Male infertility refers to the disease of the male reproductive system which leads to difficulty or inability in conceiving, depending on the underlying causes. The male reproductive system is responsible for the production of male sex hormones in addition to the synthesis, transport, and ejaculation of sperms (male sex cell). Any alteration in the concentration, delivery or genetics of the sperm may result in male infertility. A normal sperm count should be in the range of 15 to 200 million per mL of the ejaculate. Lower sperm count is known as oligospermia while zero sperm count is called azoospermia. Azoospermia causes can be divided into two major groups: Obstructive and Non-Obstructive. Non-obstructive azoospermia (NOA) is the more common of the two. NOA results in lower or no production of sperms, which in turn can be due to the presence of varicocele i.e. damage in the valves of the veins surrounding the testes. Varicocele azoospermia is reported in about 14% of the cases leading to male infertility. Most people still maintain an impression that the female in the couple shoulders the total blame for not being able to conceive. Nevertheless, data concludes that in over 30% to 50% of cases of infertility, the male factor is either the sole reason or at least plays a partial role in the inability to achieve pregnancy. It is, therefore, important to consider ruling out symptoms of infertility in both, the man and the woman, before moving on to alternate options for becoming parents.
How does varicocele azoospermia cause Infertility?
The primary reproductive organ in the male reproductive system is the testes, which are situated outside the body, along with the scrotum and the penis. Sperms are generated in the testes and the production of primary sex hormone, testosterone is also at this site. The anatomy of the human body at every hierarchy is such that the form follows function. Since spermatogenesis and maintenance of sperms require a temperature below 98.6 °F, major male reproductive organs are situated outside the body. Additionally, the scrotum also ensures temperature control around the testes. Understanding homeostasis of temperature in the testes is important to rationalize varicocele azoospermia. Varicocele causes a temperature elevation of the testes, and an accumulation of deoxygenated blood also results in the generation of oxygen free radicals, threatening the genetic integrity of the sperms. The sperm count may greatly be affected because of the varicocele, but varicocele repair can restore fertility in men.
Varicocele and azoospermia repair – There’s always a solution
In most cases, the patient realizes they have azoospermia once they go through several failed attempts at intentional conceiving and have ruled out everything else. Although specific azoospermia symptoms are not as prominent, the symptoms of underlying conditions may present themselves. In the case of varicocele azoospermia, a slight discomfort/pain and swelling around the testes are the eminent signs. Once azoospermia is confirmed in a patient, there is no need for them to panic, especially if this is due to varicocele. Varicocele infertility is reversible in most cases. If the underlying cause of azoospermia is varicocele, then azoospermia and varicocele repair can go hand in hand. To diagnose varicocele, a special Scrotal Doppler ultrasound is performed, which requires the patient to be examined first in a lying position and then in a standing position. To build intra abdominal pressure that allows for an easy visualization of any enlarged veins, valsalva maneuver is performed. This is a method wherein the patient is asked to take a deep breath, hold it and apply pressure downwards, similar to that when defecating, and then start breathing out. Last but not the least, It is substantial that a DNA fragmentation test of the sperm is also conducted to assess the extent of DNA damage and viability remaining in the sperms.
3-D Precision Guided Endovascular treatment
Azoospermia treatment in Pakistan which is linked to varicocele has long been rendered outdated due to its invasive and recurrent nature. The best varicocele treatment in Pakistan to reverse azoospermia is conducted by Dr Imtiaz Ahmad. One of the most versatile and successful approaches towards azoospermia and varicocele repair is the 3-D precision-guided endovascular treatment, which is a non-surgical procedure involving embolization and has been introduced in Pakistan by Dr Imtiaz Ahmad, a pioneer of this technique. No incisions or general anesthesia is required during the 45–60-minute procedure. To begin, a microcatheter is passed through the femoral or the jugular vein and guided under live x-ray imaging towards the testicular/gonadal vein. A contrast dye is then introduced to visualize the damage in veins, which enables an easy correction procedure. FDA approved drugs, that can only be released to and administered by licensed physicians in the US, are used to perform the embolization of the faulty veins. Once the blood is stopped, it flows through a different vein along the normal route, only this time, the varicocele is not disturbed and complications like azoospermia are, thus, solved. The patient is examined and sent home the same day, in most cases. The entire procedure has gained a lot of patient compliance as opposed to the surgical techniques, where the recovery time, alone, is of 2 to 3 weeks. Reports have suggested sperm count improvement in about 83% of patients post embolization method, versus 63% via surgical ligation.
Azoospermia does equate to zero sperm count, but it does not translate into an absolute possibility of never being able to have biological children. Males must be mindful about the activities that involve straining their reproductive organs, including sports. Additionally, knowing the logical reasoning behind the optimal temperature required for spermatogenesis, one must avoid wearing garments that are too tight, making frequent visits to the sauna or other habits that may alter the thermal homeostasis of the testes. These are some of the pointers that should help prevent azoospermia. As a rule of thumb, the health of a person largely depends on their dietary and lifestyle habits. These may not present their pros or cons immediately, but irreversible effects become prominent with age.
Infertility, in general, is a reproductive disease in a man or a woman, referred to as the inability to achieve pregnancy after continuous tries for a period of 12 months, or more. This can be either primary, meaning the couple has never been able to get pregnant, or secondary, where they have achieved at least one pregnancy before but are now unable to do so. In the past, infertility was widely associated with only the woman’s inability to conceive but male infertility is now identified as a common cause of failure in pregnancy. It is reported that (30-40%) 1 in 3 cases of infertility in a couple is due to male infertility. The reasons associated with female or male infertility correspond to their unique anatomies of the reproductive system. There are multiple causes behind male infertility, some of which include ineffective sperm delivery such as in retrograde ejaculation, altered levels of testosterone (male sex hormone), and low or no sperm count also known as oligospermia and azoospermia, respectively, usually due to varicocele. While in a few cases, male infertility treatment is of no help, in other cases the answer to the question whether male infertility could be reversed is a big YES!
Understanding Varicoceles
Pampiniform plexus is a bundle or network of veins in the spermatic cord which connects the vessels in the testicles to the abdominal cavity. Veins comprise valves that avoid the backflow of blood but sometimes, valvular dysfunction may cause blood to accumulate in some veins of the pampiniform plexus. Veins of the pampiniform plexus play an important role in thermoregulation as they cool down the artery around the testes. When the flow is disturbed, the elevation in temperature brings about several downstream effects. A varicocele is damage or lesion in the veins of the pampiniform plexus which causes them to dilate and inflame. Varicoceles are mostly observed on the left side of the scrotum where the left testicular vein combines with the left renal vein. The left side of the scrotum already receives greater blood flow, but this angular anatomy causes blood to flow against gravity. In some cases, bilateral varicoceles have also been reported, but an isolated right varicocele is rather rare. In general, about 15% of males suffer through varicoceles with greater incidence found in males who have just reached puberty. Varicoceles affect spermatogenesis not just by an elevation in temperature, but also due to oxidative stress from oxygen-free radicals. In the latter case, DNA modifications in the sperm become inevitable and greatly affect fertility.
Varicocele Treatment
The burning question in every individual’s mind who is suffering from varicocele is about the varicocele treatment and whether it is treatable without involving surgery. Varicocele male infertility treatment is advised to patients with varicocele that is associated with symptoms. Asymptomatic varicocele does not require any treatment since they are considered harmless. It is widely observed that the conventional methods of surgery used to treat varicocele are now being rendered unsafe and treatment for varicocele without surgery is the way to go forward. All surgical procedures including open microsurgical scrotal varicocelectomy, open inguinal varicocelectomy and sublingual varicocelectomy are all highly invasive and have a very high recurrence rate. Today, non-surgical alternatives are being considered by both doctors and patients. The treatment being employed without surgery is known as the embolization method.
3-D Precision Guided Varicocele Treatment by Dr. Imtiaz Ahmad:
Treatment for varicocele without surgery
3-D Precision Guided Varicocele Treatment by Dr Imtiaz Ahmad is one of the most advanced and precision-guided ways of treating varicocele, in this treatment one of the component is varicocele embolization, which is a catheter-directed procedure that involves radiological intervention in which the catheter is passed through the femoral vein or jugular vein in the neck and guided towards the testicular/gonadal vein. A contrast dye is then introduced to visualize the damage in the veins, which enables an easy correction procedure using selective catheters/microcatheters and exactly the same equipment and devices that are used in Neurosurgical procedures. The blood flow to the damaged vein is then blocked by a well-titrated mixture of FDA approved medications(only authorized to be used by certified and US-licensed physicians)to block the flow through an abnormal vein during real-time fluoroscopy (under x-rays guidance), which immediately stops blood flow and reduce the pressure being formed at the varicocele and around the testis. The blood flows through a different normal vein along the normal route, only this time, the varicocele is completely cured and the complications are thus solved. The entire procedure takes about 45-60 minutes under local anaesthesia and moderate conscious sedation which has gained a lot of patient compliance as opposed to the surgical techniques, where the recovery time alone is of 2 to 3 weeks. Reports have suggested sperm count improvement in about 83% of patients post embolization method, versus 63% via surgical ligation.
The old technology (30-40 year’s old) of placing coils and sclerosant chemical foam has been abandoned for this treatment.
In a nutshell: Can male infertility be reversed?
Yes, it can. However, time is a big factor here. The damage caused by varicocele may become irreversible if the symptoms are ignored and treatment delayed. This only leads to lifelong regret if the person plans on becoming a father. A healthy lifestyle including conscious management of weight and detachment from smoking, drinking and drugs can prevent varicocele and male infertility.
Dr. Ahmad has been practicing in the health care industry for more than 20 years.
In 1995 he completed his fellowship at Northwestern University Chicago Illinois USA.
