Varicocele

Do you have infertility? We have the solution!

Have you had difficulty conceiving? Before you decide to begin strenuous fertility treatment cycles, where your significant other will be pumped with side-effect-packed hormones, it is advisable that you also be tested.

Did you know that there is a chance that the reason for infertility depends on you?

Introducing varicocele – the most common reason for infertility in men.

What are we actually talking about when we use the term varicocele? Why is it important to diagnose on time and what innovative solutions does medicine have to offer? Dr. Alex Belenky, senior radiologist, founder of Angio Center Israel – the center for medical innovation, with all the answers.

Varicocele is the most common reason for infertility in men and may explain over 30% of infertility problems in men. This condition is caused by venous insufficiency as a result of a defect of venous valves that drain the blood form the testicle area. This blood is supposed to drain upwards out of the veins against gravity, and the one-way valves are designed to prevent the blood from flowing back into the testicles. When these valves are dysfunctional, the blood accumulated in the testicles cannot overcome gravity to evacuate. The blood accumulation results in pressure, that in turn impedes oxygen flow that is vital for normal fertile sperm production. Additionally, the pressure applied to the venous walls causes the veins to dilate and swell. Testicle heating as a result of these congested veins causes damage to sperm production, testicle reduction, damage to testosterone production and sometimes may result in damage to memory, fatigue, depression, low libido and prostate enlargement.

Prevalence of varicocele

One out of 6 men will develop varicocele in his lifetime. Approximately 50% of men over age 50 have varicocele and after age 70 this rate increases to 75%.

Varicocele may develop as early as age 15 and it worsens over the years. Since it is a gradual occurrence, it may also develop in men who have already become fathers, and make it difficult for them to bare more children. Despite the high prevalence of varicocele, the awareness to it is low. "most patients that present at the clinic are ultra-orthodox, referred by their rabbis. As opposed to them, who are more aware of the problem, maybe because of the importance of the mitzvah of reproduction, there is not enough awareness in the secular population", says Dr. Belenky.

Symptoms of Varicocele

Varicocele is characterized by testicle pain, usually during prolonged standing or during exertion. The pain occasionally radiates from the testicle area to the legs and lower abdomen, and is also characterized by a reduction of the testicle (atrophy) and testosterone level decrease. Untreated, this could damage sperm production. Therefore, if there are symptoms for varicocele, and when infertility is diagnosed, it is important to perform a test to diagnose or rule out varicocele.

How is varicocele diagnosed?

Diagnosis is performed using vascular Doppler test – a non-invasive examination of the testicle veins using a Doppler ultrasound. The veins' structure is examined as well as the blood flow direction and its normality. It is a painless, risk-free test that is completed in 15 minutes.
Treatment of varicocele aims to stop the abnormal blood flow in the dilated testicle veins by ligation or obstructing them by open surgery, micro-surgery or catheterization.

In the past, it was customary to perform open surgery for vein ligation through a large incision in the abdominal wall muscles, under general anesthesia, or close off these veins by inserting metal coils into the groin (embolization). But these treatments have been proven to be ineffective and that there is a chance of approximately 80-70% of varicocele recurrence, occasionally due to new veins or because the testicle veins are so small that some go undetected and untreated.

Innovative Treatment for Varicocele

Lately, a breakthrough has been made in the treatment of this condition, and more advanced and effective methods have been developed.

1. Micro-surgery for varicocele treatment: surgery performed under microscope that enlarges the surgical field and allows for better location and ligation of many more veins. Additionally, thanks to the use of a microscope, an incision of the abdominal wall muscles is redundant and a tiny 2 mm incision is possible, allowing hasty post-surgical recovery. Alongside, since the surgery requires locating and ligation of many veins, it is more recommended for treating only one testicle. If both testicles are involved, the procedure becomes long and complex and this method is not recommended.
2.  Catheterization of the lower abdomen veins: the most advanced and recommended treatment today is Israeli developed: Dr. Belenky is one of the few doctors who perform this procedure in Israel. It is a catheterization that treats the entire network of varicocele veins in the lower abdomen, and is designed to mend the drainage problem in the testicle, and allow normal sperm cell production. "We insert a catheter into a vein trough the groin, under local anesthesia, and inject the veins with embolic materials – a biological glue. The material spreads in the vein and blocks it, and after a while it disintegrates, is absorbed into the body and disappears", explains Dr. Belenky.

   The catheterization is completed in approximately 1 hour, does not require hospitalization and is painless. The patient is discharged after approximately 4 hours of rest, and after approximately 1 week, he may resume normal activity, except physical activities that involve lifting weights. According to recently published research, this treatment has a high success rate, and is successful in solving infertility problems in 85% of the patients!

   Approximately 4 months after treatment, it is possible to see an improvement in the amount and quality of sperm cell production. In contrast to the chance of recurrence of varicocele after surgery, catheterization provides a permanent solution in most cases.