Download Male Infertility Caused by Varicoceles

What You Need to Know About
Male Infertility Caused
by Varicoceles
INTERVENTIONAL RADIOLOGY
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Q&A
Questions and Answers About
Male Infertility Caused
by Varicoceles
Q. What is a varicocele?
A varicocele is a varicose vein of the testicle and
scrotum that may cause pain and lead to testicular
atrophy (shrinkage of the testicles).
In healthy veins within the scrotum, one-way valves
allow blood to flow from the testicles and scrotum
back to the heart. In a varicocele, these valves do not
function properly, causing blood to pool enlarging the
vein. Some experts believe that the raised temperature
that results from the pooled blood in these blocked
veins can decrease sperm count and motility of sperm
and increase the number of deformed sperm. In fact,
the incidence of varicoceles increases to 30 percent in
couples who cannot have children.
The Society of Interventional Radiology is a nation
image-guided therapeutic interventions.
Q. What are the symptoms of varicoceles?
Pain: Men who experience pain in their testicles—
particularly when exercising, standing or sitting
for a long period of time—may be suffering from
varicoceles. Typically, painful varicoceles are
prominent in size. If left untreated, varicoceles may
lead to infertility.
Fertility problems: There is an association
between varicoceles and infertility. Decreased sperm
count, decreased motility of sperm and an increase
in the number of deformed sperm are related to
varicoceles. Some experts believe these blocked and
enlarged veins around the testes cause infertility
by raising the temperature in the scrotum and
decreasing sperm production.
Testicular atrophy: The shrinking of the testicles is
another sign of varicoceles. Often, once the testicle
is repaired, it will return to normal size.
Varicoceles are fairly simple to detect and diagnose
through physical or diagnostic examination.
● 95
percent of varicoceles are found on the left side
of the scrotum.
● The
scrotum looks like a bag of worms
(see related figure).
● The
testicles may be shrunken in size.
If varicoceles are not detectable through the above
criteria, abnormal blood flow can often be detected
with a noninvasive imaging exam called color flow
ultrasound or through a venogram—an X-ray in
which a special dye is injected into the veins to
“highlight” blood vessel abnormalities.
nal organization of doctors, scientists and allied health pro
Q. How prevalent are varicoceles?
Approximately 10 percent of all men have varicoceles.
Among infertile couples, 30 percent of men
have varicoceles.
● The
highest occurrence of varicoceles is in men
ages 15–35.
● 80,000–100,000
men in America may undergo
surgical correction of varicoceles each year.
● ● Varicoceles—External appearance of dilated veins
ofessionals dedicated to improving public health through
Q. What treatments are available
for varicoceles?
There are both nonsurgical and surgical options available.
Varicocele embolization or catheter-directed
embolization: Varicocele embolization (also called
catheter-directed embolization) is a nonsurgical
treatment performed by an interventional
radiologist that is a highly effective, widely
available technique to treat symptomatic varicoceles.
With this nonsurgical treatment, an interventional
radiologist uses catheters and other instruments
to shut off blood flow to the dysfunctional vein.
Throughout this treatment, the patient is relaxed
and free of pain.
Specifically, the interventional radiologist makes
a tiny nick in the skin at the groin using local
anesthesia, through which a thin catheter (much
like a piece of spaghetti) is passed into the femoral
vein, directly to the testicular vein. The doctor then
injects contrast dye to provide direct visualization
of the veins to map out exactly where the problem is
Varicoceles—Internal appearance of dilated veins
h disease management and minimally invasive,
and where to embolize, or block, the vein. By using
coils or sclerosants (medicine injected into blood
vessels to make them shrink), an interventional
radiologist blocks the abnormal veins, which
reduces pressure on the varicocele. By embolizing
the vein, blood flow is redirected through other
pathways. Essentially blood flow to the incompetent
vein is “shut off ” internally, accomplishing what the
urologist does but without surgery.
Surgical ligation: One of the most common
treatments is open surgical ligation. In this
procedure, which is typically performed by a
urologist, an incision is made in the skin above the
scrotum down to the testicular veins, which are
tied off with sutures. Although most patients leave
the hospital the same day, 24 percent of surgical
ligation patients are required to stay at the hospital
overnight. Patients of open surgical ligation can
expect a two- to three-week recovery period.
Varicocele Embolization
Q. What are the advantages of catheterdirected embolization?
No surgical incision in scrotal area
As effective as surgery, as measured by improvement
in semen analysis and pregnancy rates
● Patients
can return to normal daily activities
immediately and without hospital admittance;
surgery requires several weeks’ recovery and
hospital admittance
● The
rare patient who has varicoceles on both sides
can have them fixed simultaneously through one
vein puncture site; surgery on both sides requires
two separate open incisions
● No
general anesthesia required
● No
sutures
● No
infections
● Cost
effective
● ● About Interventional Radiologists
Interventional radiologists are highly trained doctors who
specialize in minimally invasive, targeted treatments
performed using imaging for guidance. Using their
expertise with X-ray, CT, MR and other diagnostic imaging,
interventional radiologists guide tiny instruments (such
as catheters) through blood vessels (such as arteries) or
through the skin to treat the source of a disease internally—
and nonsurgically. Many conditions that once required
surgery can be treated less invasively by interventional
radiologists, with treatments that offer less risk, less pain and
less recovery time. Your interventional radiologist will work
closely with your primary care or other doctor to be sure
you receive the best possible care.
Interventional radiology is a recognized medical
specialty by the American Board of Medical Specialties.
Interventional radiologists are certified by the American
Board of Radiology in both vascular and interventional
radiology and diagnostic radiology.
Society of Interventional Radiology
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