Varicocele is an enlargement of the seminal veins around the testicle and the spermatic cord in the inguinal region as a result of a defect in the valve between the spermatic vein and the left renal vein or between the right spermatic vein and the vena cava. High temperature in the testicle.
Some specialists denied the existence of any effect of varicose veins on spermatogenesis and childbearing, and controversy raged between them and those who believe that this condition is one of the main causes of male infertility. One of the most important evidences presented by this team is that this condition is diagnosed in about 30% and 40% of male infertile men and that ligation or closure of varicose veins leads to an improvement in the number, movement and natural shape of sperm by about 65%, and achieving pregnancy and childbearing at a rate of 35% to 55 And that its presence in adolescents may cause testicular atrophy and dyszoospermia, and that it may cause a decrease in the level of male hormone in the blood, and that treating it in adolescents and even adults usually leads to an increase in the size of the testicle and an end to its atrophy, and that most cases of secondary infertility, i.e. after a period of success in childbearing, may return The presence of varicose veins that gradually affected the spermatic capacity of the man and that even in the absence of sperm completely in the semen, ligation of varicose veins may reappear in some cases with pregnancy or activate to a high degree that helps to achieve good results in the process of fertilizing eggs with sperm.
Significant effect on spermatogenesis
There is additional controversy among experts about the effect of the size of varicose veins on spermatogenesis, and whether it is necessary to treat those varicose veins that cannot be felt but appear on ultrasound. Several tests have proven that the size of varicose veins has an important effect on spermatogenesis, and that the larger this size, the greater the spermatic defect, and that the best results after treatment are achieved in the presence of enlarged varicose veins that can be seen under the skin of the scrotum or easily felt with fingers and resemble a bag of worms. These cases are usually diagnosed by clinical examination and based on the size of the varicose veins, and sometimes the patient is asked to press inwardly or cough hard to be able to highlight and diagnose them. In some cases, if the clinical diagnosis is not proven or not, then a Doppler ultrasound on the testicle or an imaging of the seminal veins can be used to prove its presence. As for varicose veins that cannot be felt, but appear only on Doppler ultrasound, the medical belief prevailing among experts is that they do not require treatment, and that connecting and closing them with catheters does not give any positive results in most of these cases, although some specialists still insist on treating them surgically.
They do not apply any treatment
As for the gradual effect of varicose veins on the size of the testicles, sperm, and the production of the male hormone, i.e., testosterone from Leydig cells, despite its evidence in adolescents, we do not have any evidence confirming its harm in adult men and the need to treat varicose veins in the absence of any male infertility in them to prevent its negative impact in the future on their permeability. Most experts follow up on these men with clinical examination and laboratory tests on semen and do not apply any treatment except in the event of testicular atrophy, secondary infertility, a decrease in the level of male hormone in the blood, or testicular pain.
In summary, varicose veins, which represent an expansion in the seminal veins around the testicle, are a common congenital condition that affects about 15% to 30% of men and is considered the main cause of infertility for them as a result of increasing the temperature inside the testicle and causing a deficiency in the male hormone, testosterone, and its negative impact on sperms. They are usually divided into 3 categories according to their size:
1 Large varicose veins that can be easily seen under the skin of the scrotum.
2 Varicose veins of moderate or large size that can be felt with the fingers.
3 Varicose veins that cannot be palpated unless the patient presses hard or coughs hard.
As for the varicose veins that cannot be felt and that appear only in ultrasound with Doppler on the testicles or seminal venography, the current medical belief is that they do not need any treatment, which fails in most of these cases. As for young people, the necessity of treating varicose veins is due to the gradual atrophy of the testicles, pain, or a decrease in the number, movement and shape of sperm, if it is possible to perform a semen analysis. It is known that about 60% to 70% of men with varicose veins are able to have natural sperm and have children without any treatment, which emphasizes refraining from undertaking treatment for all men with this condition, which may sometimes not affect their reproductive energy.
