Male Infertility

Male infertility is caused by a variety of factors that include structural abnormalities, hormonal disturbances, genetic defects and medical conditions that can be life threatening. Lifestyle choices and environmental exposures can also be contributors.

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Varicocele

Varicocele is the most common cause of male infertility. In fact, a varicocele can be found in about 40% of males with fertility problems and can have a profound effect on several aspects of the semen analysis and testosterone levels. It is also the most surgically correctable condition that causes male infertility.

What is a Varicocele?

The veins that drain the testicle are known as the pampiniform plexus. They are responsible for the drainage of blood from the testicles. These veins can sometimes become enlarged much like varicose veins in the leg. In fact, a scrotal varicocele is simply a varicose enlargement of the testicular veins around the testicle.

Several theories have been proposed to explain the harmful effect of the varicocele on sperm quality. These include possible effects of pressure, oxygen deprivation, heat injury, free radicals and toxins. Despite considerable research, none of these theories has been proven with certainty, although an elevated heat effect caused by impaired circulation appear to be the most reproducible defect. In addition, varicoceles may be a cause of progressive damage to the testicles, resulting in shrinkage or decreased testosterone levels.

Varicocele Symptoms

In most cases, varicoceles have no symptoms and the patient is seen primarily for evaluation of impaired fertility. However, in some cases, males complain of pain or heaviness in the scrotum, or testicular pain. Younger males may even report one testicle being smaller than another.

Varicocele Treatment Options

There are a variety of approaches to the treatment of a varicocele. In cases of testicular discomfort, pain medication and scrotal elevation may be helpful. In instances of infertility or a situation where conservative management does not alleviate discomfort, surgery is the option of choice. Surgical approaches range from laparoscopic, radiological clotting of the veins (embolization) and open surgical techniques using loops (magnified glasses), or the use of an operating microscope. All approaches have their own risks and rates of success. Dr. Gittens is fellowsghip-trained in microsurgery and uses the operating room microscope to obtain exceptional results.

Dr. Gittens’ Surgical Approach to the Varicocele

Dr. Gittens employs an operating microscopic when performing the varicocele surgery. By using the operating microscopic he can ensure precise identification of all veins, and the testicular arteries (bring blood to the testicle) leading to improved results and less likelihood of complications. This approach has the highest rates of success and the lowest rate of complications.

Varicocele Surgery Success Rate

Improvement in semen quality occurs in about 75% of patients who undergo a microscopic varcicocelectomy with Dr. Gittens. The average pregnancy occurs nine months following surgery. The first semen analysis is obtained in four months, but changes may not be seen until later. Therefore, when a varicocele is present in the infertile male who demonstrates abnormalities of semen analysis, surgical correction should be strongly considered early on in the decision making process in order to expedite pregnancy.

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Dr. Gittens is a leading expert in sexual medicine. As a board certified urologist — fellowship trained in sexual medicine and microsurgery — he is uniquely qualified to treat both men and women.

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