Did you know that varicocele disease is one of the most important causes of infertility and that it is possible to have children after treatment? Many people come to the examination with swelling in the testis. VARICOCELE – varicose veins of the testis is common. In fact, it is so common that if we go out and examine all young men, whether they have a complaint or not, we will see that one out of 6 men has varicocele! It is most common in men between the ages of 15-25! Varicocele is seen on the left in 80-90% of cases. The reason for this situation can be explained as the connection of the left veins to the renal vein instead of the jugular vein (venakava), and this situation, combined with the effect of gravity, affects the return of the blood mechanically, causing the blood to pool in the testicular veins, causing varicose and varicocele.
We call varicocele the enlargement of the veins in the scrotum, in other words, the veins that take the dirty blood from the testicles and return it to the heart. These veins are in the form of a network formed by 8-12 capillaries and are defined as the pampiniform plexus in medical language. Varicocele is very similar to varicose veins that can occur in the leg, which women encounter much more and do not like. In some patients, the enlarged veins are so prominent that they look like “worms in a bag” when viewed from the outside. This indicates urgent and advanced disease and requires urgent intervention.
Each testis is held by a spermatic cord. This cord contains the veins and arteries, lymphatic vessels, and nerves of the testis. In the healthy veins in the scrotum, one-way valves are seen that prevent the dirty blood from escaping back to the testis. In people with defective valve structures (it may be congenital or due to standing a lot), blood does not move in the vessels as it should and starts to accumulate in the veins and causes it to expand. Of course, this enlargement turns into a varicocele over time and gradually. Varicocele has no clear risk factors and the exact cause is unclear.
Does testicular varicose-varicocele cause infertility? Does it damage the testicles and harm masculinity?
Recently, a newly married male patient saw swelling in his testicles and immediately applied to Google. Of course, what do you think he might have found first? Of course testicular cancer! She went to the nearest doctor with panic. Doctor Ney rightfully requested control with ultrasonography after the examination. Our patient received the ultrasound result and the diagnosis was varicocele! In fact, because he did not know this disease exactly, Google applied again. What would you like to see? Varicocele causes infertility! 2nd Shock of course! He consulted a friend and came to me with his friend’s suggestion.
When I explained that this is not the case and that there is a risk of infertility, but that this situation is rarely seen, he was somewhat relieved. After the necessary precautions and treatment, his wife is pregnant and waiting for her first child in her arms! If it’s a boy, he called me to ask if he should get circumcised in the newborn period! You can find what I recommend about this subject in the circumcision section of the previous section!
In rare cases, varicocele can cause decreased sperm production and quality, which can lead to infertility. Not every varicocele affects sperm production. In fact, most varicoceles do not adversely affect sperm and therefore do not reduce the possibility of having children. There is a higher probability of infertility in advanced varicoceles, especially in the example of varicocele that looks like a bag of worms. Even though it is rarer, varicocele can reduce the testicle by impairing blood flow and impair its functions. This very rare condition, such as 1-2 percent, can have serious consequences and urgent intervention is required!
How should varicocele be treated?
The patient I mentioned earlier, who diagnosed himself with varicocele and thought he might be infertile after a google search, said to me, “Doctor, operate and save me immediately. I don’t want to be infertile,” she said. Of course, when he came to me, he had a more important problem than varicocele. Misinformation and related panic situation! As a physician, I felt the need to solve the panic situation due to the patient’s lack of knowledge and correct information, which is more important before the treatment of the disease. With the right information, the process progressed much healthier and calmer! First, I asked for examination, doppler ultrasound and spermiogram test, and then I held information meetings with our patient alone and then with his wife. The diagnosis of our patient was mild moderate left varicocele. Testicular sizes were normal. All tests related to male hormone and testicular functions were normal. In the sperm analysis, while the sperm count was normal, the motility rate decreased by 20 percent. I explained to our patient, who has just made the decision to have a child, that he has absolutely no infertility and that he has a mild varicocele, in which case there are two treatment options: surgery or follow-up. We discussed the pros and cons of both treatment methods. The family decided to have varicocele surgery and continue on their way without wasting time with follow-up.
Unfortunately, there is no drug treatment for varicocele! either
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