Impact of Varicocele on Male Fertility
Varicocele, characterized by the enlargement of veins within the scrotum, is a common condition that can significantly impact male fertility. The presence of varicocele can lead to various alterations in testicular function, sperm parameters, and hormonal balance, ultimately affecting reproductive potential. This article aims to provide a comprehensive review of the impact of varicocele on male fertility, drawing upon relevant scientific literature.
Varicocele and Semen Parameters
Varicoceles have been consistently associated with alterations in semen parameters, including sperm concentration, motility, and morphology. Several studies have reported a decrease in sperm concentration among men with varicocele compared to those without (1, 2). Furthermore, varicocele has been shown to negatively affect sperm motility, leading to reduced forward progression and impaired fertilization potential (3, 4). Morphological abnormalities, such as the presence of abnormal-shaped sperm, are also commonly observed in individuals with varicocele (5).
Sperm DNA Damage
One of the underlying mechanisms through which varicocele impacts fertility is the increased occurrence of sperm DNA damage. Studies have consistently shown that varicocele is associated with higher levels of DNA fragmentation in sperm, which can impair fertilization, embryo development, and increase the risk of miscarriage (6, 7). Elevated levels of reactive oxygen species (ROS) within the testicular environment, caused by varicocele-induced oxidative stress, play a crucial role in DNA damage (8).
Testicular Endocrine Dysfunction
Varicocele can disrupt the hormonal balance within the testes, leading to endocrine dysfunction that further impairs male fertility. The Leydig cells, responsible for testosterone production, can be affected by varicocele-induced hypoxia and oxidative stress, resulting in decreased testosterone levels (9, 10). Low testosterone levels can have adverse effects on sperm production, sexual function, and overall reproductive health (11).
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Impaired Testicular Microenvironment
Varicocele-induced alterations in the testicular microenvironment contribute to reduced fertility. The increased testicular temperature resulting from impaired blood flow and venous stasis disrupts the optimal conditions required for normal sperm production (12). Elevated scrotal temperature has been associated with decreased sperm production, decreased sperm motility, and increased DNA damage (13, 14).
Mechanisms of Varicocele-Induced Fertility Impairment
Multiple mechanisms are involved in varicocele-induced fertility impairment:
- Venous Hypertension and Hypoxia: Venous hypertension resulting from varicocele leads to increased pressure within the testicular veins, compromising blood flow and oxygenation to the testes (15).
- Oxidative Stress: Varicocele is associated with elevated levels of ROS and reduced antioxidant defenses within the testicular tissue. The resulting oxidative stress damages sperm cells and impairs their function (16).
- Testicular Apoptosis: Varicocele-induced oxidative stress and hormonal imbalances can trigger testicular apoptosis, leading to the loss of functional testicular cells involved in sperm production (17).
How does Varicocele Impact Fertility?
Varicocele significantly impacts male fertility through various mechanisms, including alterations in semen parameters, increased sperm DNA damage, testicular endocrine dysfunction, and impaired testicular microenvironment. The negative effects of varicocele on fertility highlight the importance of early diagnosis and appropriate treatment to optimize reproductive outcomes.
Varicocele Embolization
Varicocele embolization is an image-guided procedure performed by our double board certified vascular and interventional radiologist. The procedure is highly effective and offers a non-surgical alternative to surgery. It is less invasive and the patient is discharged within an hour after the procedure. The procedure is done through a small pinhole nick in the skin.
Varicocele embolization has a high success rate of over 90%, similar to surgery and has been performed for over 20 years with an excellent safety record. Read more here.
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Request an Appointment to meet with our varicocele specialist who will review your imaging, labs and history to determine if you are candidate for the procedure, and the outcomes you can expect. Each person is an individual and should discuss the potential risks and benefits of embolization and other treatments with our doctor to decide which option is best.
Appointments are available via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego. Why should you choose us? Read here
- Marmar JL, Agarwal A, Prabakaran S, Agarwal R, Short RA, Benoff S, Thomas AJ, Jr. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007;88(3):639-648.
- Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics (Sao Paulo). 2011;66(4):691-700.
- Schlegel PN, Goldstein M. Comparison of outcomes of varicocelectomy in men with normospermia versus severe oligospermia. J Urol. 1997;158(2):454-457.
- Abdel-Meguid TA. Predictors of sperm recovery after varicocele repair in men with severe oligospermia. Urology. 2012;80(2):409-413.
- Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993;59(3):613-616.
- Zini A, Boman JM, Belzile E, Ciampi A. Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis. Hum Reprod. 2008;23(12):2663-2668.
- Zini A, Libman J. Sperm DNA damage: clinical significance in the era of assisted reproduction. CMAJ. 2006;175(5):495-500.
- Agarwal A, Allamaneni SS. Oxidative stress and human reproduction: etiologies and therapeutic strategies. Antioxid Redox Signal. 2004;6(5):775- 793.
- Moon du G, Kim YS, Kim JH, Moon KH, Lee JG, Kim JJ. Relationship between seminal plasma interleukin-8 levels and sperm function in men with varicocele. World J Mens Health. 2012;30(2):130-136.
- Gat Y, Bachar GN, Zukerman Z, Belenky A, Gornish M. Varicocele: a bilateral disease. Fertil Steril. 2004;81(2):424-429.
- Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros JJ, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FC. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol. 2008;159(5):507-514.
- Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet. 2003;361(9372):1849-1852.
- Zorgniotti AW, Macleod J. Studies in temperature, human semen quality, and varicocele. Fertil Steril. 1973;24(11):854-863.
- Yaman O, Ozdiler E, Anafarta K, Gogus C. The effect of varicocele repair on testicular volume, sperm parameters, and pregnancy rates in subfertile men with grade III varicocele. Fertil Steril. 1999;72(1):180-183.
- Rees DC, Palmer KR, Moncada S. Role of endothelium-derived nitric oxide in the regulation of blood pressure. Proc Natl Acad Sci U S A. 198
The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion.
