Varicocele

Varicocele is a condition where the veins within the scrotum become enlarged. These veins are part of the pampiniform plexus, which helps regulate the temperature of the testicles by cooling blood before it reaches them. When varicoceles develop, they can disrupt this cooling mechanism, leading to elevated testicular temperatures. This increase in temperature can adversely affect sperm production and quality.

Key points about varicoceles and their impact on fertility:

• Prevalence: Varicoceles are relatively common, affecting about 15 out of 100 men. Not all men with varicoceles will experience fertility issues, but they are a common finding among men who seek fertility evaluations.
• Impact on Sperm Quality: Varicoceles can reduce blood flow and increase testicular temperature, both of which can impair sperm production (spermatogenesis). The quality of sperm may also be affected, leading to decreased motility (movement) and morphology (shape).
• Fertility Problems: Approximately 4 out of every 10 men who are evaluated for fertility issues have varicoceles that contribute to their condition. The exact mechanism by which varicoceles impact fertility is not fully understood, but the disrupted blood flow and increased temperature are believed to be major factors.
• Symptoms: Varicoceles are often asymptomatic (without symptoms) and may only be detected during a physical exam or imaging studies. However, some men may experience discomfort or pain in the scrotum, particularly after standing for long periods or during physical exertion.
• Diagnosis: Diagnosis typically involves a physical examination, where a healthcare provider may feel enlarged veins within the scrotum. Ultrasound imaging may also be used to confirm the presence and severity of varicoceles.
• Treatment Options: Treatment is not always necessary, especially if the varicocele is small and not causing symptoms or fertility issues. However, if varicoceles are contributing to infertility or causing significant discomfort, pain, testicular hypotrophy, treatment options include surgical repair (varicocelectomy) or embolization (blocking off the affected veins).

There are no drugs to treat or prevent varicoceles.
The patient may be able to return to normal, non-strenuous activities after 2 days. As long as they are not uncomfortable, they may return to more strenuous activity, such as exercising, after 2–4 weeks.