Microscopic Varicocelectomy for infertility

My patients and friends frequently ask me medical questions and the answers might be of interest to you. Should you have any questions that you would like me to answer, please write to me at contact@krishnanurology.com

Varicoceles are enlarged dilated gross looking veins in the scrotum, akin to enlarged varicose veins in legs. Once a patient of mine asked me that their GP had said that he has varicocele and that it could affect his fertility. Yes, and it might do so. Varicoceles are enlarged varicose veins that occur in the scrotum. They are common, and they could affect 15 out of 100 men overall. Men with infertility had been found to have varicocele and that could be because of the dilated veins affect sperm production and the quality of the sperm produced due to the heat.  Varicoceles occur most often in the left testicle. A varicocele repair is done to improve male fertility and is achieved on an outpatient basis with improvement in the sperm producing in 3-4 months after the procedure.

The common cause is that the veins in the scrotum [Pampiniform plexus] gets dilated. These dilated veins cause pains, scrotal discomfort, inability to enjoy the sexual activity and importantly male infertility.  Varicocele gives a bag of worms’ appearance and feel, and the testicles shrink and affect the sperm production. Small varicoceles are seen only by bearing down [Valsalva manoeuvre] and 85 % of varicocele are seen on the left side and remaining 15% bilateral. Spermatic cord is key in maintaining the blood flow to and from the testis. When the valves in the veins do not function properly, the vein widens and causes retrograde flow known as reflux.

Various options available, such as inguinal varicocelectomy, sub-inguinal varicocelectomy, embolization, retroperitoneal varicocelectomy and microscopic varicocelectomy.  Pros and cons of each methodology of treatment exist.

Recently I was with Dr Ranjith Ramasamy MD in Miami at the Lennar Foundation Medical Centre, Miami, to understand more about infertility associated with Varicoceles and their management



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