What is Varicocele?

Varicocele, one of the most common causes of male infertility, is the inability of the veins in the testicle, which carry the dirty blood coming out of the testicles, to fully fulfill their function due to enlargement and varicosity that may occur starting from adolescence.

Varicocele in the left testicle occurs in 90% of cases. It is thought that varicocele is more common in the left testicle because the left testicle is subjected to more pressure and relatively slower blood flow than the right testicle.

What are the Symptoms of Varicocele?

Mild varicocele may not show any symptoms, but over a long period of time, as the enlargement of the veins progresses, swelling and pain in the testicles can be seen. When standing for a long time and in hot weather, the veins in the testicles become prominent and the pain increases. In very advanced cases of varicocele, the testicles decrease in size and soften in consistency. Varicocele is easily understood when examined by hand. It can also be detected by examining the vascular structure with ultrasound.

Does Varicocele Cause Infertility?

The body temperature is several degrees higher than the temperature in the outer bags that protect the testicles. This means that sperm need a cooler environment than normal body temperature for healthy sperm production. The increased temperature due to blood pooling in the enlarged varicocele veins in the scrotum negatively affects sperm production and may impair sperm quality.

In men with varicocele, toxic substances from the kidneys and adrenal glands can accumulate in the testicle. This can lead to a decrease in the movement and quality of sperm.

Should Varicocele Always Be Treated?

Not all cases of varicocele need treatment. If there are other causes that reduce sperm count, these should be identified and corrected first. The treatment of varicocele in cases of azoospermia, or “zero sperm”, is controversial. The cause of azoospermia needs to be addressed because, in general, varicocele is not the only cause of a zero sperm count.

Are there any harms of varicocele?

Varicocele starts during puberty and its negative effects gradually increase over time;

• It can cause infertility.
• It can cause pain in the groin and leg.
• It can lead to a decrease in the male hormone testosterone.
• It may cause the testicle to remain small during puberty.

How is Varicocele Surgery Performed?

Varicocele surgery is performed microsurgically. The testicular veins are accessed through a 2 cm incision in the groin area. In the operation, a microscope is used under general or local anesthesia to ensure that the veins are more clearly recognized and the artery supplying the testicle is carefully protected. Under the microscope, the enlarged veins are separated from the other veins and ligated. This operation can take 1 hour or 2.5 hours.

It has been medically proven that the probability of recurrence and complication rate of surgeries performed with microsurgery are low.

Does Sperm Count and Quality Change After Varicocele Surgery?

The postoperative waiting period for sperm count to increase is between 3 and 6 months. After 6 months, if sperm quality and sperm count have not improved, there is no need to wait any longer. This improvement is seen in about 70% of patients. The expected pregnancy rate in one year is around 40%. However, in some patients there may be no change in sperm quality and count. Although very rare, some patients may experience a decrease in sperm count and quality after surgery. This may occur mostly with complications.

Can Varicocele Patients Become Fathers?

Assisted reproductive treatments may be recommended for patients whose sperm count or quality does not improve 6 months after varicocele operation and whose partner cannot get pregnant naturally.

Patients with low sperm count and low motility can have a child with IVF treatment. In male infertility treatments, the sperm or sperms with the best morphological and motility are selected and combined with the egg in the laboratory. In vitro fertilization treatment is performed by transferring the resulting embryo to the expectant mother.