Clinical varicoceles are common. They represent as a dilated grouping of veins and the added temperature imparted, or decrease in testicular vascular drainage are believed to affect negatively the testicular environment. This altered environment is believed to alter sperm parameters. Some may be symptomatic, affording men a dull, achy pain with intercourse. Others, a common but relatively benign finding. Should men refrain or repair varicoceles that could cause infertility?
It is true that the most common and correctable finding in men with infertility is the varicocele. Know that varicoceles are present in up to 20% of men. However, the chance of having a varicocele and infertility is amplified. Their findings occurs 2-3 times more frequently in the infertility population than the general population.
Twenty five percent of men with abnormal semen parameters were found to have varicoceles. There is commonality between infertility and varicocele but the exact mechanism of impaired sperm production is inferred and not clearly established.
Not all varicocele are the same and they are graded as such according to severity. The decision tree regarding repair is complex. There is data demonstrating that men with both varicocele and infertility, its repair improves chances of a pregnancy. However, it is unclear if correction of the clinical varicocele and pregnancy thereafter is due to improvement in sperm parameters as often there may be marginal changes in the sperm parameters.
Perhaps the changes imparted by the repair are at the molecular level – involving inflammation. Reactive oxygen species present in the impaired system may promote DNA fragmentation and affect the sperm in development. These data continue to be explored.
It is true that in some instances, varicocelectomy (varicocele repair) may improve IVF / ICSI outcomes; however it is unclear if the repair is cost effective in asymptomatic men. In couples who seek fertility treatment using ART (IVF and IUI), there is not sufficient data to demonstrate clear clinical advantages prior to IUI. However, in some instances, the repair may offer sufficient improvements in semen parameters that more conservative therapies may be acceptable modicums for pregnancy.
However, this information must be kept in mind. The converse is that repair of a varicocele may not be the first corrective measure to combat fertility and a comprehensive reproductive assessment should be warranted. If you have questions, please contact us for a free initial consult! We are here to help you.