Do Varicoceles Affect Male Fertility?

Diagram of the male reproductive system showing a varicocele.

Does A Varicocele Cause Infertility?

Varicoceles are an abnormal dilation of the veins within the spermatic chord, similar to having a varicose vein in the scrotum.  Varicoceles occur in 15% of all men, the vast majority of which are fertile, have normal sperm and do not appear to have fertility problems.

However, men with varicoceles have higher rates of infertility than those who don’t have them. In fact, 40% of all infertile men have a varicocele.(1)

One study involving more than 800 men with infertility problems revealed that nearly one-third of them had a varicocele. These findings indicate that having a varicocele can increase a man’s chances for having infertility.(2)

The exact reason for this is not known, but it is believed that varicoceles may interfere with the body’s ability to produce and store sperm. It is possible that varicoceles could affect sperm by raising the temperature of the testicle.

However, a varicocele will not cause infertility in men with a high sperm count.

Does Varicocele Treatment Improve Fertility?

Varicoceles can be diagnosed and corrected with surgery by a urologist. However, varicocele treatment does appear to improve the quality of the semen enough to result in normal fertility by restoring blood flow to the scrotum. This restored blood flow can result in increased sperm count and testosterone production.

Your doctor will perform a semen analysis to determine the extent to which your fertility improves. Varicocelectomy frequently results in a 60–80% improvement of semen analysis results.

However, although numerous studies show that the surgical treatment of varicoceles can increase sperm count and improve poor motility, research does not show a consistent improvement in pregnancy rates after varicocele treatment.

One review of prior studies seemed to show some evidence that treatment for varicoceles could potentially improve fertility, particularly when the reason for the infertility is not known. Researchers noted, however, that there is not enough evidence to support this conclusion, and that further research is necessary.(3)

These findings would indicate that any improvement in sperm quality is not substantial enough to make a significant difference, and may not be an effective way for most men to improve overall fertility.

Varicocele surgery or embolization may be more feasible for men with sperm counts that are only slightly low (15-20 million per cc). Couples are still able to conceive with sperm counts in this range even without varicocele treatment.

For couples who aren’t able to conceive, it’s important to undergo a thorough range of fertility testing, including assessments on sperm count. Don’t assume that a varicocele is necessarily the main reason for the problem.


References:

  1. https://www.uofmhealth.org/health-library/hw202906#hw202906-Bib
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215491/
  3. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000479.pub5/full
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