Varicocele

Untreated Varicocele May Lead to Testosterone Production Issues Over Time.
Can Men with Varicocele Have Children?
Varicocele is an enlargement of the veins responsible for returning unoxygenated blood from the testes to the heart. It is a congenital condition and is, therefore, more commonly observed in tall, slender men due to their anatomical structure. It is also more frequently seen in the left testicle than the right.

Although varicocele usually does not cause symptoms, in some men, it may lead to a dull pain or pressure in the testicle. Prof. Dr. Bülent Erol explains, “In men who wish to have children but have been unsuccessful after a year of regular intercourse, a physical examination can easily detect varicocele. During the examination of the testes, the veins can be assessed by having the patient cough or strain. In some cases, Doppler ultrasound may be needed. There are no known genetic causes for varicocele, but vein structural abnormalities, varicose veins, and physiological characteristics may lead to its development. For patients diagnosed with varicocele, sperm structures need to be analyzed twice via sperm analysis. In some men, sperm count is severely affected, and in some cases, sperm may not be ejaculated at all. In such cases, other underlying causes besides varicocele must be investigated.”

Varicocele is a significant issue concerning reproductive health. Prof. Dr. Bülent Erol notes that 35-40% of men who consult a doctor due to infertility are found to have varicocele: “Although men with varicocele may father children at a younger age, infertility can occur due to a decline in sperm parameters when they try to have another child later in life. Additionally, some patients may experience a decrease in testosterone levels over time.”

If other causes reduce sperm count, these should be identified and corrected first, as varicocele alone does not reduce sperm count to zero. Surgical treatment involves microsurgical ligation of the enlarged veins through an incision in the groin. Using a microscope under general anesthesia allows better visualization of the veins and careful preservation of the artery supplying the testis. This procedure has a high success rate, a low recurrence rate, and minimal complications. Patients can typically be discharged on the day of surgery and return to work within two to three days, with minimal postoperative pain.”

Prof. Dr. Bülent Erol states, “If varicocele does not cause abnormalities in sperm count, motility, or morphology, surgery is not necessary. If the patient is too young for a sperm test, surgery may be decided based on testicular volume comparison. Surgery may be advised if there is a volume loss of 2 ml or more on the affected side. The benefits of surgery for subclinical varicocele, detectable only by Doppler ultrasound, are debatable, as the benefits are not clearly known.”

The recommended waiting period after surgery for an increase in sperm count is 3-6 months, during which approximately 70% improvement is observed. The expected pregnancy rate within one year is around 40%. In some men, no change in sperm quality or count may occur. For men whose sperm quality or count has not improved 6-12 months after surgery and whose partner has not conceived naturally, assisted reproductive techniques may be recommended. Prof. Dr. Bülent Erol states, “If untreated, varicocele may not only impair sperm quality but also lead to testicular atrophy and testosterone production issues over time. In such cases, surgery is necessary to correct the condition. Men who do not wish to undergo surgery are advised to have an annual check-up with a urologist.”