How can something so soft and warm and blue, and no wider than a pencil, have such a devastating effect on your ability father children? Meet the varicocele (veri-ko-seal), the unicorn of male fertility.
The Inimitable Varicocele
As posted previously, the varicocele is unique to humans and is a consequence of our upright posture. It is a bag of veins in the scrotum that, except if it caused low-grade discomfort, you probably would never know you have.
Varicocele as Unicorn
Yet, as I live and breathe the nuances of this field daily, the varicocele never ceases to amaze me. Although first recognized in the first century AD, it gained modern notoriety when a Dr. Tulloch surgically repaired one in the 1950s in a man who had no sperm in his ejaculate. Lo and behold, sperm returned to the ejaculate and the patient’s wife conceived naturally. Is this the story of a unicorn?
Not really. Unlike the ephemeral unicorn, the varicocele exists and is, in fact, quite common. Look hard and you will find them in 15% of healthy men and in 40% of men having trouble conceiving their first child. It is even more common in men having trouble having a second child. Having said this, it is also true that most men with varicoceles are normally fertile. So how does this work?
A Susceptibility Thing
No one really knows why varicoceles affect the fertility of some men but not others. Maybe it’s the size of the lesion or maybe it’s the exposure time (time from their onset at puberty to the age at which men try to conceive) that matters. As a consequence, some clinicians don’t believe in them and others, like me, do. In fact, I have spent a great deal of time pondering them in infertile men. Because of this, I feel I know their personality quite well.
The Varicocele Personality
Dear Parent to Be:
I am delighted to write this letter of support about Mr. Varicocele, someone whom I have known well for the last 20 years and feel comfortable commenting on his personality and future potential.
- In most men, he coexists peacefully and never bothers anybody.
- In some men, he disturbs sperm production and can wreak havoc on fertility.
- Fixing him can help couples conceive naturally
- Fixing him can help eliminate scrotal pain
- Fixing him fixes a problem and can help couples build entire families (i.e. have several children)
- Fixing him can help couples considering IVF for family building to avoid IVF and conceive naturally
- Fixing him can help couples considering IVF to have children to use less invasive technology (i.e. IUI) instead of IVF to conceive
- Fixing him in men who fail to conceive with IVF can help with IVF conceptions
- Fixing him in men with genetic causes of infertility will not help them conceive naturally
- Fixing him in men with no ejaculated sperm counts will generally not help them conceive naturally but can help them conceive with IVF
In summary, I believe in Mr. Varicocele has the potential to have a great impact on the world of human fertility. Please consider him seriously whether you are simply contemplating, or actually building, your family as he can be invaluable in these situations. Personally, I recommend him highly to as one of the most common correctable conditions associated with infertility. Please call me if you have any questions about this rather strong recommendation.
Paul Turek MD
Director, The Turek Clinic