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Because surgery for varicocele repair is simple and straightforward , many doctors still repair any varicoceles they find in infertile men, following the dictum that it's better to do something rather than do nothing! However, keep in mind that varicocele surgery will result in an improvement in sperm count and motility in only about 30% of patients and it is still not possible for the doctor to predict which patient will be helped. Of course, just improving the sperm count is not enough - and pregnancy rates after varicocele repair alone are in the range of 15%. However, one danger of doing a varicocele repair is that when it doesn't help, patients get frustrated, and refuse to pursue more effective options, such as the assisted reproductive techniques. Today, most infertility specialists would advise infertile men with varicoceles to consider going in for IVF, rather than for varicocele surgery.
There are 4 methods available to repair varicoceles conventional surgery, microsurgery, laparoscopic surgery and radiologic balloon occlusion.
In conventional surgery, a small cut is made in the groin; the spermatic cord is lifted out of the scrotum; and the engorged veins are tied off. This is the commonest method used. The risks include: the risk of the varicocele recurring, which is about 20%, because some of the smaller veins are not identified and are missed during surgery; the risk of hydrocele formation - a collection of fluid around the testes, because lymph vessels are indirectly tied off too, so that more fluid is accumulated - the risk being about 5%; and inadvertent damage to the testicular artery (the blood supply to the testis) - which can actually decrease sperm production!
Microsurgery is a newer method, in which under an operating microscope, the surgeon individually ties off the enlarged veins in the spermatic cord. The testicular artery and lymphatic ducts can be preserved confidently, because the surgery is done under high magnification.
Radiologic balloon occlusion is not very commonly performed. In this minor procedure, a silicone balloon catheter is passed under X-ray guidance to the testicular vein; here the balloon is inflated and left in place permanently, thus blocking the engorged veins and repairing the varicocele.
The "subclinical varicocele": These are tiny varicoceles which cannot be felt by the doctor; but can be detected by Doppler examination. Whether correcting them is helpful or not is still a matter of individual opinion.Many surgeons will combine varicocele repair with medical therapy to try to increase the sperm count, but this is usually not effective.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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