A common male urological condition warrants more awareness and attention.
Prior to an operation a few days ago, I had bilateral varicoceles. A varicocele is an enlargement of the veins within a man’s scrotum. Similar to varicose veins found in the legs, varicoceles can disrupt blood flow, specifically to the reproductive organs. This can result in low sperm count and infertility in men. I was unfortunate to have two of them — bilateral varicoceles — one on each side of my scrotum.
When I was first diagnosed following a physical exam with a urologist (later confirmed via ultrasound), I was shocked. As a thirty-year-old male, I was otherwise healthy — I exercise regularly, eat well, and get regular check-ups. And as far as I knew, nobody in my family ever had problems having children. Before the semen analysis I took some six months into my wife and I attempting to conceive, I thought I was in peak condition. As the months went by and my wife continued to get her period, I figured our timing was poor or, I’ll be honest, I thought something might be wrong with her.
If you google the “common causes of infertility”, the results almost entirely focus on and point to women. If she isn’t pregnant, it must be her fault, right? That is the default assumption of Google and of most people. I am not a doctor, but that assumption seems unfair and gender-biased, especially considering how it takes two to tango.
Did you know that approximately 10 to 15 percent of adult men have varicoceles? That means of the 138 million or so men in the United States, at least 13.8 million of them have a varicocele. Most of the time, however, this condition will not pose any problems — many guys have no idea they even have one unless, in the rare event, it causes pain, one testicle is noticeably smaller than the other, or they have problems fathering children. Of these 13.8 million or so men, about 40 percent will experience infertility issues caused by their varicocele(s). That amounts to over 5.5 million men, a staggering number for a urological condition that general physicians do not proactively mention, let alone test.
I had no apparent symptoms. Everything worked normally. I never experienced pain, and aesthetically speaking — without too much unnecessary detail — my anatomy appeared fine. After six months of trying to conceive, my wife decided to see her gynecologist for a regular exam. Once she was given a clean bill of health, the doctor recommended that I get a semen analysis. It’s important to note though, most doctors will not recommend any infertility treatments or exams until you have been trying to conceive for a full year. I am glad we did not follow this traditional advice.
I went through multiple semen analyses, all of which showed low sperm motility and morphology. Motility refers to the efficient movement of sperm. If sperm fail to move well, the likelihood of them navigating a woman’s reproductive tract and fertilizing her egg are slim to none. Morphology is the size and shape of individual sperm (i.e., whether there are abnormalities or mutations). In isolation, morphology is not dispositive, but it is a factor when assessing male infertility.
Basically, I was firing blanks. There was a small chance that my wife could get pregnant (including through methods like in vitro fertilization), but with my low sperm motility and morphology, the odds were not in our favor. Once my urologist diagnosed me with bilateral varicoceles — a rare occurrence given that most only appear on the left side — we narrowed down the culprit (hopefully). I only hedge because surgical repair of a varicocele is not a guaranteed solution, but semen quality generally improves for 70 to 80 percent of men. Doctors will likely tell you that varicocele surgery (known as varicocelectomy) should be considered along with other fertility treatment options.
Had I not undergone semen analysis months ago, I would probably be discovering this issue now. Varicoceles form during puberty, so it’s likely that I had been living with this problem for years. No physical exam ever unearthed their presence. And no doctor ever had me take a semen analysis until my wife’s gynecologist suggested it. Why? Having been through this process now, shouldn’t a semen analysis be done periodically once a man hits puberty, simply as a general review of male health? All of the erectile dysfunction advertisements warn that problems there may be indicative of larger health issues — isn’t the same true with low sperm motility and morphology?
With all of this said, if you discover you have a varicocele, it doesn’t mean you need surgery. Varicoceles are not fatal and their causes are unknown, but unless they are tested for at an early age, millions of boys will grow up ignorant about a condition that could impede their ability to father children when the time comes. And in some men/boys, a “varicocele effect” may occur where the testicles produce sperm more poorly over time. While this may be rare, should we be putting anyone in this potential position?