• en English
birla-fertility-ivf

Varicocele – Causes, Symptoms & Treatment

  • Published on April 01, 2022
  • Updated on April 01, 2022
Varicocele – Causes, Symptoms & Treatment

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. 

In this article, with insights from Dr. Souren Bhattacharjee, we will explore the modalities for varicocele treatment. But let’s understand what varicocele is all about. 

 

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:

 

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. Souren Bhattacharjee, leading fertility specialist at Birla Fertility & IVF. 

 

FAQs

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. 

 

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. 

 

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. 

 

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. 

 

What happens if a varicocele is left untreated?

An untreated varicocele can cause infertility, testicle shrinkage, and hormonal imbalances in men. 

Written by:
Dr Souren Bhattacharjee

Dr Souren Bhattacharjee

Consultant, Birla Fertility & IVF
Dr Souren Bhattacharjee possesses 32+ years of experience as an IVF Specialist. He has extensive experience in the management of male and female infertility, including IVF and Ultrasound. Along with this, Dr Souren has encountered more than 6000 IVF cycles with a very high success rate. Dr Bhattacharjee is a graduate of Gauhati University, 1983. He earned a diploma in gynaecology and obstetrics in 1991 from Dr MGR Medical University. In 1994, he did his Member Royal College of Obstetricians & Gynaecologists from London and in 2009, he did his Fellow of the Royal College of Obstetricians & Gynaecologists from London.

Over 32 Years of Experience

Kolkata, West Bengal

You May be Interested in

Our Services

Infertility Treatments

Problems with fertility are both emotionally and medically challenging. At Birla Fertility & IVF, we focus on providing you with supportive, personalized care at every step of your journey towards becoming a parent.

Male Infertility

Male factor infertility accounts for almost 40%-50% of all infertility cases. Decreased sperm function can be the result of genetic, lifestyle, medical or environmental factors. Fortunately, most causes of male factor infertility can be easily diagnosed and treated.

We offer a comprehensive range of sperm retrieval procedures and treatments for couples with male factor infertility or sexual dysfunction.

Donor Services

We offer a comprehensive and supportive donor program to our patients who require donor sperm or donor eggs in their fertility treatments. We are partnered with reliable, government authorised banks to source quality assured donor samples which are carefully matched to you based on blood type and physical characteristics.

Fertility Preservation

Whether you have made an active decision to delay parenthood or are about to undergo medical treatments that may affect your reproductive health, we can help you explore options to preserve your fertility for the future.

Gynaecological Procedures

Some conditions that impact fertility in women such as blocked fallopian tubes, endometriosis, fibroids, and T-shaped uterus may be treatable with surgery. We offer a range of advanced laparoscopic and hysteroscopic procedures to diagnose and treat these issues.

Diagnostics and Screening

Complete range of basic and advanced fertility investigations to diagnose causes of male and female infertility, making way for personalized treatment plans.

To Know More

Speak to our experts and take your first steps towards parenthood. To book an appointment or to make an enquiry, please leave your details and we will get back to you.

    Thank you for your message. We will be in touch with you shortly.
    Thank you for your message. We will be in touch with you shortly.

    You can also reach us at

    Get in touch with usTake your first step with us TODAY

      Thank you for your message. We will be in touch with you shortly.
      Thank you for your message. We will be in touch with you shortly.

      Call Now