Varicocele
A varicocele is an enlargement of the veins within the scrotum, the loose bag of skin that holds the testicles. A varicocele is similar to a varicose vein that can occur in your leg. They are fairly common, affecting 15 out of 100 men overall and 40 out of 100 men with known infertility. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to shrink.
Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and many don’t need treatment. If a varicocele causes symptoms, it often can be repaired surgically.
Symptoms
A varicocele often produces no signs or symptoms. Rarely, it may cause pain. The pain may:
- Vary from dull discomfort — a feeling of heaviness — to sharp
- Increase with standing or physical exertion, especially over long periods
- Worsen over the course of a day
- Be relieved when you lie on your back
With time, varicoceles may enlarge and become more noticeable.
When to see a doctor
Because a varicocele usually causes no symptoms, it often requires no treatment. Varicoceles may be discovered during a fertility evaluation or a routine physical exam. However, if you experience pain or swelling in your scrotum or you discover a mass on your scrotum or you’re having problems with fertility, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.
Causes
The spermatic cord carries blood to and from the testicles. It’s not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the cord prevent the blood from flowing properly. The resulting backup causes the veins to widen (dilate). This may then result in damage to the testicle and result in worsened fertility. Varicoceles often form during puberty. Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles.
Diagnosis
Varicoceles can be discovered through self-examination or during routine physical examination. Diagnosis of varicocele is also made by identifying “pinhead” shaped sperm when a semen analysis is done.
Treatment
Varicocele repair is done to improve male fertility. It can usually be done surgically on an outpatient basis using local or general anesthetic. A small incision is made in the abdomen close to where the testicles originally descended through the abdominal wall. The veins that produce the varicocele are identified and cut to eliminate blood flow to the varicocele.
Congenital Abnormalities
Maturation Arrest Patterns
As sperm develop, they undergo a series of maturation steps. At any one of these steps, abnormalities may occur. Maturation arrest is a condition in which Sertoli cells and immature germ cells are present in seminiferous tubules. Once the abnormality is diagnosed medical therapy may be used in an effort to help sperm mature. However, the prognosis is poor.
Hypospermatogenesis
Hypospermatogenesis is the reduced production of sperm without a specific point of interruption. In some patients, all of the elements of sperm production are present, but fewer sperm are produced. This will normally result in a lower number of sperm in the ejaculate. This condition can also coexist with a maturation abnormality. Although medical therapy can be used, the results are unpredictable.
Germinal Cell Aplasia
Patients with this disorder do not have germ cells in their testes and, therefore, are not able to produce sperm. No treatment exists for this disorder. Patients may choose donor insemination or adoption to achieve family-building goals.