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Microscopic Varicocelectomy

What is a Varicocele?

Varicoceles are one of the most common causes of male infertility. Varicoceles are veins that are in the scrotum and drain the testicles that are enlarged. This enlargement can cause the testicles to function poorly.

The testicles are outside of the body in a scrotal sac for a very important reason. The proper production of sperm relies on a slightly lower temperature than body temperature. In addition to being located outside of the body, the testicles also have another mechanism to help them stay cool. This involves an arrangement of the artery that brings blood to the testicle and the veins that take blood away from the testicle in such a way that the blood is actually cooled as it is delivered to the testicle.

Our preferred method is the microscopic sub-inguinal varicocelectomy.

In approximately 40% of infertile men and 20% of men in the general population the valves that keep the veins that drain the testicle flow in one direction can fail, causing a varicocele.

In extreme cases, a varicocele can even be seen through the skin and can resemble a bag of worms. In more subtle cases, however, a slight enlargement in these venous structures can be felt when the patient holds his breath and pushes down. This is called a Valsalva maneuver and will be part of the male fertility examination.

A scrotal ultrasound can sometimes find these varicoceles however we generally feel the physical exam is the most definitive diagnosis.

By interfering with the temperature regulation of the testicles, a varicocele can impact sperm quality. There’s also a consistent and notable effect on hormone production. It can be expected that normal testosterone production can increase by about 20% after a varicocele is repaired.

Microscopic Varicocelectomy Varicocele Repair

A varicocele repair involves tying off the veins that have valves that are malfunctioning so that the body can produce new veins that have better internal structure.

There are several methods to approach a varicocele repair. The preferred method of the Men’s Fertility Center of Austin is the microscopic sub-inguinal varicocelectomy. This involves an incision made in the lower abdomen to access the testicular cord which is inspected microscopically. We then tie off the abnormal venous structures while taking care to avoid injury to the artery and vas deferens.

In approximately 40% of infertile men and 20% of men in the general population the valves that keep the veins that drain the testicle flow in one direction can fail, causing a varicocele.

Other Varicocele Repair Procedures

Our approach is one of the most commonly employed by the most advanced male fertility specialists in the world. There are other approaches, however, which we may employ in special circumstances. These can include the laparoscopic varicocele ligation, which the Men’s Fertility Center of Austin does not employ as our primary repair due to the high likelihood of damage to the testicular artery. There are additional open approaches including a retroperitoneal varicocele ligation. Many male fertility specialists will perform an inguinal microscopic ligation which necessitates a longer recovery. Because we want our patients to get back to a normal life as soon as possible, we employ the sub-inguinal microscopic varicocele approach.

Recovery after such a procedure can take about a week and can include some bruising and a feeling of scrotal swelling. In general, this procedure is well tolerated and has few side effects, which can include recurrence of varicocele, hydrocele formation, and testicular pain. We anticipate that 80% of patients will develop better semen parameters as well as improved testosterone levels.

The utility of a varicocele repair in improving a man’s fertility is debatable and not the correct course of action for all couples. Moreover, there are some cases in which a varicocele repair may be used in a couple even though they may be undergoing in vitro fertilization (IVF). This special circumstance usually involves a couple where the initial IVF was unsuccessful and a high degree of sperm DNA fragmentation or DNA instability has been found.