Varicocelectomy

What is a Varicocele?

A varicocele is an enlargement of the veins within the scrotum, the loose bag of skin that holds your testicles. A varicocele is similar to varicose veins of the leg, and often form during puberty. They can become larger and thus more noticeable with time. Left-sided varicocoele are more common than right-sided varicocoele, likely due to anatomical differences between the two sides. Varicoceles are present in an estimated 15 percent of all men.

Symptoms of a Varicocele:

Most men diagnosed with a varicocele have no symptoms, and rarely causes pain. When pain is present, it can vary from a dull, heavy discomfort to a sharp pain. The associated symptoms may increase with sitting, standing or physical exertion – particularly if any one of these activities occurs over long periods of time. Symptoms often progress over the course of the day, and they are typically relieved when the patient lies on his back, allowing improved drainage of the veins of the pampiniform plexus.

Varicocele and Fertility:

Varicoceles are thought to cause infertility and testicular atrophy (shrinkage). Varicoceles are a common cause of low sperm production and decreased sperm quality. Approximately 40 percent of cases of primary male infertility and 80 percent of cases of secondary male infertility are believed to be due to varicoceles.

Varicoceles cause pooling of blood in the scrotum and a rise in testicular temperature. Even a one degree rise in testicular temperature can have an adverse effect on sperm production and testosterone function.

Treatment Options:

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.

Alternatively, a nonsurgical procedure called percutaneous embolization can be done to repair a varicocele. A small catheter is inserted through a large vein in the groin or neck and advanced to the varicocele, which is then blocked off by a balloon, coil, or medicine.

Varicocele is  one of the most controversial issues in the field of Andrology, especially regarding why, when and to whom varicocelectomy should be applied. Many experts believe that the surgical repair of varicocele should be applied only in a meticulously selected group of infertile men, although there are no generally accepted criteria.

Our Story

When my husband was about 18, he was told he had a varicocele by his urologist. The urologist downplayed the potential problems that it could cause, and since my husband was young, didn’t have any pain, and nowhere close to wanting a baby, he was sent on his way thinking it wouldn’t be much of a problem. When we started trying for a baby, his varicocele was in the back of my mind, but since we initially got pregnant relatively quickly we were both relieved in thinking perhaps it would not be a problem. After the second miscarriage though, I demanded he see a urologist.

At the urology appointment, we learned he had a bilateral varicocele, with a grade 3 (the largest size) one one side, and a grade 1 on the other. We also received the results of his first semen analysis and they were dismal. He had a low count, poor volume, and low morphology. His motility, however was fine. We decided to repeat the SA a few weeks later at home, rather than at the clinic, and his parameters all improved into a fair range, except for morphology. He still had low morphology at 4% (normal would have been >15%).

Our urologist thought the surgery was a good idea. There is no known indication that poor morphology could be a risk factor for miscarriage, as most OBs would argue that a poorly formed sperm will not fertilize an egg. However, I remained skeptical. How had we gotten pregnant so quickly twice, given his low numbers? I also had read that a varicocele could cause high levels of sperm DNA fragmentation, which has been linked to increased risk of miscarriage, although it is not tested in a routine semen analysis. The surgery could help bring his number down.

I really just wanted to do everything I could to create ideal procreating conditions, and leaned toward having the surgery done. I spoke to two OBs and a pernitologist and none of them agreed. We even got an eye roll and a mocking tone about how quickly our urologist would jump to surgery. Going under the knife is a big deal, and should be avoided if not absolutely necessary. But we did the surgery anyway. We had heard it could lead to further complications and low testosterone in the future, which terrified my husband. And in the end, we were glad we did it.

The surgery was outpatient, and last about three hours (an hour and a half for each testicle). There are a few different techniques for this surgery, and we chose microsurgial sublingual technique, which is the gold standard.  He had two small incisions on his lower ab on the left and right said. My husband had very decreased mobility for about two days after the procedure. He spent those days sleeping, on the couch, and watching TV. Gradually, he start to walk around the house, and after 4 – 5 days we started talking walks around the neighborhood, which became a daily event to promote blood flow and healing. He had a moderate amount of pain for about two days, which was mostly relieved with his pain killers. It took one full week before he felt he could return to work, but about 2 – 3 weeks until he felt fully recovered and could exercise again. When we went to his post op appointment a few weeks after the surgery, the doctor said he was healing perfectly.

We repeated his semen analysis exactly 3 months after his surgery. We had been told it could take 3 – 6 months to see improvement, and improvement only occurs for two-thirds of men who undergo the surgery. We were lucky, he improved in every perimeter. His morphology improved enough to put him in the good/fair range. Our doctor said it was the most dramatic improvement we could have hoped for.

If you have any questions about our experience, please feel free to email me at twelveweeketernities@gmail.com