Veins are blood vessels which carry impure blood back to the heart. They have valves which maintain the direction of blood flow. If these valves fail, blood stagnates in the veins which then become dilated. These are called varicose veins and when they occur in the scrotum affecting the ‘pampiniform plexus’ – (a collection of scrotal veins) it is called a varicocele.
Varicoceles are common in men and occur in almost 15 %. However
they are commoner in infertile men and nearly 40% of men with infertility have a varicocele.
Varicoceles may be one sided or unilateral – (usually commoner on the left side) or may occur on both sides or bilateral. Varicoceles are left sided in 80 -90% of men and in 35 -40% may be bilateral.
How does the presence of a varicocele affect fertility?
It is believed that the testes are in the scrotal sac because the lower temperature (1-2 degrees lower than core body temperature) favours normal sperm production. But the presence of a varicocele with consequent pooling of blood is believed to adversely affect sperm production by raising testicular temperature.
Additionally, varicoceles may produce accumulation of free oxygen
radicals (ROS) which are toxins that may damage the sperm and reduce
Does a varicocele/varicoceles produce any symptom?
Some men may complain of scrotal heaviness or a “bag of worms”
feeling in the scrotum. Most men are however symptomless and they are diagnosed to have a varicocele on clinical examination by the doctor. Occasionally, varicoceles may be mild and can be only diagnosed by a scan.
Can a varicocele be graded according to severity?
Yes. It is important for the doctor to grade the varicocele. This will help us to choose the most appropriate treatment.
Grade III – This is the most severe form where the varicocele is large and is readily felt.
Grade II – This is moderate but is felt on examination
Grade I – This is small in size and detected only by scan or after
“Valsalva manoeuvre”. (Increasing intraabdominal pressure by pushing
What treatment is available for varicocele and when is it advised?
Varicocele has to be treated by surgery. There are no medical
treatments available for varicocele. However not all grades of varicocele require surgery. If a man has a grade III varicocele with poor sperm counts and the couple are infertile but the female partner is normal -then varicocele surgery is advised. This will improve sperm counts. However,
we cannot guarantee a pregnancy even if there is substantial
improvement in sperm counts.
However there is no evidence to show that repair of more minor grades of varicocele will increase sperm counts.
How is the surgery done?
The surgery involves tying off the dilated veins. It is done through a small incision made in the groin. It is a day procedure and you can go home on the same day as the surgery and resume work in 3 – 4 days. It can be done under local or general anaesthesia.
Other lesser used methods are laparoscopy and percutaneous
transvenous ablation. They have no advantages over the open method.
What are the risks of surgery?
The risks of surgery are uncommon and minor. They include post-
operative pain, collection of fluid in the scrotum, return of the varicocele later.
In case of further questions, please contact us at Jananam.