Varicoceles are a collection of varicose veins around the testes much more commonly on the left and are present in between 4 and 22% of all men. However if men with primary infertility are examined then between 21 and 41% have varicoceles and men with secondary infertility have an even higher incidence. Varicoceles may run in families and may worsen with time.
The association between varicocele and male infertility has been hotly debated for the last 50 years. Recently the world of science has changed its view and is now saying that repair of a varicocele which is of moderate to large size is a useful exercise in men with fertility issues.The choice of repair either surgical or radiological is also up for debate.
Varicoceles are thought to impact on sperm health by increasing the temperature of the testes. The increased pressure in the veins may cause reflux of toxic adrenal and renal metabolites into the testes along with chronic vasoconstriction of arterioles. This leads to under perfusion, stasis and hypoxia, and subsequent dysfunction of the spermatic epithelium . There is also evidence that DNA damage to the sperm is higher in men with varicoceles and that this reduces after ligation.
So what does this all mean? Men should be examined for the presence of varicoceles particularly when their semen analysis is abnormal or their DNA fragmentation level is raised.
