Fellow, Philippine Urological Association
There is hope for infertile couples to increase their chances of attaining pregnancy. Varicooele which occurs in 15% of all males is a treatable condition in contrast to other causes of Infertility. The male factor and probable cause of the couples’ infertility comprises approximately 25%. Reversing or treating the varicocoele gives an optimistic prognosis in terms of improving pregnancy rate by an average of 75%.
Varicocoele occurs when the spermatic vein’s drainage become obstructed theorized to be produced by the patient’s defective venous system. The unoxygenated venous blood becomes pooled in the testicular area. This condition provides an unhealthy environment by increasing the scrotal temperature and poor nourishment during sperm production.
Most young adult males who are athletes and physically active, those lifting heavy objects or who spend more time in the upright position are prone to painful symptoms at the groin or scrotal area. The complaints range from mild discomfort or heaviness to severe testicular pain. They are often mistaken as signs of an inguinal or groin hernia and testicular tumors. However, those in a committed relationship are often without symptoms except for being inexplicably infertile for several years. They only seek urological evaluation when referred by the obstetrician or if accompanied by the spouse. Oftentimes, they consult the urologist when their semen analysis show poor quality and reduced sperm counts.
The treatment for both groin pain and infertility due to varicocoeles is usually performed by the urologist -surgeon. The objective of treatment is to divert spermatic venous drainage to collateral systems within the testicle. This can be done by ligating or obstructing the spermatic veins via a small incision at the level of the inguinal area or through the retroperitoneal abdominal area. The inguinal approach is the preferred approach since it has the least incidence of recurrence. The procedure is performed efficiently through the use of optical or microscopic magnification to visualize of the veins to be ligated. To ensure a painless experience the incision site is injected with a local anesthestic or by spinal cord block. The patient may be discharged on the same day or by an overnight hospital stay. Patients have experienced minimal postoperative discomfort and most can immediately ambulate or resume their routine activities.
The other less common alternative of diversion is through venous embolization or blockade of the veins concerned. A catheter is inserted through the vein and then an artificial substance is injected creating an obstructing embolus. Successful varicocoele treatment provides hope for the infertile couple. They soon may finally achieve the cherished goal of experiencing the blessings and joy of childbearing.