Varicocele in Infertility

Varicoceles are fairly common, affecting 15% of men overall and 40% of men with infertility. Varicoceles occur most often in the left side.The normal age when the males initially observes the varicocele is approximately 15-25 years old. Even though the condition could be asymptomatic but in certain cases it may be painful. This is for the simple reason that the males affected will experience a dull anxiety, heaviness in the scrotum which could get worse, and a male could also feel a sensation of a protuberance or swelling in the scrotum. All these are thought to be the signs of varicocele. Experienced doctors also feel that the finding of varicocele is where the veins are warped or crammed and sometimes explained as a sack of worms.

The mechanism by which a varicocele on one side can affect the fertility of both testicles is not clearly understood. What is true is that the temperature of the scrotum is normally several degrees cooler than body temperature, which is important for normal sperm production and test is function. This temperature difference is carefully maintained by the normal anatomy of the scrotum. The dilated veins in a varicocele may decrease the effectiveness of this natural cooling mechanism and “overheat” the testis and reduce its ability to function.

EVALUATION OF VARICOCELE :

The clinical analysis of varicocele is frequently done by the physician when the physical examination is done, with the sufferer standing, and making use of the Valsalva maneuver. If sti an ultrasound of the scrotum should be done.

The “gold standard” way to diagnose varicoceles is by physical examination. With a patient in a standing position, palpation of the scrotum by a well-trained physician can reveal a varicocele. Exercise and prolonged standing may also demonstrate a varicocele. Difficulties palpating a varicocele arise when the scrotal wall is thick or contracted.

The diagnosis of varicocele can also be made with venography, ultrasound, thermography, scintigraphy and CAT scan or magnetic resonance imaging. Venography is considered to be the best diagnostic test, but it is invasive, involving catheterization of large leg veins to access this system. Conveniently, venography can be combined with embolization using balloons or coils to treat varicoceles at the same time. Doppler ultrasound is less invasive than, and correlates well with, venography and relies on the detection of venous flow within the varicocele. Thermography, scintography and MRI or CAT scans are of limited clinical use for varicocele mostly because of increased cost, and lack of controlled studies surrounding their use.

GRADING of varicocele

Subclinical

Varicocele not detected on physical exam; found by radiologic or other imaging study.

Grade I

Varicocele only palpable during or after Valsalva maneuver on physical exam.

Grade II

Varicocele palpable on routine physical exam without the need for Valsalva maneuver.

Grade III

Varicocele visible to the eye and palpable on physical exam.

Treatment Recommendations for Varicocele in Men with Infertility

Varicocele repair is performed to improve male fertility. It can usually be donesurgically on an outpatient basis using local or general anesthetic. A small incision is made in the abdomen close to where the testicles originally descended through the abdominal wall. The veins that produce the varicocele are identified and cut to eliminate blood flow to the varicocele.