Varicocele cases rising among young men: Expert highlights fertility risks

Varicocele is one of the most common yet overlooked causes of male infertility. Despite affecting a large number of men, many remain unaware of the condition until they face difficulties in conceiving. Varicocele is a condition in which the veins inside the scrotum become enlarged and swollen, similar to varicose veins seen in the legs. It usually develops gradually and is more commonly seen on the left side. The condition can affect blood circulation around the testicles, leading to increased temperature in the scrotum and affecting sperm production and quality. “The exact cause of varicocele is linked to faulty valves inside the veins, which result in poor blood flow and pooling of blood. The condition is commonly seen in adolescents and young adults but may remain unnoticed for years because symptoms are often mild or absent. Some men may experience symptoms such as a dull aching pain in the scrotum, heaviness, swelling, visible enlarged veins, or discomfort that worsens after standing for long periods or physical activity. In many cases, infertility becomes the first noticeable sign. An untreated varicocele can lead to reduced sperm count, poor sperm motility, abnormal sperm shape, shrinking of the testicles, and hormonal imbalance. In a week, 2-3 males aged 30-55 are diagnosed with this condition who undergo infertility evaluation. The condition can negatively affect natural conception and may also reduce the success rates of fertility treatments such as IVF,” said Dr. Rashmi Niphadkar, Fertility Specialist, Nova IVF Fertility, Baner, Pune.Dr. Vaishali Chaudhary, Consultant - Fertility and IVF Specialist, Motherhood Hospitals, Kharadi, Pune said “Varicocele is not uncommon among men undergoing fertility evaluation. Around 20–25% of men attending infertility clinics are found to have this condition. Varicocele refers to dilatation and stagnation of blood within the testicular veins, known as the pampiniform plexus. These veins become enlarged and prominent, and in some cases can be palpated or even visibly seen during physical examination, often appearing like a ‘bag of worms’.Many men with varicocele may not experience any symptoms at all. However, some may complain of a dull aching pain or heaviness in the scrotum, especially after prolonged standing, physical exertion, or strenuous activity. In a few cases the affected testis may appear slightly smaller in size.One of the major concerns with varicocele is its effect on sperm quality. The dilated veins increase the temperature around the testes, which can negatively impact sperm production and motility. Reduced sperm motility is commonly seen in men with significant varicocele.Dr Rashmi further added, “Treating varicocele through minimally invasive procedures or surgery can improve sperm health and increase the chances of pregnancy in many couples. In some cases, even after varicocele surgery, the semen parameters cannot be reversed, and in extreme cases, IVF is the answer to go ahead. So, men shouldn’t ignore persistent scrotal discomfort or fertility concerns. Regular reproductive health check-ups, early screening, and open conversations about male infertility can help identify the condition sooner and improve treatment outcomes. Couples undergoing IVF or fertility treatment should also ensure that male fertility factors are properly evaluated rather than focusing only on female reproductive health. It is time for women to focus on their reproductive health and seek timely help, if required. Suffering in silence can impact fertility, so be cautious and follow the guidelines given by the expert.”Dr Vaishali adds, “Diagnosis is usually made through clinical examination and confirmed with scrotal sonography with Doppler study, which can detect even early or Grade 1 varicocele. In Grade 1 varicocele, the dilated veins become prominent only after doing a Valsalva manoeuvre, where the patient increases abdominal pressure by straining. In Grade 3 varicocele, the veins are visibly enlarged even without exertion.Before planning treatment or surgery for varicocele, it is essential to evaluate the fertility status of both partners. If the female partner is above 36–37 years of age or has associated fertility concerns such as ovulation disorders, tubal blockage, or uterine factors, advanced fertility treatments like IVF may be more appropriate and successful . With the high success rates of IVF today, treating the male factor alone may not always improve the couple’s overall chances of conception. Therefore, treatment decisions should always be individualized after assessing the reproductive health of the couple as a whole.”