Extensive debate has been sparked in the international community about the necessity and effectiveness of treating varicocele.
But what is varicocele really?
Varicocele is the dilatation of the veins within the loose bag of skin that holds the testicles (scrotum), the coiled tube that carries the sperm out of the testicles towards the rest of the reproductive system. The vas deferens connects the testicle to the rest of the body and it contains the testicular artery, veins, nerves and the vas deferens, which carries sperm from the testicle to the urethra.
Varicocele is a very common condition that occurs with an incidence of about 17% in the general population and 40% in the population of men with infertility. Often, varicocele is asymptomatic and if it ever gives symptoms, these are described as mild weight and discomfort in the scrotum. The diagnosis of varicocele is exclusively clinical and its diagnosis is made by scrotal triplex. The treatment of varicocele may be surgical, with ligation of the seminal veins, or radioscopic with embolisation of the seminal veins.
The cases of the couples who may benefit from varicocele treatment are the following:
- Couples with no other underlying problems, i.e. young woman, below 38 years of age with a good hormonal profile, no endometriosis and with permeable fallopian tubes. In other words, there is no reason for the couple to ultimately require IVF treatment.
- Patient under 35 years of age
- Absence of history of cryptorchidism or delayed descent of the testicles
- A spermogram which has not been severely affected, with at least two counts, 2 months apart from each other. Meaning, it must show a sperm concentration of more than 15 millions/ml and must not show necrospermia (i.e. the sperm must show some motility)
These are four factors that should be reverently respected before deciding on surgical or radioscopic treatment of varicocele. Recent studies indicate 60% efficacy in terms of spontaneous conception in the two subsequent years after treatment of varicocele.
