The male reproductive organs are dependent upon blood circulation to control temperature in the testicles and to bring nutrients for the production of sperm (spermatogenesis). For optimal sperm production and normal testis function, the testis require an environment that is approximately 2.5 degrees celcius cooler than normal body temperature.
An obstruction to the scrotal veins is called a varicocele. They are present in approximately 15% of the normal male population. Whereas in men presenting with fertility challenges, the prevalence of a varicocele is estimated to be between 35 and 40%. Obstruction in the veins of the testicles will negatively impact the production of sperm either through impeded movement of the scrotum or venous blood reflux causing blood pooling in the testicles, both of which result in an increase in temperature. The semen analysis will often reflect an impairment to sperm motility and a reduction in sperm count. DNA fragmentation rates also tend to be higher in men with varicoceles. Higher levels of oxidative stress and obstruction to the in flow of antioxidants will also contribute to the destruction of and improper production of sperm.
So how do you know if you have a varicocele?
Most varicoceles are symptom free and are usually only detected through palpation of the scrotum. If there is pain, it is usually dull and may have a heavy feeling that can be worse at the end of the day or after exercise. The severity of a varicocele is done through palpation and visual inspection of the vessels of the scrotum. An ultrasound may be done to further assess the level of obstruction. They are graded from 1 to 3, with 3 being the most severe and visible on the surface of the scrotum.
What are my options for treatment?
Men that are trying to conceive, present with decreased count and motility, and have a palpable varicocele are usually recommended to consider varicocele repair (surgery). Additionally, surgery is usually indicated for men that have reduced testicular size on the same side as the varicocele, palpable obstructed vessels and/or reduced testosterone levels with the presence of a varicocele. The two treatments are surgical repair or embolization of the vessels. The time to improvement of semen parameters is typically three to six months. For couples that are trying to conceive and considering assisted fertility, the improvement may alter the level of intervention required and may even be sufficient to allow for natural conception.
Resources
- Dr. Turek's Clinic – Varicocele Treatment
- Don't Cook Your Balls – Varicocele
- ASRM – Report on Varicocele and Infertility: a committee opinion
