Varicose veins in the testicular area (called Varicoceles) are a phenomenon that affects many men. They are much more common on the left side than on the right or both sides. As they can negatively affect sperm maturation, this can then also reduce sperm quality.
Varicoceles can therefore stand in the way of one's desire to have children, or lead to impaired fertility in men. In addition, these varicose veins can cause an unpleasant swelling of the scrotum, as well as tension and pain.
In order find out if the venous plexus of the testicle has morbidly dilated and a varicose vein has formed, a simple examination using palpation and an ultrasound of the testes can help. Such a structure is also usually visible to the naked eye. Nevertheless, varicose veins in the testicular area are often discovered by accident, as patients often do not perceive symptoms. When patients want to have children, and, above all, when they have limited sperm quality, they should undergo a urological and andrological examination in order to rule out varicoceles or other diseases of the testicle.
If varicose veins are detected, then further tests, such as hormone testing and a spermiogram, will provide information about the effects they are having. Only then can it be determined whether the quality of the sperm cells is suffering from the varicoceles.
If patients are suffering from pain, or if the patient wants to have children and sperm quality is being impaired by varicose veins in the testes area, then a surgical procedure can be performed. The approach or therapy must be individually adjusted.
To start with, a varicocele can be severed or removed. A minimal surgical intervention is necessary for this. By means of a small incision on the left or, where applicable, right lower abdomen (similar to in an operation for inguinal hernia), the surgeon can penetrate to where the varicose vein is. This is then dissected and subsequently severed, removed or tied.
Another option is sclerotherapy of the varicose vein.
If, despite treatment, the sperm quality does not improve and one's desire to have children remains unfulfilled, couples can resort to alternatives.
Insemination: filtering out the strongest sperm and transferring these to the uterus.
In-vitro fertilisation (IVF): egg fertilisation outside of the body with subsequent transfer of the embryo into the woman.
Intracytoplasmic sperm injection (ICSI): here, the sperm cell – the man's sperm – is injected directly into the cytoplasm (ooplasm) of an egg.
Testicular sperm extraction (TESE): sperm extracted from the man's testicular tissue, which can then be used to fertilise the egg during a fertility treatment.
Sperm donation: fertilisation of the egg using third-party sperm.