It is commonly accepted that a male factor is responsible in 50% of cases of infertility in couples. The most common initial test for a man in this situation is a semen analysis which is a test of sperm count, motility and morphology (or shape). Sometimes the semen analysis will reveal low count, low motility and abnormal morphology. The most common surgically correctable cause of these findings is a varicocele.
What is a varicocele?
The scrotum is a muscular sac which contains the testicles which
are suspended by the spermatic cord. The spermatic cord contains
the vas deferens, nerves, lymphatics and blood vessels (arteries
and veins). The veins of the spermatic cord drain blood from the
testes and may at some time become tortuous and dilated, similar
to varicose veins in the leg. In fact a scrotal varicocele is simply
a varicose enlargement of the pampiniform plexus of veins around
the testicle.
How do varicoceles
cause infertility?
No one is absolutely certain. Several theories have been proposed
to explain the harmful effect of the varicocele on sperm quality,
including possible effects of pressure, oxygen deprivation, heat
injury, or toxins. Currently, the most widely accepted theory is
that a varicocele elevates intrascrotal temperature due to retrograde
blood flow. In short, it is the backward flow of venous blood that
short circuits the scrotum's attempt to maintain cooling of the
testicles.
How are varicoceles
diagnosed?
The varicocele is detected by a physician, most commonly a urologist
when performing a physical examination. If large, it may be visible
to the eye. When varices are difficult to diagnose, more objective
means can be used such as high-resolution color-flow Doppler ultrasonography
of the scrotum. Varicocele repair is performed as outpatient surgery,
with patients often returning to work as early as 3 days after surgery.
Repair is associated with improvement in semen parameters in most
patients.