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Varicocele

Of the factors causing infertility in men; a varicocele is seen in about 40% of males seeing a physician. It is the enlargement of the vessels in the sperm-producing organs, namely the testicles in men. This variation in the vessels that return the blood to the heart affect the production of sperms and testosterone unfavorably by impair the blood supply to testicle, raising the temperature of the testicles, and resulting in the accumulation of toxic materials in the deoxygenated (dirty) blood. A varicocele usually occurs on the left side, where the veins are longer. Because the veins on the left are connected to the main vessel at a sharper angle or right angle, the complete delivery of the blood supply is impaired. A varicocele can sometimes occur on both sides or may rarely occur only on the right side.
 

Diagnosis of A Varicocele 

The primary diagnostic method is performing a physical examination to identify a varicocele. The vascular and nervous structures of the testicle is examined manually by the physician.  Doppler ultrasound is one of the methods for diagnosing a varicocele. For varicoceles of mild severity not detected by a manual examination but diagnosed via an ultrasonographic examination, surgery is not necessary. If the patient presents with considerable complaints, suffers from severe pain, and the urologist defines indications for surgery; the patient will be advised to undergo surgery. Surgery is not recommended for patients with normal sperm parameters, patients with a varicocele diagnosis only made radiologically, and with a vascular diameter below normal. Performing varicocele surgery only for pain relief is not the correct approach.

 

Varicocele and Infertility

Body temperature in the skin bags containing and protecting the testicles outside the body (the scrotum) is several degrees lower compared to the rest of the body. A low-temperature environment is needed for the production of healthy and high-quality sperms; however, the blood accumulates in the vessels due to varicocele and the temperature is elevated. Also, toxic substances that may come from the kidneys and adrenal glands may accumulate in the testicle and impair sperm quality. Sperm motility may be affected unfavorably and impaired sperm motility is another cause of infertility. A varicocele is detected via physical examination in 25-30% of men seeing a physician for infertility and who have an abnormal sperm count and impaired sperm mobility in the spermiogram. Also, varicoceles are detected in 15% of men; who have children and who have normal sperm values. However, the patient is not recommended to undergo varicocele surgery unless indicated by a urologist during treatment for infertility and assisted reproduction treatment.

Treatment for Varicocele 

Varicocele is treated by microsurgery. In varicocele surgery, the veins draining the testicle are ligated via the microsurgical method applied in the groin by exercising care to protect the arteries supplying blood to the testicle. A successful diagnosis and subsequent microsurgery allows for achieving an average of 50% improvement in spermiogram values in varicocele patients. However, favorable contributions of varicocele surgery in establishing pregnancy have not been scientifically proven, yet.

Varicocele and Assisted Reproduction Treatment

The contribution of varicocele surgery to treatment of male infertility has not been scientifically proven in establishing pregnancy. Because of the high success rates in assisted reproduction treatments and because of uncertainties in the following 6 months after varicocele surgery; candidate parents can prefer undergoing assisted reproduction treatment via the direct microinjection method.

Intrauterine insemination can be advised for couples when potential female factors are ruled out, namely when the candidate mother is younger than 39 years old with intact reproductive health and when the spermiogram results of the candidate father are favorable. When severe impairments are detected in sperms, the chance of success of the intrauterine insemination method is very low. In these couples, IVF-microinjection therapy is preferred by consulting the urologist.

In azoospermic men; who have no sperms, varicocele surgery is not recommended to achieve pregnancy. 

In individuals with normal sperm values and who have a completed family, the urologist may not advise any treatment even if the varicocele can be detected prominently during a manual examination.

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