The Varicocele Myth

The job of your veins is to bring blood back to your heart from the rest of your body.  While the heart pumps blood directly into your arteries, it doesn’t have enough pressure to push the blood back up your veins, against the force of gravity.   Instead there are tiny, one-way valves inside the veins of your lower body that open when blood is pushed through on the way to the heart, and close to prevent it from flowing back down.  If you didn’t have them, blood would continuously pool in your lower legs.  The congenital condition in which these valves leak is called varicosity, or varicose veins.

What is a varicocele?

Many women are familiar with varicose veins in the legs, but they can also be a problem for men.  A varicocele is a varicose vein in the scrotum, and is often diagnosed when men seek treatment for infertility.  This is more frequent in the left testicle, and is found in about 15% of all men, including those that are fertile.  The common belief has been that a varicocele can impede blood flow, which raises the temperature of the testis and damages sperm production.  Sperm are very sensitive to temperature, and are held outside of the body because they need to be about 2 degrees lower than normal body temperature. 

Varicocelectomy

There are two ways that varicoceles are repaired.  The first is outpatient surgery, in which a small incision is made just above the groin.  The affected vein is tied off so the blood is routed through other blood vessels.  Recovery time is about a week, although heavy lifting should be avoided for up to a month.  The second method is radiographic embolization, which is also an outpatient procedure.  A small catheter, or tube, is inserted into an artery near the groin.  Dye is injected into the artery to find the varicocele, and the vein is blocked so blood cannot go through.

The Controversy

In the 1970s and early 1980s, varicocelectomy was widely recommended by urologists for any male experiencing infertility.  At one point, doctors recommended that every teenage boy should be examined for varicocele and then operated on before significant damage to sperm count occurs.  Large studies published in 1985 and again in 1994 showed, however, that there was no significant increase in pregnancy rates in couples if the man underwent a varicocelectomy.  In fact in some cases, the surgery to clear the varicocele damages blood flow to the testis enough to significantly lower sperm production.  Now only the largest, and most obvious cases are repaired, and there are some doctors who would question whether the procedure is ever necessary. 

If your doctor recommends varicocele repair as part of your infertility treatment, it may be wise to seek a second opinion.  While there are a few cases where it can be beneficial, it is now regarded as an over-diagnosed and unnecessary procedure.