Varicoceles and Male Infertility: The Facts and Treatments
By: Varicose veins have long been considered a leg problem. But for one in six men, it can be a scrotum problem, and that can have reproductive ramifications.
Varicose veins are bulging, raised blood vessels (veins) that twist and bend. This occurs because of a misfunction in the valves that should open and close to manage steady blood flow. When these valves do not work properly, blood pools in the veins and becomes difficult to push up to the heart – varicose veins.
If blood pools among the thick cluster of small veins in your scrotum, it is called a varicocele. And while not always painful, varicoceles are one of the most common causes of infertility in men.
Fortunately, varicoceles can be treated in a minimally invasive procedure. This blog will help you detect the symptoms and choose your treatment option.
A “Bag of Worms”: Conditions that Lead to Varicoceles
When varicoceles develops in the scrotum, it might be from problematic blood flow in the spermatic cord, a collection of nerves, veins, and arteries that run to and from the testes. When the spermatic cord’s regulating valve fails to close all the way, gravity makes the blood collect among the dense network of veins in the scrotum – a varicocele.
Often, varicoceles is described as feeling like a bag of worms.
The condition typically arises in just one testicle, usually the left one, and tends to develop in young men after they enter puberty. This is due to growth spurts that require more blood to the developing testicles; the veins might have trouble keeping up.
However, varicoceles can occur in men of any age. An estimated 15% of adult men and 20% of adolescent males have varicoceles, according to Johns Hopkins Medicine.
Varicoceles and Your Fertility: The Implications
Fortunately, varicoceles is not dangerous; many men who have it don’t even know they do.
Still, varicoceles can impair fertility by damaging sperm. The reason is that the testes need to be slightly cooler than your core body heat to optimally produce sperm, and the pooled blood in varicoceles raises scrotum temperature. A large varicocele can result in decreased sperm counts.
Also, several studies link varicoceles to lower testosterone levels, stemming from the inability of the crowded veins to properly circulate blood and therefore provide oxygen to the cells that make testosterone (Leydig cells).
Lastly, varicoceles can lead to testicular atrophy, when the tissue wastes away as a result of cell degeneration.
5 Signs You Might Be Developing Varicoceles
While many men don’t notice varicoceles, there are ways to detect one. It typically develops above the testicle (again, usually the left), and should be visible when you stand, but not when you’re lying down.
Symptoms of varicoceles may include:
- A dull, toothache-like scrotal pain that may become sharp.
- Slow growth of one testicle (usually the left) during puberty.
- Pain that worsens when you stand or exert yourself and that intensifies over the day.
- Scrotum discomfort that diminishes when you lie on your back.
- Trouble getting your partner pregnant.
A Minimally Invasive Treatment Option for Varicoceles
If you experience symptoms of varicoceles, an interventional radiologist can perform a specialized procedure to improve sperm production and ease discomfort, without surgery. At the Michigan Institute of Urology, we conduct these procedures at our Interventional Radiology (IR) Center.
If you seek this approach, called varicoceles embolization, this is what you can expect:
- General anesthesia is not required; instead, you can receive local anesthesia and light sedation (twilight sleep).
- The physician inserts a narrow catheter to the vein in the thigh (femoral vein) through a small incision in the groin.
- Using x-ray imaging as a guide, the physician leads the catheter from the femoral vein to the scrotum.
- A contrast is injected to reveal and chart out the impeded vein(s) in the scrotum. The physician then blocks these veins with tiny coils.
- With the affected vein(s) blocked, blood flow is redirected to nearby, healthier veins.
- Meanwhile the varicocele, eased of pressure, heals and can eventually function normally.
All in, you can expect to be at the IR Center for a few hours, with the procedure usually taking 30 to 45 minutes, followed by a two-hour recovery period.
Our urologists also treat varicoceles through outpatient surgery that entails tying off or removing the engorged veins.
What to Expect After Your Varicoceles Treatment
If you undergo varicoceles embolization, plan to return home the day of surgery (with an arranged ride). You should be able to resume moderate activity within one to two days.
If you undergo other methods of surgery, you might need to avoid exercise and take it easy for as long as two weeks but can likely return to work in a day or two.
In either approach, your sperm count will gradually improve over six months. This means if you’re planning to start or add to your family in 2027, now is a good time to talk to a urologist about varicoceles treatments.
Our website explains more about the varicoceles treatments we provide at Michigan Institute of Urology. To find out if you are a candidate for varicoceles treatment at our IR Center, fill out this online form.
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