Uploaded on August 10, 2014
What is Varicocele
My name is Amr Azim I am a reproductive endocrinologist at New York City IVF. If you are trying to conceive and your partner was diagnosed with varicocele, you and would need to understand a few facts about varicocele. Varicocele means that the veins draining the testes became elongated, dilated, and tortuous, meaning the veins draining the testes are engorged and the blood flow is slower. There is a significant portion of male factor infertility that are diagnosed with varicocele. Varicocele is commonly associated with low sperm count, low movement, low motility, and high abnormal forms of sperm. These factors are all known to alter or decrease fertility presumably because of reducing the ability of the sperm to implant. The ongoing theory is that varicocele changes the temperature of the testes and hinders spermatogenesis and also that stagnation of blood can lead to accumulation of chemicals that might hurt sperm cells but nobody has a conclusive explanation why dilated veins would impair fertility in men. The merits to surgically fix varicocele, meaning to tie these dilated veins, are number one, the varicocele has to be palpable, meaning it has to be felt, it has to be large enough, tiny varicoceles or small varicoceles detected on imaging, meaning ultrasound, should not be treated, so the varicocele has to be felt by the examining hand of the urologist. On the other hand there are no female infertility factors, meaning all of the factors in the female partner has been investigated and corrected, or none were found before proceeding to correction of varicocele.
Whether surgical treatment of varicocele improves the chance of conception of a live birth, that is a different question. This was and is still an area of intense debate. Many studies have shown that when you tie the dilated veins there is an improvement in the sperm count, in the sperm movement, and in the sperm shape, but there is no proof in any of the studies that that is translated into a higher chance of live birth. The most important and only meaningful outcome that physician interested in fertility treatment look at is the percentage of live birth in the female partner of a man that had varicocele, and that varicocele was tied, is not significantly different than if the varicocele was not tied. Because of that the choice of surgical correction of varicocele should be approached cautiously because there is no strong evidence that it is effective to the extent that it would lead to a live birth in the female partner.
Certainly varicocele repair should not for example be a choice in fertility treatment if the male has a very low sperm count. These men are better served with in vitro fertilization of their partners and direct injection of their sperm into the eggs. This will lead to a very high fertilization rate and it is certainly not to be approached if the female partner has extensive fertility factors that preclude using the sperm.