Varicoceles can cause infertility

Hypoxia and blood stasis due to the enlarged vessels. Raised blood pressure in the testicular veins. It is thought that a combination of these factors leads to impaired sperm production, affecting formation and motility. It is also thought that the increased pressure in the veins and exposure to toxins in the blood leads to the shrinkage in testicular size commonly found with varicoceles.

Unfortunately, even one-sided (or unilateral) varicoceles can affect sperm production and fertility in both testes.

So what are the treatment options? Firstly, it is important to state that treatment may not be needed at all.

Plenty of men with varicoceles will have no trouble conceiving, and have no symptoms from their varicocele. In this situation, the most prudent treatment is to do nothing at all, unless things change.

However, if the varicocele is uncomfortable, or there are known fertility problems (including abnormal parameters on a sperm test), then it is sensible to discuss the options with a surgeon or urologist – your GP can arrange a referral.

The gold standard treatment is surgery. This can be done as an open procedure, or via keyhole or ‘‘laparoscopy’’. This is a very safe operation, and it may be possible to have it performed under local rather than general anaesthetic. The risks can include damage to an artery during the procedure, recurrence of the varicocele, or buildup of fluid around the testicles (known as a hydrocele).

Some studies have shown that having this operation can restore normal testicular size in pubertal boys, although the effects on future fertility are not as clear. Some researchers have found that repair of varicoceles in men with fertility problems leads to improved pregnancy rates, but the jury is definitely still out as to when the optimal age for this operation might be. Controversy exists regarding the benefit of varicocele repair in a healthy, asymptomatic pre-pubescent boy, so it is hard for me to give you a definitive answer, I’m afraid.

I suggest talking this through with not only your son, but also a surgeon who is experienced in this area. If you are still not sure, perhaps consider waiting until your son is older, and able to understand the possible effects on his fertility. Not an easy decision, but good luck with it.

Cathy Stephenson is a general practitioner, medical forensic examiner and mother of three. If you have a question for her, write c/o Features Editor, The Dominion Post, PO Box 3740, Wellington 6140, or email features@dompost.co.nz.