It is a varicose (enlarged) vein in a man’s scrotum, which can cause infertility by reducing sperm production and quality. Structurally, a varicocele resembles a varicose vein in the leg.
Varicoceles (also called testicular varicoceles) are common in the male population, with about 15% of men experiencing one. And they most often occur on the left testicle. The majority of men with a varicocele remain fertile.
According to the American Society for Reproductive Medicine (ASRM), varicoceles are present in 40% of men diagnosed with infertility. The infertility awareness organization RESOLVE notes that the incidence of varicoceles increases in men who have once fathered a child but are infertile when trying for another child (50%-80%). This is evidence that varicoceles have a progressive effect on male infertility related to increasing age.
These factors cause fertility specialists to consider them to be a prime concern in finding the cause of infertility in men and in couples in certain circumstances.
The exact cause is not known, but many doctors think that a varicocele forms when the valves in the veins inside the spermatic cord carrying blood to the testicles don’t function properly. Varicoceles often develop in puberty and can continue to grow. Varicoceles can also cause the testicle to shrink.
In varicoceles that negatively affect testicular function, elevated temperature in the testicles and reversal of blood flow (venous reflux) appear to play a role.
Most of the time the condition causes no symptoms or signs other than infertility.
When a varicocele in the scrotum is large enough to detect by hand, it may feel like a bag of worms due to the group of dilated veins.
Infrequently, it may cause pain. This varicocele pain can be dull discomfort or sharp pain. It may increase when standing or during heavy exertion.
Evaluating a man for infertility due to a varicocele involves a physical exam, complete medical history and one to two semen analyses. We will recommend referral to a male fertility specialist if the semen analysis suggests further evaluation is needed.
Since fertility treatment often involves both partners, we encourage the female partner to be evaluated by us while the male partner is undergoing treatment by a male infertility specialists at another practice. Options for men with varicoceles include repair of the issue or the use of either intrauterine insemination (IUI) or in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Varicocele repair can improve sperm production and male fertility on an ongoing basis, where the other treatments would be needed for each attempt at pregnancy.
Various factors go into making such a decision, which we and the male fertility specialists treating the male thoroughly discuss with the patient. These include age, the female partner’s fertility potential, the assessment of the varicocele itself and weighing the cost factors of repair versus work-around treatments.