Varicocele is one of the most common abnormalities in men who cannot conceive their partners. The enlargement of the vascular system carrying dirty blood from the testicles is called the Pampiniform plexus, that is, varicocele.
It is useful to examine the relationship between varicocele and infertility from many different perspectives.
Varicocele can be seen, palpable or detected by Doppler ultrasound examination. When detected by Doppler ultrasound, it is called subclinical varicocele. Apart from infertility, the most prominent complaint in victimized men is chronic inguinal pain and feeling of pressure. Today, only visible, or palpable varicocele is considered important.
20% of men who have previously conceived their partner have varicocele. The incidence is around 35% – 40 in infertile couples in which the woman is normal. Clinical varicocele is seen in 20% of young men recruited in the United States. In the long-term follow-up of these men, there was a difference in the rate of conceiving of their spouses between those with and without varicocele. There is no universally accepted theory about how varicocele causes infertility. Although it is said that sperm morphology and movement disorder, called stress pattern, is observed in the semen of victimized men, the fact that similar disorders are also observed in non-victim men cast a shadow over the importance of this finding.
When the sperm count, mobility and structural features were compared in men with varicocele and without varicocele, the difference was not observed in all studies.
The treatment of varicocele today is surgery. With microsurgery, the enlarged veins are tied with an operation called spermatic vein ligation. While this operation can be performed endoscopically, or radiological embolization (injection of a substance that occludes the expanding vessel under radiological control) techniques can also be used. As there are no comparative studies of the techniques, there is no clear consensus as to which one is superior.
The generally accepted view among urologists is that the repair of subclinical varicoceles (cases detected by Doppler ultrasound) is of no benefit. There is a consensus on the treatment of clinical, palpable, or visible varicoceles, especially those associated with chronic groin pain or feel of pressure, and varicoceles seen at younger ages.
Treatment of infertile men with disordered semen parameters (with abnormal sperm values) is commonly performed by urologists. In contrast, andrologists and gynaecologists are more sceptical about whether the treatment of such varicoceles is beneficial or not.
When the controlled studies were evaluated collectively, it was observed that there was no change in the chances for men with and without varicocele repair to conceive their wives. Varicocele repair is meaningless, especially in cases of azoospermia (no sperm in the semen sample) or severe oligospermia (men with a sperm count of 0 or less than 1 million per ml). In cases where the sperm count is over 5 million, where the woman is young, and where the infertility period is short, treatment can be considered.
In post-operative recurrent varicoceles, a second operation is not performed unless the patient has complaints. As a result, today varicocele is a phenomenon that is diagnosed too much and repaired unnecessarily, especially in infertile couples. Because the relationship between varicocele and infertility is not fully clarified and as the treatment does not show any benefit, varicoceles are considered as incidental findings encountered in infertility research today.