Posts Tagged ‘varicocele repair’

Upgrading Fertility Status with Varicocele Repair

The most common identifiable cause of infertility in men is a varicocele.

Approximately one third of infertile men who have never fathered a child have a varicocele, and up to 80% of men who were once fertile, but are now infertile, also have a varicocele.

Varicoceles are abnormally enlarged veins draining the testicles.

They cause pooling of blood in the scrotum and a rise in testicular temperature.

Even one degree rise in temperature in the scrotum can have an adverse effect on sperm production and testosterone function.

The good news is that varicoceles are treatable, writes Marc Goldstein, MD, who is the Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology at the Weill Cornell Medical College of Cornell University, and Surgeon-in-Chief, Male Reproductive Medicine and Surgery at the New York Presbyterian Hospital, Weill Cornell Medical Center in New York, in a blog for the American Fertility Association.

“Dozens of reports have been published demonstrating the benefit of varicocele surgery to improve sperm counts,” writes Dr. Goldstein, who is also co-author of the book A Baby at Last!.

“Yet, varicocele repair remains controversial, particularly for small varicoceles that can’t be seen or felt on a physical exam.

Studies have shown greater improvements in semen quality for repair of large varicoceles compared with smaller ones.”

Dr. Goldstein details how he developed a microsurgical technique of varicocele repair using an operating microscope.

This technique can help couples achieve a 43% pregnancy rate after 1 year.

Microsurgical varicocele repair also:

— decreases sperm fragmentation, or the breaking up of DNA strands into pieces

— may cost less than in vitro fertilization with a single sperm injection (intracytoplasmic sperm injection, or ICSI)

— can induce sperm formation and help achieve pregnancy for couples in which the man has a zero sperm count (azoospermia) or a severely low sperm count and low sperm motility

— improve testosterone levels in two-thirds of men

“In conclusion, varicocele repair is a cost-effective treatment of infertility,” writes Dr. Goldstein.

“Men can upgrade to normal semen, which can allow for a natural pregnancy, or upgrade to semen of adequate quality for intrauterine insemination.

Men with azoospermia may produce ejaculated sperm adequate for ICSI.

Even if a man remains azoospermic, varicocele repair may enhance spermatogenesis allowing enough sperm production for ICSI.

Finally, microsurgical varicocelectomy will improve testosterone levels in a majority of men, which is a men’s health issue aside from fertility.”