Approximately 25 – 35% of men who have primary male factor infertility (they’ve never fathered a child) have a varicocele, as do 80% of men who have secondary male infertility (fathered previously and now struggle to conceive). So varicocele is prevalent in men with male factor issues, but that doesn’t mean it’s always causative of male factor issues.
Varicocele is an enlargement of the veins in the scrotum as a result of a breakdown in the blood drainage system in the testicles. If a varicocele does play a role in male factor infertility, it’s likely because the varicocele helps drive up the heat and pressure damage in the testes, which impinges sperm production.
Urologists diagnose a varicocele in a pretty rudimentary fashion. If the doctor can feel the varicocele by pressing on the skin, the varicocele is considered “clinical” and the doctor may want to begin treatment. About 85% of varicoceles are on the left side of the body. For men who are obese, or have a small scrotum, an ultrasound is often needed to detect the varicocele.
Varicocele is present in many male factor patients and, after years of treatment, the field has established that only treating certain types of varicoceles improves semen analysis parameters or live birth rates.
Generally speaking, here are the criteria whereby a urologist should consider treating the varicocele:
There are two types of varicocele surgeries, and both involve closing the veins where blood is pooling. Both treatments have relatively short recovery times and modest rates of adverse events. We generally hear from patients they managed to get both covered by insurance, though men who have already been given an infertility diagnosis may face more challenges than men that have yet to be given a fertility diagnosis. As with most aspects of this field, there is conflicting data on which of the two surgical approaches is better.
Few male factor patients are seen by a reproductive urologist, who will focus on treating the man’s underlying issues. Instead, male infertility is often ignored as the couple is ushered directly to IVF with ICSI. In this course we train patients to ascertain if they’re being treated by the proper clinician and whether IVF or ICSI are appropriate measures. We’ll cover the data on where the semen analysis is helpful and unhelpful, and the non-surgical ways fertility can be improved by correcting lifestyle habits and hormone imbalances. Patients will also understand when and how intervention is appropriate to remove varicocele and work around azoospermia.