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Hi Doctor, Do Varicocele Cause Infertility In Men? I Probably

Posted on Wed, 11 Sep 2019

Question: Hi Doctor,

Do varicocele cause infertility in men?
I probably had varicocele my whole life but never noticed it because it never hurt or felt uncomfortable. Recently, somebody close to me was diagnosed with cancer so it scared me and made me cautious with my health. I noticed a lump in my left testicle recently and went to the hospital to find out if it was a tumor. The nurse did a physical exam and diagnosed me with varicocele. Would this cause infertility? I took a home sperm test twice and both times I saw a faint line appear (which means I have the normal amount of sperm in my ejaculate). I told my doctor about this and asked if I can have surgery or anything to get rid of my varicocele and she said that varicocele are extremely common and the only time she saw varicocele effect fertility is when the varicocele causes extreme pain in the testicle. Also, I read online that doctors don't approve every patient for varicocele removal surgery.

What do you think? I am interested in hearing your medical advice. Is it true that if my varicocele isn't bothering me that it is not going to effect my fertility? Do you think I should do anything about it?

I feel weird getting a sperm analysis because I am not actively trying to have a child right now so it will be weird to tell the doctor that I didn't even try to impregnate a woman but just want to get sperm test done "just in case".

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Hi Doctor,

Do varicocele cause infertility in men?
I probably had varicocele my whole life but never noticed it because it never hurt or felt uncomfortable. Recently, somebody close to me was diagnosed with cancer so it scared me and made me cautious with my health. I noticed a lump in my left testicle recently and went to the hospital to find out if it was a tumor. The nurse did a physical exam and diagnosed me with varicocele. Would this cause infertility? I took a home sperm test twice and both times I saw a faint line appear (which means I have the normal amount of sperm in my ejaculate). I told my doctor about this and asked if I can have surgery or anything to get rid of my varicocele and she said that varicocele are extremely common and the only time she saw varicocele effect fertility is when the varicocele causes extreme pain in the testicle. Also, I read online that doctors don't approve every patient for varicocele removal surgery.

What do you think? I am interested in hearing your medical advice. Is it true that if my varicocele isn't bothering me that it is not going to effect my fertility? Do you think I should do anything about it?

I feel weird getting a sperm analysis because I am not actively trying to have a child right now so it will be weird to tell the doctor that I didn't even try to impregnate a woman but just want to get sperm test done "just in case".

Answered by Dr. Dr. B. Radhakrishnan. Nair (13 minutes later)

Brief Answer:
It depends on the severity

Detailed Answer:
Hi
Greetings
Varicocele has to be clinically diagnosed and confirmed with DOPLER scan to assess the grades.
Grade 1 and 2 doesn't cause much problem
Surgery is not decided by pain.You have to get a semen analysis from a reputed lab after 3 to 5 days abstinence. If any 2 variables are affected out of 3(total count,motility and morphology) then surgery may be done to improve sperm.
If semen analysis is normal you don't need to do surgery.
It will not cause cancer.
HOPE MY ANSWER HELPS YOU
REGARDS

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. B. Radhakrishnan. Nair (23 minutes later)

what are grades 1 and 2 mean?
if my testicles don't hurt does that mean that low sperm production due to varicocele is uncommon?

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

what are grades 1 and 2 mean?
if my testicles don't hurt does that mean that low sperm production due to varicocele is uncommon?

Answered by Dr. Dr. B. Radhakrishnan. Nair (32 minutes later)

Brief Answer:
yes

Detailed Answer:
Sperm production may be affected when the varicocele is severe like grade 3 or 4 as the temperature increases in testis.Also Free radicals will increase when the varicocele is severe.WHICH can be diagnosed after semen analysis.
Grade 1 and 2 is mild engorgement of veins (not visible).

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. B. Radhakrishnan. Nair (7 hours later)

How visible do they have to be?

I was analyzing my testicles the other day and when I’m standing up I can’t see the varicocele but I can feel them. When I sit down with my legs closed and testicle are on top of my legs I can see them. They never hurt though.

Also, since they are so common is it only a small percentage of men with varicocele that have fertility issues.

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Answered by Dr. Dr. B. Radhakrishnan. Nair (13 hours later)

Brief Answer:
more prominent on standing

Detailed Answer:
Varicocele is more prominent on standing.Whem you lie down or sit it reduces due to decreased venous stasis.
As I told you earlier fertlty issues are more common in higher grades to around 70%.
REGARDS

Above answer was peer-reviewed by : Dr. Nagamani Ng

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. B. Radhakrishnan. Nair (30 minutes later)

just to clarify, can i still have fertility issues doe to varicocele even if my testicles don't hurt?

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

just to clarify, can i still have fertility issues doe to varicocele even if my testicles don't hurt?

Answered by Dr. Dr. B. Radhakrishnan. Nair (1 hour later)

Brief Answer:
I don't think so

Detailed Answer:
To comment on that I need a dopler scan on the varicocel and semen analysis.
If you can provide me the results I will be able to help you

Above answer was peer-reviewed by : Dr. Nagamani Ng

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Brief Answer:
I don't think so

Detailed Answer:
To comment on that I need a dopler scan on the varicocel and semen analysis.
If you can provide me the results I will be able to help you

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. B. Radhakrishnan. Nair (10 days later)

Hi doctor,

so what you are saying is that even if there is no pain or discomfort in the scrotum the varicocele still could possibly cause infertility?

When I went to the ER they didn't tell me which grade I had. The nurse just touched my scrotum and told me automatically that I have varicocele.

Also, sometimes the varicocele is visible and I can feel it when I touch it but other times it is not visible at all and I can't feel it it all. What grade do you think this would fall under. Is one of the required symptoms of grade 3 and 4 pain and discomfort?

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Answered by Dr. Dr. B. Radhakrishnan. Nair (1 minute later)

Brief Answer:
ultrasound scan with dopler

Detailed Answer:
Hi
Greetings
You can get an ultrasound scan with DOPLER to know the grade of VARICOCELE.
If not get it examined by an urologist .
pain is not the indication of severity nor fertility.
You can get a semen analysis for that.
REGARDS

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. B. Radhakrishnan. Nair (8 hours later)

okay and is it a rule that everybody with grade 3 or 4 varicocele will have infertility issues?

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

okay and is it a rule that everybody with grade 3 or 4 varicocele will have infertility issues?

Answered by Dr. Dr. B. Radhakrishnan. Nair (15 hours later)

Brief Answer:
Need not be

Detailed Answer:
That is why I suggested a semen analysis

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Brief Answer:
Need not be

Detailed Answer:
That is why I suggested a semen analysis

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. B. Radhakrishnan. Nair (1 hour later)

i toke a home sperm test and it came back positive that I have a normal sperm count. I read online that if you have varicocele and normal sperm count that it is unlikely that I will have an isolated situation of subpar motility or morphology. is this true?

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Answered by Dr. Dr. B. Radhakrishnan. Nair (17 hours later)

Brief Answer:
Need more details

Detailed Answer:
Hi
I dont know about home sperm test.Unless we do a semen analysis to see the total count ,motility and morphology we can't comment up on the effect of VARICOCELE on semen synthesis.
As I told you it can be normal in high grade varicocele too at times.
Clinical examination with semen analysis is worth.
Regards

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. B. Radhakrishnan. Nair (3 hours later)

Hi doctor,

The name of the test is SpermCheck. You can buy it from a drug store or convenience store. You ejaculate in a cup, mix the semen with some solution and put 3 drops of the semen mixed with the solution in a little tester thing and if 2 lines show up that means you have normal sperm count (this test does not test for morphology or motility). I took the test twice and both times I saw 2 lines which means that my sperm count is normal.

my question is, is it still possible to have abnormal motility or morphology even if I am producing the appropriate amount of sperm per ejaculate? I have an appointment at a fertility clinic on Wednesday (I have to stay abstinent for 3-5 days) where they will take my semen analysis and give me the results that same day. I am just asking you this question just to have some insight.

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Answered by Dr. Dr. B. Radhakrishnan. Nair (18 hours later)

Brief Answer:
Yes.Count include dead sperm also

Detailed Answer:
Hi
Those tests are screening tests which may detects the quantity.
Even if you have 100 million sperm the motility and morphology determine the fertility.
According to WHO 2010 criteria (latest) you must have more than 16.5 million and above 42 % rapid progressive motility and more than 4% normal morphology.

So it will be wise to show an XXXXXXX or urologist directly.
Feel free to ask your doubt with more details
REGARDS

Above answer was peer-reviewed by : Dr. Raju A.T

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. B. Radhakrishnan. Nair (8 days later)

Hi doctor,

I am pretty sure I understand my results and it looks like everything is normal but I want to make sure by running the semen analysis results by you:

Results:

Volume: 3.8 mi
Concentration: 29.8 mi
Total sperm: 113.24

Motility: 44%
A 12%
B 18%
C 14%
D 56%

Forward progression 2.5

Liquefaction <45 minutes

Viscosity= ABN

Agglutination 2

Morphology = 9%

Can you please explain what each of these mean? Thank you!

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Answered by Dr. Dr. B. Radhakrishnan. Nair (9 hours later)

Brief Answer:
Need to improve motility

Detailed Answer:
Hi
Nice of you to send me the semen analysis report.
Volume,total sperm count and morphology are in normal range as per WHO GUIDELINES.
more of non motile sperm(56%) with increased viscosity and mild agglutination of sperm .
rapid progressive motility has to be around 35 to 45%.

Mild clumping of sperm is agglutination.
All this can be corrected.
I dont think it is due to grade 2 varicocele.
If you had unprotected sex with unknown person, you need to rule out any genitourinary tract infection .
Correcting infection will improve motility and viscosity.
Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. B. Radhakrishnan. Nair (1 hour later)

Hi doctor, how would I be able to correct this? I’ve received oral sex from unknown person but never had actual unprotected intercourse with random person. Beside, isn’t anything above 40% considered normal for motility?

If varicoele didn’t cause this and what did? Also, how can I easily improve motility?

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Answered by Dr. Dr. B. Radhakrishnan. Nair (17 minutes later)

Brief Answer:
40 % is normal

Detailed Answer:
Hi
40 % is normal as per the guidelines.But immotile is more.So out of 40% how many are rapid progressive matters.
I said may not be varicocele as you need to rule out genitourinary infection.
Prostatitis or epididymoorchitis has to be ruled out as you had oral sex from unknown person.

Very difficult to confirm it by tests like semen culture.
A DIRECT CHECK UP BY UROLOGIST ESPLY A DIGITAL RECTAL EXAMINATION FOR PROSTATE AND A DIRECT EXAMINATION OF TESTIS AND EPIDIDYMIS WILL RYLE OUT INFECTION

Above answer was peer-reviewed by : Dr. Kampana

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. B. Radhakrishnan. Nair (44 minutes later)

hmm...i don;t have any symtoms of prostate or testicular infection but I guess I could go see if a physician can do an STI test or the other tests you listed.

based on my results is my fertility considered good though? Is viscosity very important when it comes to conceiving?

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Answered by Dr. Dr. B. Radhakrishnan. Nair (9 hours later)

Brief Answer:
urology dr

Detailed Answer:
hi
you should be visiting an urologist.physician won't do DRE and testicular examination.

viscosity matters for natural conception as the movement of sperm can be hindered .
Are you planning for pregnancy.
Feel free to ask your doubt with more details.
Regards

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. B. Radhakrishnan. Nair (2 hours later)

Yes, I do want children one day.

Is it possible that the viscosity varies depending on the day? Maybe I was just dehydrated this day.

But would my chances of natural conception be 0% if my viscosity is abnormal?

Follow up: Dr. Dr. B. Radhakrishnan. Nair (0 minute later)

Answered by Dr. Dr. B. Radhakrishnan. Nair (7 hours later)

Brief Answer:
Dont worry

Detailed Answer:
Hi
Same sample if given to two labs the results can be different .
You can repeat after 2 months with 3 to 5 days abstinance .Preferably semen analysis is done before 1pm and within 30min to 60min.
Please give me some more details about you like weight , height ,smoking ,alcohol and other medications.
Also about working pattern.
Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Dr. B. Radhakrishnan. Nair (0 minute later)