By Oliver Pack (Medical Doctor – Reg. No. 030308944).
A varicocele is a dilation of the veins surrounding the spermatic cord, an area essential for testicular blood drainage. This abnormality is similar to varicose veins that appear in the legs and, in most cases, affects the left side (due to the anatomical arrangement of the blood vessels), although it can also occur on the right side or on both.
This condition is one of the most common causes of male fertility problems, as its presence can directly influence sperm quality and therefore the chances of achieving pregnancy. Understanding what a varicocele is and how it can be detected can make a significant difference for any man who is trying to conceive.
Some men describe:
This is because it generally does not cause any intense pain that would alert him to the issue.
The relationship between varicocele and male fertility is mainly explained by the effects of venous dilation on the testicular environment. When pressure increases, venous return can be compromised, raising testicular temperature and altering both the production and maturation of sperm cells.
This directly impacts parameters such as sperm concentration, motility and morphology, reducing the chances of fertilisation. In more severe cases, these changes may even affect sperm DNA integrity. For this reason, an appropriate evaluation helps determine whether the varicocele is affecting fertility.
It is important to note that not all varicoceles require treatment. However, when they negatively affect sperm quality or cause persistent pain, treatment is recommended. If left untreated, they may progress and further impair testicular function. In younger men, an untreated varicocele may even affect the development of the affected testicle.
A varicocele can have a significant physiological impact on sperm quality. Increased scrotal temperature disrupts the environment needed for proper sperm formation, which can slow motility, reduce sperm count and increase the number of abnormal forms. In some cases, varicocele also increases oxidative stress, a process thatdamages the structure of sperm DNA and reduces its ability to fertilise the egg. Nevertheless, when treated promptly—especially in more advanced cases—these parameters can show clear improvement.
Varicocele correction is usually performed through a surgical procedure called varicocelectomy. This involves tying off or sealing the dilated veins to restore normal blood flow. As mentioned earlier, not all men require surgery; the decision depends on the varicocele grade, associated pain, and the degree of alteration in the semen analysis.
When fertility is clearly affected, surgery can significantly improve sperm quality and increase the chances of achieving pregnancy, either naturally or through assisted reproduction techniques.
When pregnancy is not achieved after surgery, or when surgical intervention is not recommended, several assisted reproduction options can help overcome the effects of varicocele. Techniques such as in vitro fertilisation (IVF) allow the selection of a single high-quality sperm cell to fertilise the egg, which may be decisive in achieving pregnancy. The choice of technique depends on semen quality, the age of the couple, and other individual factors that should be carefully evaluated.
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Varicocele and male infertility.
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Revisión sobre la relación entre el varicocele y la infertilidad masculina:
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Effect of varicocele on semen characteristics according to the new 2010 World Health Organization criteria: a systematic review and meta-analysis.
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Revisión sistemática y metaanálisis sobre el efecto del varicocele:
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The benefits of varicocele repair for achieving pregnancy in male infertility: A systematic review and meta-analysis.
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