Varicocele is the most commonly known cause of male infertility, and it is observed in approximately 30% of patients who seek medical attention due to complaints of infertility. Varicocele occurs due to the dilation of the veins in the testicles. Varicocele develops on the left side in about 90% of cases. Varicocele can manifest with symptoms such as swelling of the testicle, pain, and the prominent appearance of dilated veins under the skin. The exact mechanism through which varicocele leads to infertility is not fully understood. However, the most widely accepted theory is that the increased blood flow in the dilated veins causes an increase in testicular temperature, which in turn damages sperm count, motility, and morphology.
How is Varicocele Diagnosed?
The diagnosis of varicocele is made through a physical examination conducted by urology specialists. The patient is examined in an upright position at room temperature. The patient is examined both in the normal position and during the Valsalva maneuver, both visually and by touch. The gold standard method for diagnosis is the physical examination. In some cases, Scrotal Doppler ultrasonography may be performed as an imaging method to support the clinical diagnosis.
How is Varicocele Treated?
The treatment for varicocele is varicocelectomy, which is a surgical procedure. However, not everyone with varicocele requires surgery. Surgery is recommended for individuals with varicocele who experience infertility, have abnormalities in sperm analysis values, or exhibit a decrease in testicle size or consistency on the same side. Patients with varicocele who do not have infertility problems can be monitored. In cases where there is minimal impairment in sperm motility or morphology, some supportive treatments may be recommended. Additionally, for patients with varicocele who have previously had unsuccessful assisted reproductive techniques and are suspected to have an underlying male factor, varicocelectomy may be recommended to improve the success of subsequent treatments.
How is Varicocelectomy Performed? Are There Risks?
Varicocelectomy is performed through a small incision of approximately 2 cm in the groin area to access the dilated testicular veins. Then, under a microscope, these veins are individually freed and ligated. Since varicocelectomy is currently performed using microsurgical techniques, the risk of injury to the testicular arteries is low. Furthermore, microsurgery has reduced the long-term risk of developing hydrocele, which is the accumulation of fluid around the testicle. Other risks such as bleeding and infection, which can occur after any surgery, are also present but relatively low with varicocelectomy.
Should Every Varicocele be Operated On?
No. In couples who desire to have children, if the woman is young, has a good ovarian reserve, and the cause of infertility is solely attributed to low sperm values, then varicocelectomy has become a more widely accepted approach in recent years. In other words, for couples planning in vitro fertilization (IVF), if there are no varicocele-related complaints such as pain, or if varicocele does not cause a decrease in testicular size, surgery is generally not recommended. In some cases, there may even be a deterioration in sperm values after the operation, unfortunately. Therefore, the evaluation and treatment should be guided by experts experienced in the field of IVF.
When Do Sperm Analysis Values Improve After Varicocelectomy?
The maturation period of sperm in the testicles is approximately 90 days. Therefore, the general approach is to perform the first sperm analysis 6 months after the surgery. After the operation, an improvement in sperm analysis values is observed in about 60-70% of patients.