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.
Explaining Varicocele
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.
Diagnosing Varicocele
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.
Varicocele Treatment
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 performed by Dr. Imtiaz Ahmed, whose lives are restored to a hassle-free state that they have been looking for a very long period of time and couples are able to have successful pregnancies and children.
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.
