Infertility is becoming a growing concern among both young men and women, largely attributed to the lifestyle prevalent in the 21st century. The gradual increase in stress levels, spurred by societal modernisation, is a significant contributing factor. The IVF centre in India has shed light on one of the primary causes of male infertility: Varicoceles. Let’s delve deeper into this issue to gain a comprehensive understanding.
What is Varicoceles?
A varicocele occurs when the veins in the testicle and scrotum become enlarged and twisted, similar to varicose veins. This enlargement can cause discomfort, testicular shrinkage, or fertility problems. The pouch that contains the testicles in males is known as the scrotum. Simply put, varicocele can be described as the swelling of these veins. The testicles comprise:
- A spermatic cord
- The arteries
The reproductive glands, like the seminal vesicles and prostate, receive blood through veins. Any irregularity, malfunction, or wrongdoing in these veins can signal the presence of varicocele in the body.
What are the possible complications associated with Varicocele?
Men with Varicocele may experience low sperm motility and a decreased sperm count, both of which can contribute to male infertility.
How does varicocele influence male reproductive function and contribute to infertility?
Due to varicocele, infertility arises from an excess of blood pooling in the scrotum. This surplus blood is intended to regulate the temperature of the testicles. It’s widely understood that optimal sperm quality is contingent upon production in a cooler environment, below the body’s normal temperature. Surplus blood does not allow the scrotum to produce a cooler environment.
Diagnosis and confirmation of varicocele
The initial diagnosis involves the doctor inquiring about your symptoms. You’ll be asked to change standing or sitting positions to confirm any physical symptoms. In around 90% of cases, varicoceles are found only in the left testicle, known as unilateral varicocele. However, they can also occur in both testicles, termed bilateral varicoceles.
To confirm your diagnosis, an ultrasound may be necessary. The doctor will conduct semen and blood tests to assess whether the varicocele is impacting your fertility. The ultrasound offers a detailed view of the veins in your testicles.
Once the varicocele diagnosis is confirmed, your doctor will assess its severity. The severity of varicocele is categorised into different grades as follows:
Grade 0: This represents a mild varicocele that is challenging to detect through a physical exam alone. Diagnosis typically requires an ultrasound. It’s also referred to as subclinical varicocele.
Grade I: During a physical exam, your doctor can only feel the varicocele when you perform the Valsalva manoeuvre. This manoeuvre involves attempting to exhale while closing both the nostrils and mouth or the glottis.
Grade II: This varicocele is larger than Grade I. While it’s not visible to the naked eye, your doctor can easily feel it during a physical examination.
Grade III: Considered the most severe, Grade III varicocele is readily visible during a physical examination.
Depending on the grade of your varicocele, your doctor may recommend various surgical and treatment options.
How can varicocele be addressed or managed?
In many cases, varicocele may not necessitate treatment. However, for men grappling with infertility, surgical correction of the varicocele might be recommended as part of their fertility treatment regimen.
For people who are not actively pursuing fertility treatment, a healthcare provider might advise regular annual checkups to observe any alterations. Surgery may be suggested under the following circumstances:
1. Subdued growth of a testicle.
2. Low sperm count or other abnormalities in sperm
3. Persistent pain that is not effectively alleviated by pain medication
Treatment outcomes may include the following:
- The affected testicle may “catch up” in development and eventually may return to its expected size.
- In the case of a teenager, Sperm counts may improve, and sperm irregularities may be corrected.
- May improve fertility
- May improve semen quality for in vitro fertilisation.
Open surgery (Varicocelectomy)
In this surgical procedure, the blood flow is rerouted into healthier veins, after closing off the affected vein. This is achievable due to the presence of two alternate artery-and-vein networks that provide circulation to and from the scrotum. This surgical option is more invasive and requires cutting through your tissues and skin.
Open surgical varicocelectomy encompasses the following:
Inguinal ligation: The varicocele is treated by securing it through the inguinal canal located in your groyne area, which is part of the abdomen.
Subinguinal ligation: The varicocele is treated from the groyne, beneath the inguinal ligament, also known as Poupart’s ligament.
Retroperitoneal high ligation: The varicocele is treated from behind the peritoneum, a thin, watery membrane lining the abdomen.
Potential complications of Varicocelectomy
There are potential risks linked with this surgery, including:
- The possibility of harming an artery.
- The development of hydrocele, characterised by fluid buildup around the testicles.
- The chance of varicoceles recurring in the future.
- Chronic pain in the testes.
- The risk of hematoma formation, which involves a collection of blood around the testicle.
Is Varicocelectomy painful?
Similar to many surgical procedures, varicocelectomy can induce moderate discomfort. Typically, this discomfort goes away within a few days. Over-the-counter pain relievers can effectively manage this discomfort. However, if you experience severe or persistent pain, it is advisable to seek guidance from your doctor.
Varicocele Embolization
In this procedure, a catheter and imaging guidance are utilised to redirect blood flow away from a varicocele. Tiny coils and/or a liquid are placed in a blood vessel using the catheter and imaging guidance. Compared to traditional open surgery, this approach is less invasive and causes less harm to your tissues and skin. It aids in reducing swelling and pain, as well as improving sperm quality.
Potential complications of Varicocele Embolization
1. There’s a rare chance of an allergic reaction if the injection contains contrast material.
2. Inserting a catheter into a blood vessel carries its own risks. It may damage the blood vessel, and the puncture site could bleed or become infected.
3. Since this procedure involves radiation exposure, there’s a slight risk of cancer.
4. It may cause discomfort in the lower back and inflammation of the veins and scrotum.
Is Varicocele Embolization painful?
The doctor applies local anaesthetic to numb the skin incision site, reducing sensation during the procedure. When a catheter is inserted into a vein or artery, you may feel slight pressure or discomfort, but it’s generally manageable.
Can fertility improve after varicocele removal?
Certainly, varicocele removal has been shown to enhance fertility. Following a varicocelectomy, pregnancy rates can elevate significantly, approaching nearly 70%.
Recovery and Self preservation
How soon can one expect to recover?
The recovery period varies depending on the severity of the condition and the overall health of the patient. External factors such as swelling and bruising in the groyne and scrotum typically subside within 3-4 weeks, while groyne tenderness may take up to 6 weeks to resolve.
It’s important to maintain cleanliness in the affected areas to prevent infection. Be cautious about hygiene when changing bandages and avoid prolonged exposure to water.
Refrain from lifting heavy objects, as this can exert pressure on the cuts. You may feel discomfort during bowel movements, so it’s advisable to consume a diet rich in vegetables, fruits, and high-fibre foods to prevent constipation. Staying hydrated can also aid in smooth bowel movements.