Varicocele Treatment: The Definitive Solution to the Most Common Cause of Male Infertility
What is varicocele, and what are its symptoms? How is varicocele, which causes infertility and pain, treated? Expert guide on microsurgical varicocele surgery, the recovery process, and its effect on sperm quality.
The ‘Silent’ Obstacle Delaying Your Dream of Becoming a Father
You have decided to have children, stopped using contraception, but despite months passing, you have not received the happy news. When you consulted your doctor, a sperm test revealed low count or poor motility. In this scenario, the culprit is most likely varicocele, which is the enlargement of veins in your testicles.
Although varicocele, which is similar to varicose veins in the legs but occurs in the testicles, is a nightmare for men, it is one of the areas where modern medicine is most successful. With the correct diagnosis and microsurgery performed by skilled hands, it is possible to get rid of the pain and become a father naturally by increasing sperm values.
In this comprehensive guide, you will find answers to all your questions, from the causes of varicocele and the risks of surgery to non-surgical treatment methods (embolisation) and herbal remedies.
What is Varicocele?
Varicocele is the abnormal enlargement, twisting and lengthening of the veins that carry deoxygenated blood from the testicles back to the body.
Normally, these vessels contain valves that allow blood to flow upwards (towards the heart) and prevent it from flowing back down due to gravity. When these valves malfunction, deoxygenated blood accumulates (pools) in the testicle. This leads to increased heat and the accumulation of toxic substances in the testicle.
Why is it usually on the left?
Ninety per cent of cases occur in the left testicle. The reason for this is anatomical; the vein in the left testicle is longer and drains at a more acute angle into the main vein, which increases pressure. However, if it occurs on the right side, more detailed examination (CT scan) may be required due to suspicion of an intra-abdominal mass.
Varicocele Symptoms: How to Recognise Them?
Varicocele is an insidious disease, sometimes causing no symptoms at all. However, an observant man may notice the following signs:
Swelling and Bulging of the Testicle: In advanced stages, twisted veins become visible under the skin of the scrotum. In medicine, this is referred to as the ‘Bag of Worms’ appearance.
Pain: A dull ache and pulling sensation that increases after standing for long periods or after sexual activity, and subsides when lying down and resting.
Testicular Atrophy: The testicle, whose blood circulation is impaired, may become malnourished over time and remain smaller than the other.
Infertility: The inability to conceive despite unprotected intercourse.
Varicocele Grades (Staging)
The decision on treatment is made according to the severity of the disease.
- Grade 1 (Mild): Varicocele only palpable during a doctor’s examination when the patient strains (Valsalva manoeuvre).
- Grade 2 (Moderate): Veins palpable without straining but not visible to the eye.
- Grade 3 (Severe): Veins that are visible to the naked eye, appearing as worm-like clusters.
Important: Surgery is generally not recommended for varicoceles that are only visible on ultrasound but not palpable during examination (subclinical), as their effect on improving sperm parameters is debatable.
Does Varicocele Cause Infertility? (Mechanism)
Yes, varicocele is the number one correctable cause of male infertility. So how does vein enlargement damage sperm?
Increased Heat: Sperm production requires the testicles to be 1-2 degrees cooler than body temperature. Varicocele disrupts this ‘factory setting’ by heating the testicle.
Toxic Substance Accumulation: Waste products (metabolites) from the adrenal glands flow back and accumulate in the testicles, poisoning the sperm.
DNA Damage: It increases oxidative stress, leading to breaks (fragmentation) in sperm DNA. This increases the risk of miscarriage even if pregnancy occurs.
Diagnostic Methods
- Physical Examination: This is the gold standard. A physical examination by an experienced urologist is sufficient for diagnosis. The patient is examined both standing and lying down.
- Scrotal Colour Doppler Ultrasound: Shows vessel diameters (in mm) and the reflux of deoxygenated blood (reflux flow). It is used to confirm the diagnosis.
- Spermogram (Sperm Test): It is essential to determine whether the disease has impaired sperm production.
Varicocele Treatment Methods
Not all varicoceles require surgery. If there is no pain, sperm values are normal, and testicle sizes are equal, only monitoring is recommended. However, if infertility or severe pain is present, treatment is essential.
A. Microsurgical Varicocelectomy (Gold Standard)
It is the most successful and lowest-risk method accepted worldwide.
How is it done? A very small incision of 2-3 cm is made in the groin area.
Microscope Difference: The surgical site is magnified 10-15 times under a microscope. This allows the surgeon to:
Preserve the artery supplying the testicle (preventing testicular loss).
Preserve the lymph vessels (preventing hydrocele, or fluid accumulation).
Ligate only the damaged veins.
Success Rate: Improves sperm values by 60-70%, provides a 40-50% chance of spontaneous pregnancy. The risk of recurrence is below 1%.
B. Laparoscopic Method
It is performed by making incisions in the abdomen. However, as distinguishing between arteries and lymph vessels is more difficult under the microscope, the risk of complications is slightly higher and it is less preferred.
C. Embolisation (Non-Surgical Method)
It is performed by interventional radiologists, who insert a catheter into a vein in the groin or neck, similar to angiography, and close the varicose vein with occlusive materials.
Who is it performed on? It is a good alternative for patients who have previously undergone surgery but have experienced a recurrence. It is not as common as surgery as a first option.
D. Traditional Open Surgery (Palomo/Ivanissevich)
It is a procedure performed without a microscope, using the naked eye. Due to the high risk of arterial injury or lymphatic damage, it has been replaced by microsurgery in modern urology.
The question patients are most curious about is ‘When can I return to work?’
Microsurgery is a comfortable procedure:
Hospitalisation: Patients are usually discharged on the same day or stay overnight.
Pain: It is mild and can be managed with simple painkillers.
Return to Work: For desk jobs, 3-4 days later; for heavy work, 2-3 weeks later.
Sexual Activity: Sexual activity is usually permitted after 2-3 weeks.
Sports: Heavy lifting and intense sports should be avoided for 4-6 weeks.Post-operative Recovery Process
Varicocele and Sperm DNA Damage
Recent studies have shown that varicocele causes sperm DNA damage (fragmentation), even if it does not reduce sperm count.
- In men who have failed IVF attempts or whose partners have recurrent miscarriages, varicocele surgery is recommended even if sperm count is normal. This surgery improves IVF success rates by repairing DNA damage.
Natural Methods and Nutrition
Varicocele is a mechanical vascular problem (valve malfunction), therefore no herbal tea or medicine can eliminate varicose veins. However, the following can be done to support sperm quality:
- Cold Application: Keep the testicles cool. Avoid wearing tight jeans and synthetic underwear.
- Antioxidants: Supplements such as fenugreek, vitamin E, vitamin C, zinc and selenium protect sperm by reducing oxidative stress.
- Quitting Smoking: This is the most important step for vascular health.
Frequently Asked Questions (FAQ)
Question: Does varicocele surgery reduce sexual desire? Answer: No, quite the opposite. Varicocele can suppress testosterone production. After a successful operation, testosterone levels will increase, positively affecting sexual desire (libido) and erection quality.
Question: Does varicocele recur after surgery? Answer: When performed using microsurgical techniques by experienced surgeons, the risk of recurrence is close to 1%. However, in surgeries performed without a microscope, the risk of residual veins remaining means the recurrence rate can rise to 15-20%.
Question: When does sperm count increase? Answer: Sperm production takes approximately 3 months. The initial effects of the surgery begin to be seen in the 3rd month, with the best results obtained in the 6th month and 1st year. Therefore, patience is required after surgery.
Question: Is unilateral surgery sufficient? Answer: If varicocele is present only on the left side, unilateral surgery is sufficient. However, if varicocele is clinically present (palpable on physical examination) on both sides, bilateral surgery yields more successful results.
Conclusion: Don’t delay, increase your chances of becoming a father.
Varicocele is the easiest cause of male infertility to resolve. The fear that ‘if I have surgery, will it make things worse?’ is unfounded, as microsurgical techniques have minimised this risk.
If you have been unable to conceive for a year or if you experience pain or deformity in your testicles, consult a urology/andrology specialist without delay. A simple examination and surgery could bring you the most beautiful gift of your life.
We wish you healthy generations and a happy future.