He was worried about surgery and recovery time affecting his job. A varicocele was found on his left side. Tests showed his sperm count was low. A varicocele (VAIR-ick-oh-seal) is a common disorder that enlarges the veins in your scrotum. A healthcare provider can diagnose a varicocele and recommend the proper treatment. However, they’re a common cause of infertility. Prospective, long term, randomized trials are needed to help elucidate the benefit of varicocele repair on hypogonadal adolescent males. Consideration should be given to measuring T levels in adolescents with a varicocele. In 2011, Goldstein published a series of 110 infertile men with clinical varicoceles in whom pre- and post-operative T measurements were available. I will ask you to stand, take a deep breath, and hold it while I feel for any enlarged veins . The staff is used to nervous patients. They focus on andrology and urology services and treat many patients from outside India as well . Delhi has excellent medical care for varicocele. I have done more varicocele embolizations than almost anyone in the country . The best places offer both embolization and microsurgery. Embolization is less invasive with faster recovery, while microsurgery has very low recurrence rates. Both embolization and microsurgery are highly effective. Dr Pradeep Muley specializes in non-surgical embolization with over 30 years experience . Maybe some dull ache for a day or two, easily managed with over-the-counter pain medication. In a large 1995 large observational series of 9,034 men presenting for infertility, varicoceles were found in 25.4% of men with abnormal semen, compared with 11.7% of men with normal semen. In this regard, many studies concluded that varicocelectomy significantly improves Leydig cells activity and testosterone production as a result of reversible pathological mechanism. High FSH levels and low testicular volume in young patients could be a marker of varicocelectomy timing, expecially if semen analysis could not be assessed (37, 38). A study including fifty-five patients with varicocele and infertility showed that 16% of patients had basal FSH levels above the normal confidence limits with a significant difference between the control and the varicocele group. The authors concluded that varicocele causes a disturbance in Leydig cells function resulting in decreased testosterone biosynthesis, and that surgical repair significantly increases testosterone levels in men with varicocele (26). In contrast to adults with varicocele, fertility status is not yet known and it is not generally feasible to obtain a semen analysis in adolescents in order to guide treatment. Castro-Magana et al. observed an increased androstenedione/testosterone (A/T) ratio after hCG administration before, and its normalization 3 months after varicocelectomy, suggesting an impaired 17β-HSD activity in males with varicocele (46). Maintaining normal estrogen concentrations is very important since they play a negative role in the testis by inhibiting Leydig cells 17β-hydroxysteroid dehydrogenase (17β-HSD), and thus inhibiting the conversion of androstenedione to testosterone, lowering testosterone production. The higher than normal temperature impairs Leydig cells function causing reduced testosterone production. Your healthcare provider may not recommend treatment if you have a small varicocele that doesn’t bother you or cause fertility issues. Some studies show that people who receive varicocele treatment may still sometimes fail to achieve an erection, but not as often. In some people, a varicocele may cause infertility. The surgical treatment of the adolescent varicocele is controversial and debated. Six of 18 men (33%) with pre-operative subnormal T levels decreased after the repair (28). Yet not all men with subnormal T levels improved after repair. In fact, they increase only when the azoospermia is related to impaired spermatogonia number and function, whereas they persist in the normal range when the azoospermia is related to maturation arrest at spermatocyte or spermatide stage (8, 51). FSH levels seem to depend on the different steps of spermatogenesis at which the impairment occurs. In some cases the adrenal androgen secretion might compensate in the first weeks for the impaired Leydig cells function due to varicocele (50). We know that varicocele can cause Leydig cells dysfunction in various ways, and it becomes gradually more impaired with the duration of the varicocele. On the contrary, the relationship between clinically detectable varicocele and hormonal pattern alterations is still unclear. A meta-analysis of Agarwal et al. showed that varicocele was the primary reason for alteration of spermiogram in adult infertile men (47). In men with higher rise in FSH and LH after GnRH infusion, free testosterone levels were lower, and free estradiol and SHBG levels were higher.
