Male Infertility Caused by Varicoceles

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1 What You Need to Know About Male Infertility Caused by Varicoceles INTERVENTIONAL RADIOLOGY Find us on

2 Q&A Questions and Answers About Male Infertility Caused by Varicoceles Q. What is a varicocele? A varicocele is a varicose vein of the testicle and scrotum that may cause pain and lead to testicular atrophy (shrinkage of the testicles). In healthy veins within the scrotum, one-way valves allow blood to flow from the testicles and scrotum back to the heart. In a varicocele, these valves do not function properly, causing blood to pool enlarging the vein. Some experts believe that the raised temperature that results from the pooled blood in these blocked veins can decrease sperm count and motility of sperm and increase the number of deformed sperm. In fact, the incidence of varicoceles increases to 30 percent in couples who cannot have children. The Society of Interventional Radiology is a nation image-guided therapeutic interventions.

3 Q. What are the symptoms of varicoceles? Pain: Men who experience pain in their testicles particularly when exercising, standing or sitting for a long period of time may be suffering from varicoceles. Typically, painful varicoceles are prominent in size. If left untreated, varicoceles may lead to infertility. Fertility problems: There is an association between varicoceles and infertility. Decreased sperm count, decreased motility of sperm and an increase in the number of deformed sperm are related to varicoceles. Some experts believe these blocked and enlarged veins around the testes cause infertility by raising the temperature in the scrotum and decreasing sperm production. Testicular atrophy: The shrinking of the testicles is another sign of varicoceles. Often, once the testicle is repaired, it will return to normal size. Varicoceles are fairly simple to detect and diagnose through physical or diagnostic examination. 95 percent of varicoceles are found on the left side of the scrotum. The scrotum looks like a bag of worms (see related figure). The testicles may be shrunken in size. If varicoceles are not detectable through the above criteria, abnormal blood flow can often be detected with a noninvasive imaging exam called color flow ultrasound or through a venogram an X-ray in which a special dye is injected into the veins to highlight blood vessel abnormalities. al organization of doctors, scientists and allied health pro

4 Q. How prevalent are varicoceles? Approximately 10 percent of all men have varicoceles. Among infertile couples, 30 percent of men have varicoceles. The highest occurrence of varicoceles is in men ages , ,000 men in America may undergo surgical correction of varicoceles each year. Varicoceles External appearance of dilated veins fessionals dedicated to improving public health through

5 Q. What treatments are available for varicoceles? There are both nonsurgical and surgical options available. Varicocele embolization or catheter-directed embolization: Varicocele embolization (also called catheter-directed embolization) is a nonsurgical treatment performed by an interventional radiologist that is a highly effective, widely available technique to treat symptomatic varicoceles. With this nonsurgical treatment, an interventional radiologist uses catheters and other instruments to shut off blood flow to the dysfunctional vein. Throughout this treatment, the patient is relaxed and free of pain. Specifically, the interventional radiologist makes a tiny nick in the skin at the groin using local anesthesia, through which a thin catheter (much like a piece of spaghetti) is passed into the femoral vein, directly to the testicular vein. The doctor then injects contrast dye to provide direct visualization of the veins to map out exactly where the problem is Varicoceles Internal appearance of dilated veins disease management and minimally invasive,

6 and where to embolize, or block, the vein. By using coils or sclerosants (medicine injected into blood vessels to make them shrink), an interventional radiologist blocks the abnormal veins, which reduces pressure on the varicocele. By embolizing the vein, blood flow is redirected through other pathways. Essentially blood flow to the incompetent vein is shut off internally, accomplishing what the urologist does but without surgery. Surgical ligation: One of the most common treatments is open surgical ligation. In this procedure, which is typically performed by a urologist, an incision is made in the skin above the scrotum down to the testicular veins, which are tied off with sutures. Although most patients leave the hospital the same day, 24 percent of surgical ligation patients are required to stay at the hospital overnight. Patients of open surgical ligation can expect a two- to three-week recovery period. Varicocele Embolization

7 Q. What are the advantages of catheterdirected embolization? No surgical incision in scrotal area As effective as surgery, as measured by improvement in semen analysis and pregnancy rates Patients can return to normal daily activities immediately and without hospital admittance; surgery requires several weeks recovery and hospital admittance The rare patient who has varicoceles on both sides can have them fixed simultaneously through one vein puncture site; surgery on both sides requires two separate open incisions No general anesthesia required No sutures No infections Cost effective About Interventional Radiologists Interventional radiologists are highly trained doctors who specialize in minimally invasive, targeted treatments performed using imaging for guidance. Using their expertise with X-ray, CT, MR and other diagnostic imaging, interventional radiologists guide tiny instruments (such as catheters) through blood vessels (such as arteries) or through the skin to treat the source of a disease internally and nonsurgically. Many conditions that once required surgery can be treated less invasively by interventional radiologists, with treatments that offer less risk, less pain and less recovery time. Your interventional radiologist will work closely with your primary care or other doctor to be sure you receive the best possible care. Interventional radiology is a recognized medical specialty by the American Board of Medical Specialties. Interventional radiologists are certified by the American Board of Radiology in both vascular and interventional radiology and diagnostic radiology.

8 Society of Interventional Radiology 3975 Fair Ridge Drive, Suite 400 North Fairfax, VA P: (703) F: (703) Copyright 2012 by the Society of Interventional Radiology. All illustrations are copyright 2012 by the Society of Interventional Radiology and may not be used without permission. All rights reserved. No part of this publication covered by the copyright hereon may be reproduced or copied in any form or by any means graphic, electronic or mechanical, including photocopying, taping or information storage and retrieval systems without written permission of the publishers.