The term varicocele hides a pathological condition characterized by the expansion of the varicose veins of the spermatic cord. This disease is a reproductive rather than a cosmetic problem, as it can have a pronounced negative effect on sperm quality . Varicocele occurs in 15–20% of men in the population, and more than 40% of them show signs of spermatogenic dysfunction.
Causes of infertility with varicocele
Venous outflow of blood from the testicle is carried out through the veins of the pterygium that runs along the spermatic cord. After fusion, these vessels fall into the inferior vena cava and renal veins. At the same time, on the left, the vessels form an acute angle, thereby forming an obstacle to the outflow of blood. That is why varicose veins of the spermatic cord is more often to the left.
The development of infertility with varicocele is associated with the impact of several adverse factors:
- mechanical compression of the vas deferens by the dilated veins;
- blood stasis in the vessels of the spermatic cord, contributing to the development of hypoxia in testicular tissue;
- violation of venous outflow from testicular tissue;
- retrograde blood flow in the vessels of the testicle, increasing the temperature of the appendages;
- changing the balance of sex hormones;
- decrease in the size of the testicles ;
- violation of the integrity of the blood-test barrier with the development of autoimmune processes.
In the case of a male varicocele, the function of production and maturation of spermatozoa invariably suffers. At the same time, even the one-sided nature of the pathological process causes the appearance of violations in the testes on both sides. However, a significant relationship between the degree of varicose veins and the severity of deterioration in the quality of spermogram is not observed. The presence of varicocele does not exclude paternity, but significantly reduces the chances of it over time.
Diagnosis of infertility with varicocele
Examination of a patient with suspected varicocele begins with an examination of the spermatic cord veins. During palpation, the doctor may feel veins that have been altered by varicose disease in the scrotum. In the later stages of the development of the disease, the pathological vessels become visible with the naked eye. The most accurate diagnostic method is ultrasound. Color Doppler sonography makes it possible to detect varicocele even at the asymptomatic stage of the course.
To assess the nature of changes in spermatogenic function in patients with varicocele allows the study of semen. When conducting this analysis can be identified the following violations:
- aspermia ( aspermatism ) - the complete absence of sperm;
- oligospermia - a decrease in the volume of ejaculate;
- pyospermia - detection of a large number of leukocytes in the ejaculate;
- hemospermia - detection of blood in the urine;
- azoospermia - the absence of sperm in the semen;
- oligozoospermia - a pronounced decrease in the number of spermatozoa in the ejaculate;
- asthenozoospermia - reduced sperm motility.
The only radical treatment for varicocele is surgery. Indications for surgery may be infertility, testicular atrophy and severe pain. Currently, there are several options for surgical treatment of varicocele:
- classical surgery - access to the testicular vein is carried out using tissue incision. After this, the vessel is ligated in two places and intersected between the ligatures;
- endoscopic surgery - in contrast to standard surgical intervention, such operations are performed through small incisions using modern endoscopic techniques;
- microsurgical revascularization of the testicle - the purpose of this surgical intervention is to restore normal blood flow through the testicular vein. For this, the surgeon replaces the affected vessel with a healthy vein;
- sclerotherapy - the essence of this surgery is the introduction of sclerosant in the veins affected by varicose veins. As a result, the reverse flow of blood in the altered vessels stops.
The timely detection and treatment of varicocele is a reliable method for preventing the development of male infertility.