Varicoceles in men and its link to infertility

Difficulty conceiving a baby can be a frustrating and unexpected consequence for some couples wanting to start a family. Very often, infertility is presumed to be a woman’s issue. Yet, about one out of every three infertility cases is due to the man alone.  Clinical infertility is defined if pregnancy is not achieved after 12 months or more of regular unprotected sexual intercourse.  

Male infertility can be attributed to many factors such as drug abuse, toxic environments, heat, chronic disease, obesity, or stress.  But another reason affecting 3 million men a year is a condition called varicoceles.  

Veins inside the scrotum that become enlarged are called varicoceles. Varicoceles are comparable to varicose veins that develop in a leg.  A man’s scrotum is a sac that holds the testicles. A man’s scrotum is part of the male reproductive system responsible for making, storing, and mobilizing sperm.  The testicles make sperm and the hormone testosterone. As sperm mature, they will move through a coiled tube called the epididymis, situated behind each testicle.

Men with varicocele veins within the scrotum will likely have noticeable swelling, pain, atrophy or shrinkage of the scrotum, and/or infertility.  Sometimes, several veins may be affected, appearing bunched together like a “bag of worms.” 

Causes of varicoceles

The scrotum has veins that contain one-way valves allowing blood to flow from the testicles and scrotum back to the heart.  Failure of the valves causes pooling of blood which can increase the pressure that enlarges veins around the testicles in the scrotum that forms a varicocele. 

Varicoceles affect on infertility

There are several incidences in which a man with varicoceles could have his ability to father a child affected:

• Lower sperm count

The scrotal temperature needs to be about 2 degrees Fahrenheit lower than the rest of the body for sperm to develop and for spermatogenesis to proceed normally. However, men with varicoceles can result in blood pooling in the scrotum. Consequently, this results in a rise in testicular temperature, reducing sperm production. Each one-degree rise in temperature in the scrotum and testes causes a 40 percent reduction in sperm count. 

• Low testosterone

Varicoceles may lower a man’s testosterone levels in the testicles. As a result, this could cause a chain reaction resulting in lower fertility.

• DNA damage in sperm

Varicoceles may cause damage to sperm’s DNA.  As a result, men with varicoceles will have more sperm damage than men without varicoceles. 

Symptoms of varicoceles

Generally, most men do not have any symptoms associated with varicoceles.  But some men may experience one or more of the following:

• Pain – Testicular pain, described as a dull ache or feeling of heaviness, can occur if a man stands or sits for long periods or when exercising.  
• Testicle size – The testicle may atrophy or shrink in size
• Appearance of a vein – Veins within the scrotum may grow larger than normal with a twisted or worm-like appearance.
• Infertility – Conceiving a baby becomes more difficult. 

Treatment of varicoceles

There are no medications that treat or prevent varicoceles. Therefore, they are left untreated. But treatment may be offered to men with fertility problems, pain, or if a male child with varicoceles has one testicle growing more slowly than the other. If a man has pain, his doctor may suggest painkillers such as acetaminophen or ibuprofen.

Boys with smaller testicles may face higher fertility rates as adults. 

There are two treatment options men with varicoceles should discuss with their doctor:

• Surgery – A urologist may perform open surgery, laparoscopy, or microsurgery to treat varicoceles. The veins in each surgical option will be permanently tied off to prevent continued abnormal blood flow.  
• Embolization – This minimally invasive, image-guided procedure is an alternative surgery performed by an interventional radiologist.  This procedure can be just as effective as surgery with much less pain and risk and a quicker recovery time.  

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.