Varicocele & Male Fertility: Can Surgery Improve Your Chances of Conception?

The male reproductive organ is nourished through blood vessels that provide both nutrition and oxygen to the testicles. When the blood vessels in the scrotum become blocked, they swell, causing discomfort and pain. This condition is medically referred to as varicoceles. Varicoceles tend to develop gradually over time, beginning at puberty, and many times, they do not have any impact on a man’s reproductive system. However, when they do become blocked and swollen, it can cause challenges in a person’s reproductive system, resulting in low hormone and sperm production, as well, lowered sperm quality. Varicoceles can be treated and this is good news for people who desire to build their families. So let us discuss how varicoceles affect family building and how surgery can improve chances of conception.

How Varicoceles Affect Sperm Production

The way in which varicoceles affect sperm production is by interfering with the production of testosterone and sperm in the testicles. Problematic varicoceles tend to be twisted around the testicles, swollen due to blood pooling in them, resulting in the testicles becoming squeezed. Another thing that occurs as a result is that the general temperature around the testicles becomes elevated, pressure increases, and oxygen is lowered. 

Symptoms and Diagnosis of Varicoceles

The Symptoms

While common and generally asymptomatic in general, varicoceles can cause symptoms such as: 

• Pain 
• Discomfort 
• A tangible or visible mass in either testicle
• A difference in size between the two testicles
• Poor hormone production
• Poor sperm production
• Infertility 

The Diagnosis

Varicoceles are usually diagnosed based on several factors. Typically, when a person desires to build their family and is unable to do so, the initial symptoms will be evaluated by a professional healthcare provider. Typically for men, a physical scrotal exam will be conducted to check if the varicoceles are visible or tangible. If they are not, an ultrasound may be conducted to see if they can be detected. As well, because varicoceles do affect hormonal production, a blood sample will be taken to evaluate hormonal levels. To begin with, a person’s symptoms will be evaluated, then likely a physical examination of the scrotum will be conducted. In addition, a semen analysis will be done to check on the quantity and quality of sperm production.  

Surgical Treatment Options

The treatment of varicoceles is typically surgical and is known as a varicocelectomy, done under anesthesia. The ways in which a varicocelectomy is done depends on where the varicoceles are located and their size. There are options for both minimally invasive and open surgical prcedures: 

Minimally Invasive Surgery Options

Microsurgical Varicocelectomy

This type of surgery is done by making an incision on the upper part of the groin. Microsurgery instruments and a surgical microscope are inserted through this incision and the procedure is conducted. 

Laparoscopic Varicocelectomy 

This procedure is similar to the microsurgical one, but several incisions are made in the abdomen and the surgical tools, i.e. a laparoscope and surgical instruments are passed through the incisions and the surgery is conducted.  

Open Surgery Options

Open surgery for varicoceles is ligation. Ligation is basically a removal of the blocked part of the varicocele and binding the blood vessel together again. Different approaches are used in ligation, based on the location of the varicocele:

Inguinal Ligation

The inguinal canal is located on the lower part of the groin. An inguinal ligation thus is conducted by accessing the varicocele through the inguinal canal and ligating it. 

Subinguinal Ligation 

The location just below the inguinal canal is referred to as the subinguinal canal. This is where the varicocele is accessed from in a subinguinal ligation procedure. 

Retroperitoneal Ligation 

The peritoneum is the inner lining of the abdomen. This procedure is done by accessing the varicocele from the rear of the peritoneum and ligating it.

Success Rates of Varicocele Repair & Fertility

Varicocele repair improves male fertility outcomes, as observed by improved sperm production, better sperm retrieval, increased pregnancies and higher live birth rates. While these results are generalized, it is understood that each individual case is unique. Therefore in order to know if you have varicoceles or need varicocele repair surgery, consult with the fertility experts at NCFMC. We are happy to support you in understanding male factor infertility better, as well, helping you to achieve your family building goals.

FAQs:

When should I consider IVF or other assisted reproductive technologies (ART)

ARTs are typically considered when lifestyle changes and medications to improve fertility have not been effective. As well, if a person has serious infertility factors ARTs may be considered. However any interventions are considered on a case by case basis under the direction of a fertility expert. 

How long does it take to see results after varicocele repair?

It is likely to take upward of 72 days after varicocele repair for professional healthcare providers to diagnose any improvements in fertility. This is because it takes sperm about that much time to mature and be ready for ejaculation. As well, depending on how severe the varicoceles were, it could take up to six months following surgery for any improvements to be noted.