Varicoceles

A varicocele is a collection of enlarged, abnormal veins found within the scrotum, next to the testicles. These veins are similar to varicose veins that occur in the legs. 

Varicoceles can develop during puberty and are most commonly found on the left side of the scrotum.

The exact cause of varicoceles is not always clear, but they are thought to develop due to abnormalities in the valves within the veins, leading to blood pooling and enlargement of the veins. They are not dangerous but can cause testicle pain/aching, shrinking in testicle size and abnormal sperm production.

Varicoceles can affect sperm production and quality in several ways:

• Temperature Regulation: The veins in the scrotum are involved in regulating the testicle temperature. Dilated, enlarged veins, can lead to an increase in testicular temperature; which in turn can negatively impact sperm production and quality.
• Blood Flow: Altered blood flow may affect the delivery of oxygen and nutrients essential for sperm production.
• Hormonal Changes: Varicoceles may also cause hormonal imbalances that can interfere with sperm production.

The impact of varicoceles on fertility is very variable. Some men will have large veins and no problems with fertility at all. Whilst others can have significantly reduced sperm counts, decreased sperm motility (movement), and abnormal sperm morphology (shape). 

Treatment options 

• Observation: In some cases, especially if the varicocele is small and not causing symptoms or fertility problems, the doctor may recommend periodic check-ups without any immediate treatment. It is also important to remember if any treatment is carried out, there will be no improvement in sperm parameters for 4-6 months. This can be important if the female partner is aged above 35 or has a poor ovarian reserve.
• Microsurgical varicocele repair: This is a surgical procedure carried out under a general anaesthetic. It is a day case procedure carried out by Miss Sangster. Using microsurgical skills and an operating microscope, ties are used to cut off the affected  blood supply to the veins thus reducing the size of the varicocele. 

• Embolisation: This minimally invasive procedure is performed by our specialist uro-radiologists. It tends to be a local anaesthetic procedure which takes roughly 45 minutes to carry out. A small catheter is inserted into a vein in the neck and guided down to the varicocele. A mixture of small platinum coils and/or foam is then injected into the vein to block it off and redirect blood flow away from the varicocele.

It’s essential for men with varicoceles who are concerned about fertility to consult with a healthcare professional, preferably a urologist or fertility specialist, for proper evaluation and management