What are varicoceles?

So it’s basically a large inflamed veins in the testicle that can cause a problem and blockage and pain in the testicles which then could lead to either reduced amount of sperm being produced or passed out or it can actually, in some degrees. actually stop the production of a sperm altogether. So, it’s basically a problem with the veins that are inside the testicles.

Varicoceles are an enlarged vein in the testicles and it can affect your fertility. It tends to either reduce the amount of sperm you’re producing and/or there is some evidence that it can also affect your sperm DNA fragmentation, so they don’t definitively cause infertility but it is associated with it. It’s one of those things if you have been diagnosed with a low sperm count and you’ve got a varicocele, some urologists will decide to remove them which means a testicular surgery and it’s just done on a patient-specific basis depending on what your sperm parameters are.

Varicocele is actually a dilated vein around the testicular tissue. Every organ receives its blood supply from the arteries and the blood is drained back through the veins, so if the veins which drain the testes become dilated, then what happens is that blood stays there for a longer time and it can lead to increased temperature in the local area which you are aware is not good for the spermatogenesis process. The reason behind this is that the veins contain the valve which pushes the blood towards the heart and if the veins valvular function is disturbed due to any reason such as prolonged standing, overweight or some genetic insufficiency of the valves, then the blood is not properly drained and it stays there and it can appear as a dilated vein. The patient can see it or feel it, commonly it is described as a bag of worms, especially if the patient stands for a long time they could feel a dull itchy sensation in the groin or scrotal area and this can be further evaluated by clinical examination by a doctor to categories the severity of that varicocele, whether it is mild, moderate or severe and whether it is in one side or both sides. Commonly it is on the left side because of the anatomy of the left sided vein compared to the right sided vein. You could also do imaging through testicular ultrasound scan and can find out about this presence or the severity of the varicocele. This is also the relation with fertility, because the blood stays for a longer time, it generates heat and it can sometimes have an impact on the number and quality of sperm.

Varicocele is a very common condition which involves a disturbance in the vascularity of the testicles and may have an impact (not always) on the quality of the sperm, an impact on spermatogenesis and hence, the quality of the sperm and it may affect the fertility status of a man. So once a male infertility is diagnosed, one a part of our investigation routine is to refer this male men to be tested for varicocele and in case varicocele is diagnosed, then an andrologist or urologist will decide whether intervention varicocele repair will have a benefit and will improve the fertility status of these men.

Much like varicose veins, varicose veins obviously occur in the leg and they’re due to the fact that the valves that prevent backflows of the veins aren’t working properly – the blood can pull in a dependent kind of manner assisted by gravity and the same thing can occur in the scrotum. So they’re pretty common. About 15 percent of men have a varicocele and they’re more common in men coming through fertility clinics. Varicoceles are more common on the left side and are believed to have a harmful effect on sperm by kind of heating the testicle – that’s the most commonly believed theory. Sometimes you’ll see a patient who’s got, say for example, a large left-sided varicocele and a small left testicle so clearly we think the varicocele may have an impact on the development of that testicle or on its general health. So the best examiner for the patient standing. Sometimes they can be uncomfortable towards the end of the day. Quite often though they are painless, severe pain in the testicle is not until uncommon but it’s unlikely to be caused by a varicocele itself but often people are scanned at that point and the varicocele is detected and the assumption is made that the pain is caused by the varicocele – it might not be testicular pains are very common like pelvic pain in women and they can be quite difficult to treat but certainly varicoceles are something that you should be examined for, if you’ve got a sperm quality issue.

The varicocele is a pathological dilatation of testicles veins. These varicose veins surrounding the testicles cause increase of the temperature and alteration of the oxygen that compromise the process of the spermatozoa. Varicoceles are present in 15-20% of the general male population and 35-40% of infertile men. For anatomical reasons 95% of cases involve the left testicle. Among the various approaches in treating the varicoceles, microsurgical varicocelectomy is considered the golden standard technique.

Varicoceles are dilations of veins that feed into the entity and the scrotum, is called pampiniform plexus and when you have a dilation of those veins, you get a pooling of blood within the scrotal, within the testes and that increases testicular temperature and as a result of increased testicular temperature that can result in poor sperm quality, an increase in reactive oxygen species which damages the sperm DNA et cetera but also, it can reduce the number of sperm produced as well.
Now the symptoms can be subclinical or clinical. Sub-clinical is where it’s not really seen physically whereas in some cases it’s graded to various grades and in some cases, you can see the veins within the scrotum and that would be the clinical varicocele. One of the most common causes of infertility, male infertility is varicoceles. About 30% or more of men coming through for IVF have some level of a varicocele so, if this if it’s recognized earlier and if it’s treated earlier, it can really improve sperm quality and avoid the whole IVF journey of the males in some cases. So varicocele is a really important cause of male infertility, if it’s recognized and treated earlier it can improve sperm quality and fertilization outcomes.

Something like about 40% of men and who are having difficulties in fathering children have varicosities and a varicocele is like a varicose vein on the testes, on the scrotum and as we know, the testes are outside the body to keep them cool because that’s where sperm like to be at 35 degrees instead of 37 but if they have varicose veins around the testes, then that increases the temperature and that can decrease the quality of their sperm and decreases their chances of becoming a dad.

A varicocele is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum). To understand it better, a varicocele is similar to a varicose vein you might see in your leg.

Varicoceles commonly cause a low production of sperm and also decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production, some varicoceles can also cause testicles to fail to develop normally or shrink.

It’s more common to see varicoceles during puberty and young adult age and normally on the left side, most likely because of the position of the left testicular vein. There is a considerable debate about the effects of varicoceles on future fertility, but the current evidence suggests that varicoceles are found in around 40% among males attending the infertility clinics and it is important to note that treatment of varicoceles is associated with increased spontaneous conception rates among infertile couples. 

Most varicoceles develop over time and fortunately, most varicoceles are easy to diagnose and many don’t need treatment. A varicocele often produces no signs or symptoms, however in some cases it can cause pain and in these cases, it often can be repaired surgically.
To explain a little bit about how the varicocele can be formed, I will talk about the spermatic cord. The spermatic cord is in charge of carrying blood to and from the testicle. Therefore, many experts agree that a varicocele forms when the valves inside the veins in the spermatic cord don’t work properly and prevent the blood from flowing correctly. The resulting accumulation of blood makes the veins widen, and dilate and also it raises the temperature.

We can find two types of varicocele; the primary varicocele appears on the left side and normally doesn’t show symptoms and it is the most frequent. 

On the other hand, the secondary varicocele is usually manifested on the right side and in most cases, it has a tumoral origin. In that type of varicocele, it is more common to feel pain.

Moreover, it’s important to highlight that clinical varicocele had been classified into three grades depending on the severity of the pathology. 
Varicocele treatment is indicated in patients who are symptomatic and are investigated for infertility. There is strong evidence that reparation through surgery is successful in 90% of the cases and it can restore testicular volume and semen parameters, as well as increase the rate of pregnancy.

Varicocele is a vascular disease and it is characterised by the abnormal enlargement and tortuosity of veins in the pampiniform plexus. It is considered one of the most common reasons for male infertility. Particularly it is a correctable reason as by performing varicocelectomy this vascular disease can be fixed. It is mostly common in infertile men and around 35-45 percent of men with primary infertility show varicoceles while it is present in around 45 to 80 percent of men with secondary infertility. It has also been estimated that varicoceles is estimated to appear in 1 out of 7 adolescents over 15 years old.