Varicocele and Male Fertility
Wednesday, September 29th, 2010
Most people are familiar with something called varicose or “spider” veins, an unsightly condition characterized by enlarged and swollen veins usually seen on the legs and feet. What you may not know is that a similar condition exists that specifically targets the veins located within a mans scrotum. Known as a varicocele, this is an irregular dilation of the testicular veins resulting in abnormal enlargement. While often painless and correctable through surgery, there is some evidence that varicocele can have a direct negative impact on male fertility.
All men have within them a structure called a “spermatic cord” which contains various arteries, veins, nerves and tubes. This cord functions to circulate blood to and from the testicles. Located within the veins are valves that regulate blood flow to ensure it goes in the right direction and doesn’t flow backwards.
Unfortunately these valves can sometimes fail which allows some of the blood to flow in reverse. When this happens the backed up blood can start to pool in the veins causing them to swell and stretch. This is what is known as a varicocele.
The size of the varicocele can vary from being very large and easily visible to those that are not noticeable at all and can only be felt by touch. In many cases the varicoceles will seem to disappear as you lie down because the blood drains away from the veins. Once you stand back up however, gravity will then force the blood to pool again and the varicocele will reappear.
Although this condition is usually painless, some percentage of men do report discomfort or will notice an aching or heavy feeling from within the testicles. It can present more of a problem if it appears in men over the age of 40 (it’s most common in men between the age of 15 and 25). In older men it may signal a larger problem such as a possible blockage of a larger vein in the abdomen or compression of the vein by a nearby structure. For a complete and accurate diagnosis of this condition, a full evaluation should be performed by a licensed medical professional.
Varicocele can often be corrected through minor out-patient surgery in a procedure that involves tying off the veins that are enlarged. Usually this is only performed if the condition is causing significant discomfort or, in the case of adolescents, the testes are not developing properly because of the varicocele.
While largely successful, this surgery is not always a permanent solution since some men will develop new varicoceles months or even years later. This is often because the remaining veins become enlarged due to the additional blood flow they are left to carry. Recent surgical advances such as laparoscopic varicocelectomy have helped greatly improve the overall effectiveness of this type of procedure.
The results of some studies suggest a direct connection between higher male infertility rates and the presence of a varicocele. When the veins become dilated because blood is unable to drain properly, the extra blood that pools in the scrotum can be detrimental to overall sperm production. The pooled blood is believed to generate slightly higher than normal temperatures in the scrotum. This elevated temperature may reduce the number and quality of sperm made by the testes which effectively decreases fertility.
“Recent studies have shown that varicocele, a bilateral disease, causes hypoxia in the testicular microcirculation. Destruction of one-way valves in the internal spermatic veins (ISV) elevates hydrostatic pressure in the testicular venules, exceeding the pressure in the arteriolar system. The positive pressure gradient between arterial and venous system is reversed, causing hypoxia in the sperm production site. Sperm production deteriorates gradually, progressing to azoospermia.“
Source:Andrologia / DOI: 10.1111/j.1439-0272.2010.01047.x
“Azoospermia” is a medical condition in which a male lacks a measurable level of sperm in his semen. This condition is associated with very low levels of fertility or even sterility and is thought to affect approximately 1% of the male population.
Although the presence of a varicocele can affect male fertility, it’s important to note that this may not always be the case. For instance, while up to 40% of infertile men are believed to have a varicocele, another 15% of healthy men also have the condition but it does not have an impact on their fertility whatsoever. It’s important to keep in mind that there are many infertility treatments and it’s always best to contact a qualified physician for advice and counseling.
Posted by PRS on Friday, September 24th, 2010
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