According to the latest data from the World Health Organization (WHO), 15% of couples worldwide experiencing infertility. According tο the same researches, the male factor is the main cause of infertility in 1/3 of women couples. Male infertility can be caused by many different factors such as the burdened lifestyle, hormonal disorders, dysfunctions in ejaculation, chromosomal abnormalities and presence of varicocele. Varicocele is responsible for 35-50% of cases of primary infertility, and for over 80% cases of secondary infertility. Some patients may have mild symptoms such as pain, heaviness or discomfort, while in others it can prevent the proper development of the testicle, to affect the quality of the sperm, thus also its fertilizing capacity. More specifically, there is a negative impact on concentration, mobility and sperm morphology. Progressively, if it remains untreated, it can cause damage to the sperm's genetic material.
We can distinguish 3 stages of varicocele, depending on the way it can be identified and therefore diagnosed. In the first stage (grade 1) the varicocele is detected by palpation after increasing intra-abdominal pressure, the second stage (grade 2) is detected by simple palpation, but is not visible when the patient is calm and in the third stage (grade 3) varicocele is visible while the patient is standing upright and at complete rest. Additionally, to the previous categories of Varicocele, there is subclinical varicocele as well, which is diagnosed only after ultrasound check and is asymptomatic.
In patients with a history of varicocele, the main cause of fertility problems are oxidative stress and increased rate of DNA fragmentation (DNA fragmentation) in spermatozoa. However, researches have been shown that it does not exist significant difference in egg fertilization rate, in individuals with high and low percentage of fragmented DNA. The high rate of DNA fragmentation of sperm could affect the development of embryos and determine the outcome after an IVF attempt.
More specifically, the percentage of fragmented DNA is usually increased in men with varicocele, regardless if there is normal or abnormal sperm count. Varicocele is mainly treated surgically (microsurgery, laparoscopic surgery, and spermatic vein embolization). Moreover, antioxidant medication could be used for 3 to 6 months as an adjuvant, to help improve sperm quality and quantity.
The World Health Organization (WHO) recommends surgical treatment of varicocele in patients with abnormal sperm parameters, as the main infertility treatment. Before surgery, cryopreservation of the patient's sperm is recommended, as in most cases it is unclear what to expect after the surgery and if it will be possible to improve the parameters. In cases of varicocele, a spermogram is not enough, as the chromosomal abnormalities of the sperm are not detected with this test. So additionally, patients with varicocele should be checked with a DNA fragmentation test, in order to have safer conclusions about the infertility treatment plan.
If you are struggling with male infertility due to varicocele or other factors, Newlife IVF Greece can help. Our experienced fertility specialists offer personalized treatment plans tailored to your specific needs to help improve your chances of conceiving. Contact us today by filling out our online contact form to schedule a consultation.
Natasa Desli, BSc, MSc
Natasa is a Clinical Embryologist at the Newlife IVF Greece.
