In historic times, when a couple was unable to conceive, the onus directly fell onto the female partner. It was a popular misconception that infertility is only a women’s health issue. The truth of the matter is that nearly 50% of the total infertility cases are attributed to male infertility. Thanks to evolving Assisted Reproductive Techniques (ART), awareness about infertility issues has spiked and led to a positive dialogue around the issue. One such issue we shall be discussing today is varicocele. Varicocele is a male infertility factor affecting close to 4-30% of the Indian population. While there is a high prevalence of this condition, various effective varicocele treatment measures are also available.
What is a Varicocele?
A varicocele is a condition in which the veins inside the scrotum become enlarged. Varicoceles can develop gradually over time leading to infertility issues. To put it briefly, varicocele is similar to varicose veins but it affects the scrotum.
Before we study the concepts of varicocele, let us gather an understanding of the anatomical structures of the male reproductive system and how they function.
Anatomy of the Male Reproductive System
The male reproductive system broadly includes internal and external organs. Internal organs are the vas deferens, prostate and urethra while the external organs are the penis, scrotum and testicles.
The scrotum is a loose, pouch-like sac that holds the testicles and ensures that the testes are under a slightly cooler temperature for normal sperm production. Testes are small oval organs responsible for making testosterone and production of sperm.
The testes are attached with epididymis which is a long, coiled tube responsible for carrying and storing the sperm cells. The sperm, after being produced in the testes, travels through the vas deferens and stores in the prostate. When a man ejaculates, the sperm from the prostate gets mixed with seminal fluid, travels through the urethra and reaches the penis.
In addition to the above, the male reproductive system is supported by a large group of veins and blood vessels.
Varicocele Symptoms
In most cases, the first indicator of varicocele is identified by an inability to help your female partner conceive. Varicocele symptoms develop in everyone differently. A large number of men do not display any obvious signs and symptoms while others may have some indicative signs.
Common varicocele symptoms include:
- Pain felt during physical exertion
- Dull pain in the testes
- Decreasing pain when lying on the back
- Worsening pain when standing
- Changes in size and appearance of the testicles
- Swelling in the testicles and scrotum
- Small lump over the affected testicles
Varicocele Causes
There is a network of small veins called the pampiniform plexus which are responsible for transporting oxygen-depleted blood from the testicle to the main testicular vein. The pampiniform plexus also cools down the arterial blood before it reaches the sperm since sperm production occurs most efficiently at 3 degrees lower below your body temperature.
Varicocele occurs when the pampiniform plexus becomes enlarged. Why exactly do these veins enlarge leading to varicocele is not exactly known.
One of the possible varicocele causes can be attributed to the malfunctioning of the valves inside the network of veins. There are certain valves (one-way valves) present inside your veins which are responsible for keeping the blood flow moving. Damage to these valves can make them faulty resulting in their abrupt function. When the valves do not open or close properly, the blood begins to pool causing the vessels to dilate.
There are no significant risk factors associated with the development of varicocele. This condition can occur in anyone with testicles at any age.
Varicocele Diagnosis
Most people are diagnosed with varicocele when they consult their healthcare provider while seeking help for their reproductive health. In other cases, you may visit a fertility centre for diagnosis of varicocele if you have the above-mentioned symptoms.
Your fertility specialist will first physically examine your condition. He/she will perform a complete health check and discuss your medical history with you in detail. You should inform your doctor about any medication you are taking, your family history and your lifestyle choices.
Most of your physical health exam will be done while you are lying down and standing up. Your doctor may ask you to hold your breath for a few seconds and gradually bear it down. This examination technique is known as Valsalva manoeuvre that makes it easy for the fertility specialist to examine the varicocele more easily and properly.
To further confirm the diagnosis, your healthcare provider will perform a screening test for a vivid analysis. He/she may order an ultrasound scan to visualise the images and structures of your internal organs properly. An ultrasonography also allows your doctor to eliminate the chances of other health conditions.
Varicocele Grading
Once your varicocele diagnosis is confirmed, you will want to address the condition at the earliest. However, your doctor may order additional tests to understand the level of varicocele to design tailor-made treatment.
Varicocele grading is a novel system to help categorise the extent of varicocele by distinguishing its size. Knowing the size of the varicocele helps your fertility doctor plan a personalised treatment. There are several scales utilised for varicocele grading, most common is:
| Grade | Description |
| Grade 0 | No physically detectable; Visible on ultrasound |
| Grade I | Felt during Valsalva manoeuvre |
| Grade II | Visible even without Valsalva manoeuvre |
| Grade III | Visible deformity of the scrotum |
Varicocele Treatment
Varicocele treatment is based on many factors including the age and overall health of the patient, his family and health goals and the grade of varicocele. Each individual is offered a personalised treatment plan tailored to his unique needs and biological markers.
If a person experiences varicocele during puberty, his treatment plan will be different from a man experiencing varicocele in his adulthood years and trying for a baby.
There are different treatment alternatives available today to help men with varicocele get rid of their condition and become parents. Common alternatives include:
Home Remedies for Varicocele
There are several home remedies that you use to improve the symptoms as well as treat varicocele. The home remedies for varicocele include the following:
- Ice packs/cold compresses
- Wear a jockstrap for proper support
- Do yoga and meditation regularly
- Stay away from rigorous physical activities
- Choose fibre-rich diet
- Horse chestnut supplements
- Increase the intake of antioxidant
- Avoid junk, processes and greasy foods
- Avoid refined grains and refined sugar
- Quit smoking and say no to alcohol consumption
- Limit the consumption of caffeine
If you apply these home remedies religiously, you will get to see an amazing improvement in varicocele within a few weeks. Also, it is recommended to consult a specialist on time so that proper and timely treatment along with home remedies can set you free from this problem quickly.
Varicocele Surgery
A varicocele surgery allows the affected vein (with the malfunctioning valve) to be sidelined. Since there is a network of veins supporting the male reproductive system, especially the blood flow to and from the scrotum, it is possible to surgically remove the diseased vein.
In a varicocele surgery, your fertility doctor will seal off the affected or damaged vein to restore the flow of the blood into healthy veins.
Surgery for varicocele has various health benefits including:
- Restoration of affected testicle to its original size
- Improvement in sperm count
- Improvement in semen quality
- Enhanced fertility & better chances of conception through In-vitro fertilisation (IVF)
Varicocele surgery, however, has several health effects and associated risks. Common risks include:
- Building up of fluid around the testicles
- Recurrence of varicocele
- Infection
- Damage to the artery
- Pain in the testicles
- Buildup of blood around the testicles
Varicocelectomy
Varicocelectomy is a surgical procedure to treat varicocele. In this procedure, the surgeon stop the flow of blood to the affected vein by clipping or stitching it and shutting the vein (litigation). This procedure can be done via two methods –
- Microscopic varicocelectomy – In this procedure, the surgeon makes a small incision on the low groin area to access the affected veins. He/she then stitches or clips them using a powerful microscope.
- Laparoscopic varicocelectomy – In laparoscopic varicocelectomy, the surgeon makes use of a medical equipment called the laparoscope. It is a thin, long tube with a tiny camera attached at one end that allows the surgeon to access varicocele. For this procedure, the surgeon makes several small incisions in the lower abdomen region.
- Embolisation – Another varicocele treatment available today is a procedure known as embolisation. It is an invasive procedure in which the surgeon blocks the affected vein to stop the blood supply from accumulating. This procedure is done by creating a tiny dam and creating a blockage in the vein.
You will be offered general or local anaesthesia for this procedure. Your doctor will insert a tiny tube into your groin or neck and guide it to the treatment site. Through this tube, he/she will release some coils or solution causing scarring to create a blockage in the testicular vein.
Complications of varicocele
Varicocele is usually a painless condition. Depending on the grade of varicocele, you may feel varying levels of discomfort and associated symptoms. However, if left unaddressed and untreated, varicocele can lead to various complications including:
- Infertility
The increased amount of temperature in the scrotum disrupts health sperm production leading to infertility.
- Shrinking of the testicles
A large portion of the testicles is taken up by the sperm-producing veins. Damaged veins can easily become soft and short leading to the testicles shrinkage.
- Hormone imbalance
The pool of blood caused by varicocele can affect pressure levels and hence change the hormonal levels, causing testosterone problems.
The Takeaway Note
Varicocele is a common condition causing infertility issues in men. However, these issues can be effectively addressed with surgical interventions. If you are experiencing any infertility problems, you can seek expert guidance and care from Dr. Vivek P Kakkad, leading fertility specialist at Birla Fertility & IVF.
FAQs
1. What are the 5 signs of varicocele?
Five signs of varicocele are infertility, change in size of one of the testicles, pain while standing up or sitting, dull pain in the testes and swelling in the scrotum.
2. What is the main cause of varicocele?
There is no exact cause of varicocele. It is primarily caused by build up of a pool of blood in one of the veins in the scrotum disrupting the blood flow.
3. How do you fix a varicocele?
A varicocele can be effectively treated with surgical interventions. There are several invasive, minimally invasive and non-invasive methods for varicocele treatment.
4. Can varicocele be cured?
Yes, you can cure varicocele with timely and effective intervention. It is important to treat the varicocele at the right grade and time to avoid complications.
5. What happens if a varicocele is left untreated?
An untreated varicocele can cause infertility, testicle shrinkage, and hormonal imbalances in men.
6. Can varicoceles be repaired without surgery?
Non-surgical treatment for varicoceles is called embolization, however, this procedure isn’t as widely used as surgery.
