Varicocele is the presence of varicose veins in the testicles, a dilatation of the veins leading from the testicles. These testicular varicose veins are one of the main causes of correctable male infertility. It can affect both testicles, although it is more common in the left testicle, as it is longer than the right one.
Varicocele, causes and symptoms
Varicocele is caused by an absence or failure of the valves of the veins. These act as gates, allowing the blood to rise freely and prevent it from flowing back down into the testicle.
In most cases varicocele does not produce symptoms. It is diagnosed after a genital exploration performed on patients with infertility problems.
Other times it may cause pain, discomfort or a feeling of heaviness. When it is very conspicuous it causes deformities that affect the esthetics of the testicle (symptomatic varicocele). It can present as thickening in the upper part of the scrotal sac, classically defined as a “bag of worms” which are the dilated testicular veins forming varicose veins.
Decreases the quantity and mobility of spermatozoa.
Testicular varicose veins can cause an increase in temperature, lack of oxygenation and obstruction by compression of the beginning of the seminal duct. In addition, waste elements from the kidney or adrenal gland can reach the testicle and act as toxicants. All these effects can result in decreased sperm production and/or quality. There is a decreased quantity of sperm (Oligozoospermia) along with decreased motility (Astenozoospermia).
Another possible consequence is the increase of oxidative stress in the testicle which results in sperm DNA fragmentation, leading to the inability of the sperm to fertilize or repeated miscarriages.
Varicocelectomy, the treatment of varicoceles
The treatment of varicocele consists of ligating the veins of the testicle at groin level (varicocelectomy). There are different surgical techniques; currently, due to its low recurrence rate, subinguinal microsurgery is the technique of choice. Another type of treatment is percutaneous embolization, but with higher recurrence rates.
Varicocele surgery is intended to improve seminal quality and the fertilizing capacity of the sperm, increasing pregnancy rates, both naturally and with assisted reproduction techniques.