Posts Tagged ‘scrotal mass’

Varicocele-A Cause of Male Infertility

May 9, 2010

Varicocele is a mass of enlarged and dilated veins that develops in the spermatic cord within the scrotal sac. A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle.

Incidence and Prevalence

Approximately 40% of infertile men have a varicocele and among men with secondary infertility -those who have fathered a child but are no longer able to do so-prevalence may be as high as 80%.

Signs and Symptoms

Most men who have a varicocele have no symptoms. Asymptomatic (i.e., symptom-free) cases are often diagnosed during a routine physical examination. Signs and symptoms include the following:

  • Ache in the testicle
  • Feeling of heaviness in the testicle(s)
  • Infertility-can suppress sperm counts and sperm movement
  • Shrinkage (atrophy) of the testicle(s)
  • Visible veins under the scrotal skin-the veins collapse when the man lies down
  • Recurrent or constant discomfort or pain in the genital region should be reported to a urologist to determine the cause.


If the patient with varicocele is asymptomatic and infertility is not an issue, no treatment is warranted. If the discomfort is mild, the condition usually can be managed by wearing an athletic supporter or snug-fitting underwear during strenuous activity or exercise.


If the varicocele causes pain or atrophy (rare) or if the condition is causing infertility (most common), surgery may be recommended. Most varicoceles can be corrected through a surgical procedure called varicocelectomy (i.e., surgically “tying off” the affected spermatic veins).

Surgical ligation

This treatment usually requires general or regional anesthesia. In this procedure, a 2- to 3-inch incision is made in the groin or lower abdomen, the affected veins are located visually, and the surgeon cuts the veins and ties them off above the varicocele to reroute the blood through unaffected veins. Surgery can be performed on an in- or outpatient basis. The patient typically can resume light activity within a week and strenuous activity in about 6 weeks.

About 50% of men who undergo varicocelectomy to correct infertility father children within the first year. It takes about 90 days for a sufficient quantity of new sperm to be produced to permit fertilization. Semen analysis usually is done at 3- and 6-month intervals after the operation.

Bottom Line: Varicoceles are very common and can be a cause of male infertility.  Help is available and most men can have improvement in their sperm counts after surgical correction