Varicocele and male infertility: what you need to know

Varicocele is a dilation of the veins in the testicle that is usually unilateral. It predominantly affects the left testicle and very rarely the right.

Its incidence is estimated at between 10 and 15% of the male population, but in the infertile male population, a variability of between 25 and 40% of men with altered semen quality has been postulated.

In most cases, varicocele is asymptomatic, which means that many men are unaware that they have it. That is why we want to dedicate this article to the subject, to tell you a little more about varicocele and its relationship with male fertility.

How does varicocele occur, and what are its symptoms?

Varicocele is caused by reflux or decreased venous drainage from the main vein of the testicular venous drainage system.

It is usually asymptomatic and is diagnosed by a urological examination, but sometimes it causes symptoms such as heaviness or pain in the testicles/scrotum and/or groin. This intensity usually increases when standing up.

Does varicocele affect male fertility?

Varicocele has been reported to cause infertility, affecting semen quality in several ways:

1. By increasing the temperature of the testicle by 2 or 3 degrees, which affects sperm production and alters sperm count and motility.
2. By increasing oxidative stress and, therefore, sperm fragmentation (damage to sperm DNA). This reduces fertilisation capacity.
3. In the long term, it could alter the cells of the seminiferous tubule, causing damage to sperm cells and also to testosterone production.

What treatments are available for varicocele?

The treatment for symptomatic varicocele, or in infertile men, is surgical. This surgery is called varicocelectomy, and is indicated in the following cases:

• In young patients, to prevent possible infertility in the future.
• In men who have obvious symptoms.
• In patients who are trying to conceive and decide to undergo surgery to improve their reproductive outcomes.

Varicocele can also be reduced by methods such as embolisation using interventional vascular radiology techniques.

What is the prognosis for fertility in men with varicocele?

If surgery is not possible, the patient does not want to undergo the procedure, or the procedure fails, assisted reproduction techniques can be used.

Sometimes, before starting treatment, the doctor will try to improve semen quality with empirical treatments that combine antioxidants, vitamins and anti-inflammatories, with the aim of reducing oxidative stress and thus improving semen parameters.

If the varicocele does not present symptoms and does not affect testicular function or sperm quality, treatment is not necessary. However, regular medical follow-up is recommended, as well as maintaining certain habits that will help boost male fertility.