHS.

If you’ve been diagnosed with a Varicocele through the NHS then it is unlikely that you’ll be referred for corrective surgery for fertility reasons alone. Currently there is limited evidence around the effectiveness of Varicocele repair in improving fertility outcomes which means the NHS aren’t likely to fund it. If, however you are experiencing pain because of your Varicocele then you will be referred for treatment under the NHS.

If you’ve been diagnosed through a private clinic / Andrologist then you will more than likely be given the option of having surgery to repair the Varicocele if the grading is of a level that causes concern or if you have high levels of oxidative stress or DNA fragmentation.

What you must bear in mind is that Varicocele repair does not guarantee an improvement in sperm quality and you need to discuss this with your Urologist / Andrologist.

Surgical options

Once you do move forward with surgery you’ll be offered a couple of options. Both come with their own benefits and risks which you should discuss with your clinician before going ahead.

Varicocelectomy

A Varicocelectomy is where a surgeon will be looking to tie or clip shut (ligation) the veins that are causing the problem. This will be done through a small incision in the groin or abdomen. Surgery time varies from 40 mins up to 3 hours depending on the type of surgery used and the complexity of the Varicocele. Recovery will take around a week or so and you will have some mild pain for the first few days.

Embolisation

Embolisation is an alternative to the surgical technique mentioned above and is carried out by an interventional radiologist. With the embolisation technique a small tube is inserted through the groin or neck allowing the radiologist to work his way through to the affected veins. Here they insert either small coils or a chemical that blocks or destroys the veins cutting of the blood supply to the affected veins.

This technique can generally be done whilst awake with just a local anaesthetic for the tube insertion and the recovery is much quicker meaning it is a more popular technique.

Naturally many men are quite nervous about any kind of surgery that involves their testicles but generally speaking Varicocele treatment is relatively straight forward with minimum pain and recovery time.

Other options

One of the biggest issues in relation to Varicocele is the heat generated by the excess blood pooling in the veins of the scrotum. For those men who have a confirmed Varicocele and are awaiting surgery then regular cooling of the testicles may help improve sperm quality. This can be achieved through loose fitting underwear, applying cooling pads or ice packs (not direct onto the skin) or with the use of Snowballs underwear.

Snowballs underwear allows you to apply cold packs through specially designed underwear for 8 hours at a time. Daft as this may sound it has proven to be effective with some research showing that regular scrotal cooling can improve sperm quality.

Another consideration for men with a confirmed Varicocele is regular ejaculation. The longer sperm are stored up the more prone they are to heat damage especially if there’s a Varicocele present. Really if you’re trying to conceive you should be ejaculating every 2 – 3 days in order to keep your sperm as healthy as possible.

You can read more about the myth of storing sperm up here.

Summary

Varicocele is an important element to the male fertility equation and is something that all men should consider and get checked. It is one of the primary causes of fertility problems and early treatment and intervention could make all the difference.  

If you suspect you may have a Varicocele then we would recommend speaking to your GP or arrange an appointment with a Urologist.