As an IVF specialist, I see a lot of couples who have male factor infertility because of a low sperm count. The technical name for this conditon is a tongue-twister, and is labelled oligoasthenospermia - quite a mouthful for the infertile man to have to swallow. Once he recovers from the blow that he is "shooting blanks", the next question every man wants to know is how to improve his sperm count. Lots will try home remedies such as a high-protein diet; or wearing boxer shorts to cool off their testes, but none of these work. They then attempt medical therapy or alternative medicine, both of which have a dismal track record. They then end up being referred to their friendly urologist, who usually diagnoses that they have a varicoele.
A varicocele is a swollen varicose vein in the scrotum - usually on the left side . The condition occurs because blood pools in the varicose testicular veins (pampiniform plexus) since the valves in the veins are leaky and do not close properly. The reason for infertility associated with a varicocele are unclear. Perhaps the accumulation of blood causes the testes to be hotter and so damage sperm production; or the pooled blood brims over with abnormal hormones which may change the way the testes make sperm. The effect of the varicocele on an individual's sperm count is variable - and this may range from no effect whatsoever, to causing a decreased sperm count. Varicoceles may also have a progressively damaging effect on sperm production, so that the sperm count may decline with time.
How is a varicocele diagnosed? The doctor examines the patient in the erect position and feels the spermatic cord - the cord like structure from which the testis hangs. The patient is also asked to cough at this time. A varicocele feels like a "bunch of worms" and on coughing, this gets transiently engorged. Confirmation of this diagnosis is best done by a Doppler test at the same time. The Doppler is a small pen like probe which is applied to the cord. It bounces sound waves off the blood vessels and measures blood flow by magnifying the sound of blood flowing through the veins. This can be recorded. Patients with a varicocele have a reflux of blood during coughing which shows up as a large spike on the tracing. Other tests which are done to confirm the diagnosis of a varicocele include a Doppler ultrasound, which confirms the "diagnosis" in colour !
Most doctors are still not sure whether a varicocele causes a low sperm count or not ! It is possible that the varicocele may be an unrelated finding in infertile men - a "red herring" so to speak. Strangely enough, only a quarter of men with varicoceles have a fertility problem. Thus, many men with large varicoceles have excellent sperm counts which is why correlating cause (varicocele) and effect (low sperm count) is difficult.
This means that surgical correction of the varicocele may be of no use in improving the sperm count - after all, if the varicocele is not the cause of the problem, then how will treating it help? In fact, controlled trials comparing varicocele surgery with no therapy in men who have varicoceles and a low sperm count have shown that the pregnancy rate is the same – so that it does not seem to make a difference whether or not the varicocele is treated or not!
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.
The only group of men varicocele surgery consistently seems to help are the surgeons who perform it !
As an IVF specialist, I see a lot of couples who have male factor infertility because of a low sperm count. The technical name for this conditon is a tongue-twister, and is labelled oligoasthenospermia - quite a mouthful for the infertile man to have to swallow. Once he recovers from the blow that he is "shooting blanks", the next question every man wants to know is how to improve his sperm count. Lots will try home remedies such as a high-protein diet; or wearing boxer shorts to cool off their testes, but none of these work. They then attempt medical therapy or alternative medicine, both of which have a dismal track record. They then end up being referred to their friendly urologist, who usually diagnoses that they have a varicoele.
A varicocele is a swollen varicose vein in the scrotum - usually on the left side . The condition occurs because blood pools in the varicose testicular veins (pampiniform plexus) since the valves in the veins are leaky and do not close properly. The reason for infertility associated with a varicocele are unclear. Perhaps the accumulation of blood causes the testes to be hotter and so damage sperm production; or the pooled blood brims over with abnormal hormones which may change the way the testes make sperm. The effect of the varicocele on an individual's sperm count is variable - and this may range from no effect whatsoever, to causing a decreased sperm count. Varicoceles may also have a progressively damaging effect on sperm production, so that the sperm count may decline with time.
How is a varicocele diagnosed? The doctor examines the patient in the erect position and feels the spermatic cord - the cord like structure from which the testis hangs. The patient is also asked to cough at this time. A varicocele feels like a "bunch of worms" and on coughing, this gets transiently engorged. Confirmation of this diagnosis is best done by a Doppler test at the same time. The Doppler is a small pen like probe which is applied to the cord. It bounces sound waves off the blood vessels and measures blood flow by magnifying the sound of blood flowing through the veins. This can be recorded. Patients with a varicocele have a reflux of blood during coughing which shows up as a large spike on the tracing. Other tests which are done to confirm the diagnosis of a varicocele include a Doppler ultrasound, which confirms the "diagnosis" in colour !
Most doctors are still not sure whether a varicocele causes a low sperm count or not ! It is possible that the varicocele may be an unrelated finding in infertile men - a "red herring" so to speak. Strangely enough, only a quarter of men with varicoceles have a fertility problem. Thus, many men with large varicoceles have excellent sperm counts which is why correlating cause (varicocele) and effect (low sperm count) is difficult.
This means that surgical correction of the varicocele may be of no use in improving the sperm count - after all, if the varicocele is not the cause of the problem, then how will treating it help? In fact, controlled trials comparing varicocele surgery with no therapy in men who have varicoceles and a low sperm count have shown that the pregnancy rate is the same – so that it does not seem to make a difference whether or not the varicocele is treated or not!
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.
The only group of men varicocele surgery consistently seems to help are the surgeons who perform it !