Varicocele, an abnormal enlargement of the veins within the scrotum, is a common condition that affects approximately 15% of the male population and is found in up to 40% of men evaluated for infertility. It can impair sperm production and function, making it one of the leading correctable causes of male infertility. Understanding the relationship between varicocele and male reproductive health is essential for accurate diagnosis and effective treatment strategies aimed at improving fertility outcomes.

Can varicocele cause infertility in men?

Yes, varicocele can cause infertility in men.

Varicocele is a condition where the veins in the scrotum (pampiniform plexus) become enlarged, similar to varicose veins in the legs. This can lead to infertility through several mechanisms:

1. Increased Scrotal Temperature: The pooling of blood raises the temperature in the testicles, which can negatively affect sperm production and quality.
2. Oxidative Stress: Varicocele is associated with higher levels of reactive oxygen species (ROS), which can damage sperm DNA and reduce motility and viability.
3. Hormonal Imbalance: It may disrupt the normal levels of testosterone and other hormones involved in spermatogenesis.
4. Impaired Blood Flow: Poor drainage can affect nutrient and oxygen delivery to the testes, further impacting sperm health.

While not all men with varicocele experience infertility, it is one of the most common reversible causes of male infertility. Treatment, such as varicocelectomy (surgical repair), can improve semen parameters and increase the chances of conception in selected cases.

Is varicocele related infertility reversible?

Yes, varicocele-related infertility is often reversible, especially with appropriate treatment.

Surgical repair of varicocele, called varicocelectomy, can improve sperm quality by:

• Lowering the temperature around the testicles
• Reducing oxidative stress
• Restoring normal blood flow

Many men experience improvements in sperm count, motility, and morphology after surgery, which can increase the chances of natural conception. However, the degree of improvement varies depending on factors like the severity of the varicocele, the duration of infertility, and overall testicular health.

In some cases, assisted reproductive techniques (like IVF or ICSI) may still be needed, but varicocelectomy can significantly improve outcomes. Early diagnosis and treatment generally offer better chances of reversing infertility caused by varicocele.

If man has varicocele is it possible get a woman pregnanat?

Yes, it is definitely possible for a man with varicocele to impregnate a woman, but it depends on several factors like the severity of the varicocele, how much it affects his sperm quality, and whether he has received any treatment.

• Many men with varicocele have normal fertility and can conceive naturally without problems.
• However, if the varicocele causes significant sperm abnormalities (low count, poor motility, or abnormal shape), it can reduce the chances of natural conception.
• Treatment like varicocelectomy often improves sperm quality and increases the likelihood of pregnancy.
• In cases where natural conception is difficult, assisted reproductive technologies (such as IVF or ICSI) can help couples achieve pregnancy.

So, having varicocele does not automatically mean a man cannot father a child—it’s quite variable and often manageable. If there are concerns about fertility, it’s a good idea to see a specialist for evaluation and guidance.

What percentage of men with varicocele infertile?

Approximately 20-40% of men with varicocele experience infertility.

To give a clearer picture:

• Varicocele is found in about 15% of the general male population.
• Among men evaluated for infertility, the prevalence of varicocele rises to up to 40%.
• Not all men with varicocele are infertile—many remain fertile without issues.
• Studies suggest that around 20-40% of men with varicocele have impaired fertility, meaning their sperm quality or reproductive capacity is affected enough to cause difficulty conceiving.

So while varicocele is a common finding in infertile men, it doesn’t cause infertility in all cases. The impact varies based on the severity and individual factors.

Is varicocele related varicocele permanent?

Varicocele-related infertility is not necessarily permanent. In many cases, the negative effects of a varicocele on sperm production and quality can be improved or even reversed with appropriate treatment.

Here’s why it’s generally not permanent:

• Varicocele causes changes like increased testicular temperature and oxidative stress, which impair sperm function but don’t always cause irreversible damage.
• After varicocelectomy (surgical repair), many men see improvements in sperm count, motility, and morphology over time (usually within 3 to 6 months).
• Early diagnosis and treatment improve the chances of reversing infertility before long-term damage occurs.

However, if the varicocele has been present for a long time or has caused significant testicular damage, some effects may be harder to reverse completely.

In summary: varicocele-related infertility is often treatable and reversible, but the outcome depends on individual circumstances and timing of intervention.

What is the best treatment of varicocele in infertile men?

The best treatment for varicocele in infertile men is usually varicocelectomy, which is a surgical procedure to repair the enlarged veins. Microsurgical varicocelectomy is generally considered the best treatment for varicocele-related infertility because it maximizes fertility improvement and minimizes complications.

What is the success of microscopic varicoclectomy in infertile men?

The success of microscopic varicocelectomy in infertile men is generally high and well-documented. Here are the key points:

• Improvement in semen quality: About 60-80% of men experience improved sperm count, motility, and morphology after surgery.
• Pregnancy rates: Natural pregnancy rates after microsurgical varicocelectomy range from 30% to 60% within 6 to 12 months post-surgery.
• Low complication rates: Microsurgery minimizes risks like hydrocele formation and varicocele

Summary

Varicocele is an abnormal enlargement of veins in the scrotum that can impair sperm production and function, making it a common cause of male infertility. It affects up to 40% of men evaluated for infertility but not all men with varicocele are infertile. The condition can increase testicular temperature and oxidative stress, damaging sperm quality. Treatment, especially microsurgical varicocelectomy, often improves sperm parameters and fertility outcomes, making varicocele-related infertility largely reversible in many cases.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE