WHAT IS A VARICOCELE?

It’s a condition where the veins within the scrotum become enlarged and swollen. A bit like the purple varicose veins that appear in people’s legs. Although they can occur on both sides, Varicoceles usually occur on the left side, due to the anatomy of the veins, the left testicle is fed by the kidney veins and the right from the heart. 

WHAT DOES A VARICOCELE FEEL LIKE?

It can feel like a soft, irregular mass just above the testicle, the texture is like a small bag of worms due to the dilated veins. There may or may not be a little tenderness or discomfort when touching the area. 


HOW DO YOU GET THEM?

Varicoceles usually form during puberty and develop over time. They can also form from an injury or trauma to the veins in the testicles. Sports injuries, surgical trauma, blunt force trauma, or crushing or compression of the scrotum are all potential reasons for a varicocele forming.


HOW DO I FIND OUT IF I HAVE IT?

Sometimes you can feel the Varicocele by self-examination, but even so you must go to your GP for a proper examination. If you are trying to conceive, the GP should refer you for an ultrasound on your testicles. This can also be done privately by a Urologist if the wait is too long. 

A routine NHS basic sperm test can sometimes flag up an issue. I always recommend my clients who are trying to conceive, do an advanced sperm test, as there are lots of other areas of sperm health that do not get covered by the basic NHS test.

I WAS TOLD IT WOULDN’T AFFECT ME. DO THEY RANGE IN SEVERITY?

Sometimes they cause no symptoms or issues. 40% of men with diagnosed fertility issues have some evidence (Grade 1-3) of varicocele.

This is why it is important to get an up to date check if you are trying to conceive. They are generally graded 1-3:

• 1 being mild; a small mass that can only be felt when the person is performing a bearing down movement such as squatting or during a bowel movement.

• 2 being an easily palpable mass that is noticeable but not visible.

• 3 being a large mass that is easily feelable by touch and visible. There may be issues with pain or tenderness.

WHICH VARICOCELES MATTER?

Potentially Grade 2-3:

• Over 2.6mm in size

• Causing reverse flow of semen

• Tests come back sub optimal, especially with DNA Fragmentation issues, Oxidative stress or infection.

WHAT IS THE POSSIBLE IMPACT ON OUR FERTILITY?

A varicocele could cause poor development of a testicle, low sperm production and possibly: 

• Bacterial infection

• DNA Fragmentation issues

• Oxidative Stress

• Antibodies

All the above can be associated with a varicocele through increased temperature in the testicles, impaired blood flow, or atrophy to the testicle. Sperm DNA damage can be caused by varicocele, just as oxidative stress can result from both varicocele and infection. Antibodies can be created because of varicocele, because when sperm cells become damaged the immune system may mistakenly identify them as foreign invaders and produce antibodies against them. Additionally, the presence of sperm antibodies may trigger an immune response in the female reproductive tract, potentially affecting fertility.

Because the NHS test does not test for these issues, it is so important to get tested early.


WHAT DO I DO?

I KNOW I HAVE A VARICOCELE AND MY TESTS HAVE COME BACK WITH SUB OPTIMAL SPERM

If you are trying to conceive it is important NOT to ignore this. There are different guidelines from different health authorisations:

• The American Urology Association (AUA) say treat Grade 2-3 Varicocele if DNA Fragmentation present

• The Emergency Use Authorisation (EUA) say consider treating Grade 2-3

• National Institute for Health and Care Excellence (NICE) Say no evidence for treatment

Varicoceles can be treated by either Subinguinal Microscopic Ligation or Radiological Embolisation. There is now growing evidence to show that clinical varicocele repair may improve sperm DNA integrity. If you have had an advanced sperm test with impaired results, there is a referral pathway to either an NHS Urologist or via a private Urologist.

If you would like support with any aspect of Male Fertility, I offer a comprehensive treatment plan so reach out for help.