Varicocele: Causes, symptoms and its impact on male fertility

varicocele It is a common condition in the male sex that consists of abnormal dilation of the veins present in the spermatic cord that supports the testicles, a problem that affects both male health and fertility. Although it may be asymptomatic or go unnoticed in many cases, its impact on testicular function and seminal quality makes it a highly relevant issue.

What is varicocele and why does it occur?

Varicocele is the result of a failure in the valves of the veins of the spermatic cord, which prevent the normal flow of blood from the testicles to the heart. This causes a build-up of blood in the affected veins, leading to their progressive dilation. In visual terms, it can be seen as a enlargement or a lump in the scrotum.

It is estimated that varicocele affects approximately between 15% and the 20% of men globally, being more frequent on the left side of the scrotum due to the unique anatomy of the veins in this region. In rarer cases, it can be unilateral, right-sided, or bilateral.

Triggers and types of varicocele

Varicocele is classified into two main types depending on its cause:

• Primary or idiopathic: It is the most common and is not associated with serious underlying conditions. It arises mainly due to incompetence of venous valves, commonly in the left spermatic vein.
• Secondary or acquired: It appears as a result of another medical condition, such as a tumor which obstructs blood flow in the spermatic veins. This type requires a comprehensive clinical evaluation.

Varicocele grades

Varicocele is also classified according to its severity, which is determined by a physical exploration and/or imaging tests such as Doppler ultrasound. The grades are as follows:

• 1 Grade: It is only detectable when performing the Valsalva maneuver (increasing abdominal pressure).
• 2 Grade: It can be palpated without the need for specific maneuvers, but it is not visible to the naked eye.
• 3 Grade: It is visible to the naked eye as a package in the scrotum, even without physical examination.

Varicocele symptoms

Varicocele is asymptomatic in most cases, but in others it can manifest with different symptoms, such as:

• Pain or feeling of heaviness in the scrotum, especially after standing for long periods or doing strenuous physical activity.
• Testicular atrophy, which means a decrease in the size of the affected testicle.
• Sensation of veins dilated that can be palpated in the scrotum.
• Male infertility, which may be the only visible symptom in some cases.

The pain is usually mild and described as an intermittent discomfort that may worsen throughout the day.

Impact of varicocele on fertility

One of the most worrying aspects of varicocele is its direct relationship with the male infertility. According to data from the World Health Organization (WHO), until a 40% of infertile men have varicocele. This condition affects the quality of semen, decreasing the number of spermatozoa, their mobility and altering their morphology.

The exact mechanism by which varicocele affects spermatogenesis is not completely clear, but it is believed that the increase in temperature in the scrotum, due to the accumulation of blood in the dilated veins, plays a crucial role. This increase in temperature can damage sperm DNA and alter testosterone production.

Diagnosis of varicocele

The diagnosis of varicocele usually begins with a physical exploration performed by a doctor, who can detect enlarged veins in the scrotum. Imaging tests may also be used, such as:

• Scrotal Doppler ultrasound: It is the most accurate technique to confirm the presence of varicocele and evaluate the degree of venous dilation.
• Spermiogram: It is used to analyze semen quality and determine the impact of varicocele on fertility.

Treatment options

Treatment for varicocele depends on the severity of symptoms and their impact on the patient's fertility. The main options include:

• Scrotal support: Indicated in mild cases to relieve discomfort and reduce pressure on the scrotum.
• Varicocelectomy: It is a surgical procedure that involves tying off the affected veins to redirect blood flow. It is performed using different approaches (open, laparoscopic or microsurgical).
• Embolization: It is a less invasive technique that uses catheters to block dilated veins.

Approximately one 60-70% of patients with varicocele experience an improvement in seminal quality after treatment, and the pregnancy rate increases up to 50% in couples struggling with infertility.

Prevention and care for varicocele

While not all cases of varicocele can be prevented, certain habits can help reduce the risk of complications:

• Perform regular testicular self-examinations to identify changes in the scrotum.
• Consult a doctor if you notice any lump or persistent discomfort in your testicles.
• Adopt a healthy life style, reducing risk factors such as stress.

In adolescents diagnosed with varicocele, regular medical follow-up is crucial to avoid future fertility complications.

Varicocele management should be tailored to the patient's needs and the impact the condition has on their quality of life. For many men, treatment can make a significant difference to their reproductive health and overall well-being, restoring hope of parenthood to those who are struggling to conceive.