Varicocele is the commonest cause of low sperm count with poor motility (oligoasthenozoospermia). Fifteen percent of the general male population. Forty percent of men evaluated for primary infertility and Fifty percent of men evaluated for secondary infertility have varicocele.
Varicocele , in fact is the most common identifiable and surgically correctable factor contributing to poor testicular function and decreased semen quality.
A) Clinical Examination: The doctor examines the patient in the standing posture and feels the spermatic cord - the cord-like structure from which the testis hangs. Varicocele feels like a bunch of worms in a bag. On coughing, this feel gets transiently exaggerated.
B) Color doppler sonography is the most accurate and objective method of detecting and documenting a varicocele.
|Grade III or Large||On inspection one can see the 'bag of worms'|
|Grade II or Moderate||On palpation without coughing one can feel the 'bag of worms'|
|Grade I or Small||Only on coughing can one feel the 'bag of worms'|
|Subclinical Varicocele||Detected only by color doppler|
Numerous theories have been suggested.
Left testicular vein enters the left renal vein perpendicularly
Long (8 - 10 cm) left testicular vein (aided by gravity)
Compression of left renal vein between aorta and superior mesenteric artery ('nut cracker' effect)
Absence or incompetent valves in testicular vein.
Varicocele may cause dragging pain in scrotum in 5% to 10% of patients.
Stress pattern of semen
a) Low sperm count (oligospermia)
b) Poor motility (asthenospermia)
c) Abnormal forms
d) Tapered forms
Loss of Testicular size, Flabby testes
The mere presence of varicocele doesn't mean that surgical correction is necessary.