Varicocele and fertility: causes, diagnosis and treatments to reduce male infertility

Do you know what a testicular varicocele is? Despite being one of the leading causes of male infertility, this problem is rarely talked about. This alteration of the veins of the spermatic cord, although in most cases asymptomatic, can affect sperm quality and make it difficult for a man to have children.

Male infertility is present in almost half of all couples who have problems conceiving, and varicocele is one of the most frequent causes.

In this article, we will explain how varicocele affects male fertility, what its main causes are, how it is diagnosed and what treatments exist to reduce its impact and achieve pregnancy regardless of testicular varicocele, either naturally or with the help of assisted reproduction techniques, such as in vitro fertilisation.

How varicocele causes infertility

Varicocele occurs when some veins in the testicle become dilated and do not drain blood properly. This causes blood to pool in the veins of the testicle, increasing the temperature of the area and generating more oxidative stress. This complex situation can directly affect testicular function and thus sperm production and quality.

The most common effects of varicocele on male fertility include:

• Alterations in sperm formation (spermatogenesis) and concentration.
• Reduced sperm motility.
• Alterations in sperm morphology.
• Damage to sperm DNA due to oxidative stress.

Because of all these possible alterations, varicocele is considered to be one of the main treatable causes of male infertility.

Diagnosis and testing for varicocele

As mentioned above, varicocele is, in most cases, an asymptomatic condition. In other words, many men do not notice any discomfort or obvious physical change, which means that it often goes unnoticed for years. It is much more common on the left side than on the right and can be the cause of testicular pain, usually of a dull, non-acute nature.

For this reason, it is often discovered by chance, during a routine medical examination, or when the patient consults for a feeling of heaviness or mild testicular discomfort. However, for many couples, the diagnosis of varicocele usually comes about when they undergo fertility testing after several unsuccessful attempts to conceive.

Diagnosis of varicocele is usually made by physical examination by palpation of the scrotum to check for obvious dilatations. In many cases, it is confirmed by testicular Doppler ultrasound to check blood flow and determine the severity of the involvement.

In addition, if a varicocele has been detected, the specialist may request a semen analysis to assess whether it affects fertility. This study assesses parameters such as sperm number, concentration, motility and morphology, which are essential to determine whether varicocele is interfering with a man’s reproductive capacity.

Varicocele treatment options

Treatment of varicocele depends on whether it is considered to be affecting male fertility or whether the pain is impacting on the patient’s quality of life.

It is important to note that having a varicocele does not necessarily imply a fertility problem, although it is known to occur up to seven times more often in men with infertility.

In cases where male fertility is not affected and causes no symptoms, no treatment is necessary. Periodic check-ups are enough to check that it is not progressing. In fact, there is a percentage of men with mild varicocele who have achieved natural pregnancy with their partners without any problems.

However, when the varicocele causes discomfort or alters seminal parameters, effective surgical treatment may be necessary:

• Varicocelectomy: It consists of conventional or laparoscopic surgery that ligates the affected veins to improve blood flow.
• Percutaneous embolisation: A minimally invasive technique that blocks dilated veins using a catheter.

It is estimated that 90% of varicocele surgeries are successful when cases are carefully selected beforehand. In other words, by eliminating the presence of varicocele, the sperm produced in the testicles can be ejaculated normally, leading to pregnancy or improving parameters to optimise a reproduction technique.

When to consider varicocele surgery

Basically, varicocele surgery is particularly indicated in complex cases in which:

• The semen analysis shows significant alterations that we believe will improve with treatment.
• The patient suffers from testicular discomfort or pain.
• The couple experiences infertility with no other identifiable cause.

Can pregnancy be achieved with varicocele?

The answer is: YES. As we have seen, there are cases where a varicocele has little effect on semen quality, and pregnancy can be achieved without any treatment.

In complex cases, varicocele surgery can improve semen characteristics, and the pregnancy rate is also increased by about 50%.

Many men with varicocele are able to reverse the problem and achieve pregnancy naturally, especially if diagnosed and treated early.

However, in those cases in which, after surgery, sperm quality does not improve sufficiently and natural pregnancy does not occur, it may be necessary to resort to assisted reproductive techniques, such as artificial insemination or in vitro fertilisation (IVF). These techniques allow the selection of spermatozoa with better motility and morphology, thus increasing the chances of fertilisation and pregnancy.

Initial study of the couple and diagnosis of male infertility in Tambre

At Tambre, we carry out a comprehensive initial study of the couple to identify the possible causes of infertility. This study includes a semen analysis, the basic test for assessing male fertility, and a testicular ultrasound. For this purpose, our clinic has its own andrology laboratory equipped with the latest technology, which allows us to diagnose and treat most cases of male infertility without the need to resort to donor sperm.

Thanks to the collaboration between our urology team and the Andrology laboratory, we offer a comprehensive approach to identify the cause of male infertility. Depending on the results, we can complement the study with advanced genetic and hormonal tests, such as the Comet Fertility, which analyses sperm DNA fragmentation; the Chromosperm and FISH tests, which allow us to evaluate the chromosomal profile of the spermatozoa. All this helps us to offer an accurate diagnosis and a personalised treatment for each patient, thus increasing the chances of achieving a pregnancy with varicocele or with other causes of male infertility.

Contact Tambre and request your first consultation now at our clinics in Madrid and Alicante.