In this age, the concept that infertility is somehow associated with only a woman’s inability to conceive has become outmoded. It is now widely understood that 30-40% of infertility cases may be due to problems with male counterparts. This is owing to either ineffective sperm delivery as seen in retrograde ejaculation, altered testosterone levels, or abnormal sperm count that can be associated with a condition known as varicocele. Regretfully, there are cases which can’t be helped; however, on the brighter side, all hope is not gone with the availability of multiple infertility treatment options in the market. Perhaps, if you suspect being the victim of varicocele, it is best suited to seek immediate medical attention than to wait until the condition gets worse to the point that it can’t is untreatable.
The reasons associated with male infertility correspond to their unique reproductive anatomy. In men, the scrotum is a skin-covered sac that holds the testicles along with arteries and veins that deliver blood to the reproductive system. Varicocele is a clinical condition that causes the enlargement and dilatation of the scrotal veins. These veins form a vascular network known as pampiniform plexus in the spermatic cord, which ultimately connects to the vessels in the abdominal cavity and takes blood back to the heart. A varicocele is a varicose vein of the testicle and scrotum that is very similar to varicose veins that occur in the leg. It results in low sperm count and decreased quality, which is usually the main culprit behind infertility issues. It is deemed as the most common yet correctable cause of male infertility which has been associated with deleterious effects on spermatogenesis, sperm quality, testicular atrophy, reproductive hormones and pregnancy outcomes.
Varicocele raises the temperature of the testicles, which has mainly two effects. First, it affects the development and quality of sperm and second, it leads to a decrease in the production of testosterone, which is involved in the production of sperm. Moreover, the increased temperature is said to lead to a rise in reactive oxygen species (ROS), which damages the sperm DNA.
Symptoms Associated with Varicocele
It’s scary to be in oblivion, when you don’t know what is wrong with you while nothing is going your way. Following are the few symptoms associated with varicocele.
Pain: Where many patients do not find any scrotal discomfort. Some go through mild discomfort or severe pain when standing or sitting for prolonged periods due to the pressure that builds up in the affected veins, which is relieved when the affected person lies on its back.
Infertility Issues: Nearly 30% of couples that are facing fertility issues are diagnosed with presence of varicocele in the male counterpart. Infertility has been said to be associated with raised temperature in the scrotum, which affects sperm production.
Testicular Atrophy: Testicular shrinking is another giveaway of varicocele in the affected individuals.
Varicocele diagnosis is traditionally made upon physical examination, which is typically performed in the laying and standing position, wherein the scrotum is examined for visible swelling during rest and straining conditions. Along with physical examination, scrotal ultrasound, venography, and color doppler ultrasonography are also used for its diagnosis.
It is graded ranging from grade 0-3 depending on the clinical findings on palpitations and testicular size. Where grade 3 varicocele is easily identified through physical examination however, lower grade varicoceles are difficult to pinpoint, particularly in case of certain clinical comorbidities.
Below are listed some available options patients suffering from varicocele can opt;
Surgical Procedures: There are three types of surgical approaches that are typically used for its treatment, namely, laparoscopic surgery, open surgery and microsurgery. All of these options involve hospitalization, incisions, extended recovery time, scarring and recurrence potential.
Healthy Diet and Supplements: It’s been observed that foods that are rich in fiber and antioxidants are exceptionally good for varicocele patients in relieving the symptoms. Furthermore, supplements might prove to be beneficial as well since our daily diet lacks all the necessary nutrients therefore, taking these will allow the consumption of the nutrients that we are missing out on in appropriate amounts which will have their long-term effects.
Varicocele Embolization: It is a minimally invasive 3-D precision guided treatment first time introduced by Dr Imtiaz Ahmad in 2019 in Pakistan. Dr Imtiaz Ahmad is an American trained and highly qualified Endovascular Surgeon and interventional Radiologist.This procedure is performed using real-time fluorescent imaging to guide catheters inside the body through the Jugular vein and sometimes femoral vein. Using either mild IV sedation or local anesthesia, patients remain relaxed and experience minimal pain during the procedure.No surgical incisions are formed with no risk of scars. The blood flow to the affected vein is stopped by injecting FDA approved medications through the catheter, which embolizes the abnormal veins with defective valves and thus reduces the pain, pressure and high temperature in the groin and specifically along the testis.Through embolizing the vein, the blood flow is redirected to healthy vessels in the vicinity.
Varicocele Embolization has been first introduced as a 3-D precision guided endovascular treatment in two of the major cities of Pakistan; Karachi and Lahore. The embolization procedure is carried out using FDA approved medications by Dr. Imtiaz Ahmad, who is a world renowned interventional radiologist and endovascular surgical specialist. As a part of post-treatment practice, the patient can expect a follow-up for up to 6 months. There are numerous success stories of patients that underwent the procedure perfor