Varicocele and Infertility: Assumed Innocence, Proven Guilt
Innocent until proven guilty. Although pondered since the Digest of Justinian in 6th century Roman law, this tenant of justice only saw widespread acceptance in the US in the late 1890s. For those of us Latin buffs: “ei incumbit probatio qui dicit, non qui negat” describes it best.
You probably didn’t know this but we’ve applied this legal dictum to varicoceles for centuries. Although these lesions are found in 15% of teenage boys, in 30-35% of primarily infertile men and 60-70% of infertile men with previous pregnancies, we thought for the longest time that they were simply a few extra veins in the scrotum, no big deal. If it don’t hurt, leave it alone.
The Unusual Suspect
And varicoceles have certainly been around for a while. They began when we stood up as Homo Erecti since blood leaving the testicle now had to go “uphill” against gravity to get out. Their existence was first documented in the first-century by Celsus, a Greek physician, who described them in De Medicina: “ The veins are swollen and twisted over the testicle, which becomes smaller than its fellow.” To boot, you will find very little mention of doing anything about them for close to two millennia!
But this all changed in the 1950s when an Edinburgh surgeon named Tulloch fixed a varicocele in a man with azoospermia and sperm returned to the ejaculate. So, maybe they weren’t the cute little innocent lesions that humanity thought they were for so long! The sixteenth century anatomist Ambrose Pare had an inkling of this when he noted that varicoceles might be filled with “a melancholic blood.”
Today, varicoceles are considered the most common, correctable cause of male infertility. But there’s more. In addition to causing scrotal pain and impairing semen quality, both of which are lead indicators for varicocele repair, this subtle set of veins surrounding the sex sack has been implicated in all of the following:
- A correctable cause of low testosterone levels.
- A way to improve not only sperm numbers but also sperm DNA health (DNA fragmentation)
- A way to improve IVF outcomes.
- A way to decrease time-to-pregnancy with IVF.
- A way to decrease the levels of assisted reproductive technology needed to conceive.
- A way to reduce the need for sperm retrieval in couples needing IVF-ICSI.
- A way to increase the yield of testicular sperm at surgical sperm retrieval
Not a bad list of guilty verdicts for an entity that was thought to be so innocent for so long. Now, if you’re looking for reasons that things aren’t happening on the baby front, have him checked out. He may not be as innocent as he looks.