Varicocele

A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum, present in about 15% of all men and 40% of men presenting with infertility. The pooling of warm blood raises testicular temperature, which impairs sperm production and increases oxidative stress, leading to reduced count, motility, and morphology — and increased DNA fragmentation.

Diagnosis is typically by physical examination and confirmed with scrotal Doppler ultrasound. Grade 3 varicoceles are palpable at rest; lower grades may only be visible or detectable by ultrasound. Treatment (varicocelectomy or percutaneous embolization) improves semen parameters in many men. ASRM guidelines support repair in men with a palpable varicocele, abnormal semen parameters, and otherwise unexplained infertility when the female partner has normal fertility or treatable conditions.