A varicocele is a condition in which veins become enlarged inside your scrotum. About 15 of every 100 males have a varicocele. Most of the time, varicoceles cause no problems and are asymptomatic. Sometimes varicoceles can cause pain, fertility problems, or testis to grow slower or shrink. Varicoceles are the most common cause of both primary (fathering first child) and secondary (fathering a child after their first) infertility.
How are varicoceles treated?
Microsurgical approach to repair dilated varicose scrotal veins to improve semen quality is a gold standard. Repair is indicated if:
⦁ Couple trying to conceive a child, but thus far have been unsuccessful
⦁ You have been diagnosed with a varicocele.
⦁ Your semen analysis or sperm function tests are abnormal
⦁ Your partner has normal fertility
⦁ You are an adolescent male with a varicocele and reduced testicle size
This operation uses a high-powered microscope to provide direct visual access to veins and arteries and a micro doppler to identify the arteries. A small incision in the groin, can help the doctor to reliably separate and preserve testicular arteries, while identifying and ligating both large and small veins that could dilate in the future. Also microsurgical varicocelectomy virtually eliminates the risk of developing a hydrocele, the most common varicocele repair complications. In fact, microsurgical techniques have significantly reduced recurrence rates to less than 2 percent and complications rates to less than 5 percent while significantly increasing fertility. The effectiveness of this procedure has been reported in the scientific literature to be as high as a 43 percent pregnancy rate for couples after one year and 69 percent after two years.
Is varicocelectomy necessary even though the couple are planning for IVF?
Literature shows that varicocelectomy improves success rates in couples undergoing IVF compared to men who did not have their varicoceles repaired before IVF (Esteves et al. J Urol. 2010). Most promising hypothesis appears to be improvement in sperm DNA fragmentation following varicocelectomy (Zini et al. Int J Androl. 2011). Improved sperm DNA fragmentation is associated with better success with IVF (Simon L et al. F&S 2011). In addition, even though the couple is undergoing IVF, repairing varicocele may improve future chances of natural conception or even future IVF cycles.
