The Male Health Center - Infertility in Men

Infertility

Varicocele
Few men know about this common cause of infertility.

If you don't know what a varicocele is, let alone how to pronounce it, you're in good company. In the simplest terms, it's an enlarged (varicose) vein in your scrotum between a testicle (almost always the left one) and your abdomen. Say vair-uh-ko-seal.

Reports indicate that about 15 percent of males have a varicocele, and my own experience providing physicals to high school football players confirms that about 1 in 6 has one. Varicoceles rarely produce any discomfort; most of the time, men find out they have a varicocele when they see a urologist because they're unable to have children. It's the first thing we look for when a couple can't conceive.

Varicoceles are associated with a number of changes in a man's testicles and semen, but it's not clear exactly how they make men infertile. Hormonal changes, increased temperature in the testicles, and other effects may all play roles. The potential results of having one, though, are clear: low sperm count, reduced activity of the sperm, and increased numbers of immature sperm.

Even though I've detected varicoceles in many young men, there isn't usually any need for immediate action. As long as the testicle isn't abnormally small, which could indicate a lack of adequate blood flow, treatment isn't necessary. I just tell them to continue doing their regular self-exams—checking for unusual lumps on their testicles and for significant differences in size—just as all men should. Later, if infertility does prove to be a problem—it will for only about one in five who have a varicocele—we can look at correction.

Repairing a varicocele involves closing off the enlarged vein. This can be done by conventional surgery through the abdomen or by several less-invasive, newer techniques. All of these can be done as outpatient procedures under general or local anesthetic.

Correcting a varicocele results in improved semen quality in about 70 percent of cases and leads to pregnancy in about half. Success has been reported as soon as three months after the operation, but it usually takes between six and 18 months for sperm counts to rise to their maximum.

Can you detect a varicocele yourself? Large ones are easy to find. Standing in a warm shower, the spermatic cord above the testicle will feel like a bag of worms, and coughing may produce a throb. Smaller ones, however, may require a more experienced hand, and there is no correlation between size and infertility. If you suspect you have one, don't panic. Just get it checked out, so you can rule out other, more serious, problems.

Infertility Solutions or Reproducible Results
Reproduction—an instinct perhaps even more basic than survival—carries tremendous emotional importance for most couples. Yet as common and frustrating as infertility is, many men and women ride this emotional roller coaster alone.

Men often resist seeing a doctor about fertility out of a mistaken notion that their maleness is somehow linked to fatherhood. In fact, fertility and potency are entirely separate. And medically, the man is the best place to start when a couple has trouble conceiving.

Male fertility depends simply on there being enough active (motile), normal sperm in healthy semen. An analysis of semen—which is made up of less than 5 percent sperm and the remainder fluids from the prostate gland and seminal vesicles—can readily identify any problems.

When a man has a fertility problem, low sperm count is usually to blame. In some cases, though, inactive or abnormally shaped or sized sperm may inhibit fertility. Where do these problems come from and what can we do?

Vasectomy, voluntary male sterilization, can be reversed surgically 50 to 90 percent of the time.
Undescended testicles, when the testicles remain in the abdominal cavity at birth, may cause low sperm count. That's one reason it's so important to catch this problem early and correct it.
Varicocele—where veins in the scrotum become varicose, causing a high temperature and killing sperm—can be surgically corrected 30 to 40 percent of the time.
Sexually transmitted disease—gonorrhea, syphilis, and chlamydia—can scar and block the epididymis (tubes on the back of the testicles where sperm mature) preventing sperm delivery, or they may affect the sperm themselves. Infections should be treated, and microsurgery can sometimes repair epididymal blockages.
Insufficient levels of male hormone, though rare, may lower sperm production. Testing and appropriate supplementation may help.
Giving up cigarette smoking and drugs (such as cocaine)—which mutate sperm, making them incapable of fertilizing an egg—can restore fertility.

Unfortunately, sometimes there's little we can do solve a male infertility problem. Few medical treatments improve sperm count, so I'm often left to suggest a course of multivitamins.

Delivering that news to an anxious couple makes for a down day in my normally satisfying career. On the other hand, when a formerly infertile couple announces they're expecting, the joy more than compensates.

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