About 40% of all infertility is caused by a sperm defect and this is referred to as male factor infertility.
A varicocele is an abnormal tortuosity and dilation of veins of the pampiniform plexus within the spermatic cord.. A varicocele could possibly affect sperm by increasing testicular temperature..
Urologists often diagnose and surgically repair varicoceles. However, correcting a varicocele (surgical procedure) often does not improve the semen quality enough to change the therapy that will be required to result in pregnancy for the couple.
Several studies have shown that varicocele surgery can improve sperm counts or low motility but randomized and controlled trials do not consistently show improved pregnancy rates (see below). There could be a difference between getting a higher sperm count, and getting the female partner pregnant.
In other words, if a couple will need inseminations with male partner's sperm, or possibly in vitro fertilization anyway, why waste time, money, etc. on surgery for a varicocele. These treatment options depend on the degree of abnormality in the semen and other factors involved in the individual couple's case.
For example, if the count is under about 10 million per cc, or the motility below about 30%, it is unlikely that the semen quality will improve enough after varicocele repair to result in pregnancy without inseminations or IVF. These couples should consider seeing an infertility specialist for a Meta analysis of these 6 studies (a statistical technique that combines results from multiple studies) showed no significant effect of surgery on pregnancy rates.
The jury is still out on how effective varicocele surgery is as a treatment of male infertility. The waters are still murky.
- Couples considering varicocele surgery should see a well trained urologist as well as an infertility specialist for education about all of their options before proceeding
- Some couples (with a young female partner) will decide to proceed with the varicocele surgery and see what happens.
- It is not a big surgery and recovery is pretty easy. If they don't get pregnant within 6-12 months after the surgery, the other treatment options such as insemination and/or IVF and ICSI are available.