Male infertility is as much a valid pursuit in fertility treatment as female infertility. In fact, in the case of couples, both members should be tested so as to fully probe infertility concerns. From what is thought to be the most shared problems regarding male infertility that has to do with sperm production, low sperm count, problems with sperm motility, erectile dysfunction, hormone dysfunction related to LH or testosterone levels, or already retrograde ejaculation (where the ejaculate flows back to the bladder instead of the normal pathway), in some situations, alert physicians should also probe the possibility of varicocele.
The varicocele refers to the widening and dilatation of the veins around the spermatic cord inside the scrotum, usually on the left side. The incidence of varicocele is that it affects about 15-20% of the general male population. Contrary to what some have been led to believe, the truth is that most of the affected males are high when their sperm is analyzed with a normal semen analyzer, however, it can affect 20 to 40% of infertile men, if they are smokers.
Presentation and Diagnosis of Varicocele
The average age that males first notice the varicocele is 15-25 years old. Although the condition can be asymptomatic, in some situations it may be uncomfortable. This is because those affected can experience a dull discomfort, heaviness in the scrotum that can worsen over a given day, and there might also be sensations of a lump or swelling in the scrotum. These are also considered the symptoms of varicocele, in addition as its presentation upon examination by the physician. Experienced clinicians also point out that the diagnosis of varicocele is where the veins are twisted or congested and sometimes described as a bag of worms. Please observe that males that self examine the testicles, as all males should do for signs of testicular cancer, a serious problem, you should always consult a physician if there are reasons for concern, and you should never assume from this article that lumps on your scrotum are simply varicocele. Leave the diagnostics for a specialized. This article however, is about varicocele as it may present in some situations of male infertility.
The clinical diagnosis of varicocele is often done by the physician upon physical examination, with the patient standing, and employing the Valsalva maneuver. If the diagnosis of varicocele is nevertheless not definitive, the clinician may order an ultrasound of the scrotum.
Causes of Varicocele
Varicocele is due to an abnormal valve function inside the veins of the scrotum, which causes blood to back up and rule to swelling and widening of the veins. Among older geriatric men, it may be due to a kidney tumor, but that is extremely scarce. Treatment considerations regarding varicocele are important in situations where males present with infertility who are also smokers. As there may be some situations of testis atrophy due to the accumulation of toxins. There was also research that showed that varicocele increases the temperature of the scrotum and the intratesticular pressure reduces the blood flow. These findings were thought to possibly rule to hypoxia and the reflux of toxic metabolites from the adrenal gland. This influenced the DNA in the sperm head. However, these studies were inconclusive, because there was not a meaningful difference between men who were high with varicocele and men who were infertile with varicocele.
Treatment Recommendations for Varicocele in Men with Infertility
First of all, in many situations of varicocele, it is harmless. No further treatment may be needed. However, there are things to be done to help relieve the discomfort of varicocele, and these could include wearing special underwear, or lying down when the discomfort is distinct. And surgery could be considered. However the surgery option is not to be seen as a quick and easy fix, as it is not something to be recommended except in situations where there is extreme pain due to varicocele, or where men who are smokers present with both definitive varicocele and infertility.
There were studies that showed that the effects of surgery on the varicocele improved sperm motility and pregnancy rates, however later meta analyses of these studies did not show the same considerably higher rates of pregnancy following the surgery. If surgery is to be considered among the situations described (extreme pain and among those with varicocele and infertility, who are also smokers), there are several surgical options that may be considered. Namely: (a). open surgery as an outpatient operation, under general or local anesthesia by a small incision in the groin; (b). microsurgery where a microscope can be used; (c). laparoscopic surgery; this requires general anesthesia. Also, percutaneous embolization may also be performed, where this can be done under local anesthesia, but this is truly non surgical.
Because of the research frequently cited, many clinicians will recommend surgery quite freely, however, it should only be considered in situations of male infertility where varicocele is present if the male is a smoker, in addition as considering other factors. These other contraindicating factors that require dutiful diligence by the clinician, should include: duration of infertility; very low sperm count and very low motility (in such situations it is doubtful that surgery will enhance the count enough to consequence in pregnancy versus IUI or ICSI); the presence of other factors that affect fertility from the female (in the case of couples) like progressive maternal age, confined tubes, anovulation, ovarian save problem. In the presence of such problems; it is not advised to do the surgery. Also, varicocele that is not detected clinically, but has only been diagnosed by Doppler ultrasound should not be operated on, as there has not been proven evidence of assistance. Finally after surgery, if the couples didn’t unprotected to pregnancy within 6-9 months, then IUI or ICSI should nevertheless be considered.
In conclusion, varicocele is a valid condition if clinically present to be considered by the clinician in situations of infertility, if certain contraindications are not present and if the male is in extreme pain and/or is a smoker.