Case: 27 year old male with 5 children in a previous marriage is now newly remarried and has had difficulty conceiving. As his wife is undergoing an infertility evaluation, he consults with an Urologist who performs a physical examination and semen analysis. The semen analysis is “normal” and the Urologist also finds a large left sided varicocele.
Question: What is the reproductive importance of the varicocele that is identified for this man?
Varicoceles are not uncommon in men, with an incidence rate of about 15% of normal fertile men. If a varicocele is detected in a man with a normal semen analysis or proven fertility then surgical repair of the varicocele is of questionable (no known) benefit. If a varicocele is identified in a man with proven fertility (previous pregnancies) and a normal semen analysis then the benefit of surgical repair is not commonly believed to outweigh the potential risks of surgery.
Case: 40 year old male with proven fertility (a child from a previous relationship when he was 19 years old), an abnormal semen analysis (a reduction in sperm motility and an increased number of “tapered” (shape) sperm cells), and a large left sided varicocele.
What (fertility) treatment options should be considered by this man
Varicoceles can be identified in about 15% of normal fertile men so they do not need to be repaired just because (whenever) they are identified. Varicoceles can affect sperm quality and this effect generally is progressive. Therefore, a man with a varicocele may have no difficulty with fertility when he is younger and then may find that there is a problem with his sperm when he is older.
A thorough basic infertility evaluation would be suggested for this couple, including a hormone evaluation for the woman (TSH and prolactin), a hysterosalpingogram and a postcoital test. If the abnormalities seen in the semen analysis are the only identified problems, then proceeding with varicocele repair or intrauterine inseminations would seem appropriate.