Varicocele

Varicocele is a bunch of dilated blood vessels (veins) in scrotum.

Left side varicocele is more common than the right side due to the joining of left testis vein with left kidney vein, as opposed to joining of right testis vein with inferior venacava directly.

What is the main cause of varicocele?

Varicocele is most commonly due to weakness of the valves in the veins in scrotum.

Is varicocele life-threatening?

Varicocele is not life-threatening if untreated, but intervention for varicocele may be considered if fertility is a concern. Not all varicoceles require surgery. The decision to undergo surgery or not will be decided based on several factors, which is best discussed with the treating andrologist after physical examination.

How does varicocele affect male fertility?

Following are the various oxidative stress mechanisms proposed about the role of varicocele in male infertility:

• Higher reactive oxygen species (ROS)
• Increase in the temperature of scrotum (scrotal hyperthermia)
• Low oxygen supply (hypoxia)
• Reflux of kidney and adrenal metabolites
• Hormonal imbalances
• Formation of antisperm antibodies

What is the surgery for varicocele?

Subinguinal microscopic varicocele ligation (varicocelectomy) with the use of intra-operative handheld doppler yields the best results in terms of fertility outcomes with least complications.

When is varicocele surgery indicated in infertility?

Varicocele surgery is advised when all four criteria are met during infertility work-up: 1) Couple should have difficulty in conceiving, 2) Normal Female fertility, 3) Abnormal Semen analysis and 4) Clinically palpable varicocele (not just ultrasound diagnosed varicocele).

The varicocele surgery prior to IVF may also improve success rates of IVF-ICSI (Kohn JR, et al. Res Rep Urol. 2020).

Is varicocele allowed in the Indian Army?

Guidelines with regard to physical and medical standards are given in the notification of AFCAT 01/2023 for Indian Airforce candidates. The following scrotal and testis cases will be made unfit: Bilateral atrophied testis, Varicocele (Unilateral or bilateral), any abnormal location of testis (Unilateral or Bilateral), hydrocele and epididymal lesions e.g. cyst. Hence all varicoceles require surgical intervention, and a post-operative ultrasound should confirm absence of varicocele if joining Air Force or Army.

Who is the best doctor for Varicocele?

Dr Pramod Krishnappa is the best andrologist dealing with Men’s’ Sexual Health and Male Fertility. He has been trained extensively in high volume Andrology centres in Madrid (Spain), Belgrade, Budapest, Chicago, and New York.

Dr Pramod Krishnappa has undergone microsurgical training and a dedicated male infertility fellowship under Prof Dr Craig Niederberger at the University of Illinois at Chicago (UIC), who was the Chief Editor of “Fertility Sterility” Journal, the official journal of the American Society of Reproductive Medicine (ASRM).