Varicocele is a prevalent but frequently overlooked contributor to male infertility. Despite affecting numerous men, awareness often remains low until conception difficulties arise. This condition involves the enlargement and swelling of veins within the scrotum, akin to varicose veins in the legs. It typically develops gradually and is more common on the left side. Varicocele can impair blood circulation around the testicles, raising scrotal temperature and adversely impacting sperm production and quality.
Causes and Symptoms
According to Dr. Rashmi Niphadkar, Fertility Specialist at Nova IVF Fertility, Baner, Pune, the exact cause is linked to faulty valves in the veins, leading to poor blood flow and blood pooling. The condition is often seen in adolescents and young adults but may go unnoticed for years due to mild or absent symptoms. Some men experience a dull ache, heaviness, swelling, visible enlarged veins, or discomfort that worsens after prolonged standing or physical activity. Infertility is frequently the first noticeable sign. Untreated varicocele can result in reduced sperm count, poor motility, abnormal sperm shape, testicular shrinkage, and hormonal imbalance. Dr. Niphadkar notes that 2-3 men aged 30-55 diagnosed weekly during infertility evaluations may have varicocele, which can hinder natural conception and reduce IVF success rates.
Dr. Vaishali Chaudhary, Consultant at Motherhood Hospitals, Kharadi, Pune, adds that varicocele is not uncommon among men undergoing fertility evaluation, with 20–25% of clinic attendees affected. It involves dilatation and stagnation of blood in the pampiniform plexus, making veins enlarged and sometimes palpable or visible like a "bag of worms." Many men are asymptomatic, but some report dull pain or heaviness, especially after standing or exertion. In some cases, the affected testis may appear smaller. The main concern is the impact on sperm quality due to increased testicular temperature, commonly reducing sperm motility.
Diagnosis and Treatment
Diagnosis is made through clinical examination and confirmed with scrotal sonography with Doppler, which can detect early or Grade 1 varicocele (visible only during Valsalva maneuver). Grade 3 varicocele shows visibly enlarged veins without exertion. Surgery is the treatment choice for Grade 3 varicocele. Dr. Niphadkar emphasizes that minimally invasive procedures or surgery can improve sperm health and pregnancy chances, though in some cases, semen parameters may not reverse, necessitating IVF. She advises men not to ignore persistent scrotal discomfort or fertility concerns, and encourages regular reproductive health check-ups and open discussions about male infertility. Couples undergoing IVF should ensure male factors are evaluated, not just female health.
Dr. Chaudhary stresses that before planning treatment, the fertility status of both partners should be assessed. If the female partner is over 36–37 years or has ovulation disorders, tubal blockage, or uterine factors, advanced treatments like IVF may be more appropriate. With high IVF success rates, treating male factors alone may not improve overall conception chances. Treatment decisions should be individualized based on the couple's reproductive health.
