In my article, we will examine azoospermia and varicocele, how they can be managed to best improve chances for positive outcome and what are these male fertility conditions and how can they be managed to improve chances of IVF success?
If you and your partner have been trying to have a baby for 6+ months, then it might be time to consider having a fertility health check-up completed. Often, the emphasis is placed on a women’s fertility health, but assessing the man’s health is just as important. Your partner could be facing infertility because of a few conditions, including azoospermia and varicocele. These two words may sound daunting and unfamiliar to many, but they are simply common terms used by medical professionals, such as myself, to describe when there is no sperm in a man’s ejaculate (azoospermia) or an enlargement of a vein next to the testes (varicocele). In fact, either of these conditions may be causing male infertility.
To truly understand what these terms mean and how they could be affecting your fertility, let’s look at them in more detail.
Azoospermia
Azoospermia is defined as the lack of sperm in ejaculate. Inevitably, this is a huge contributing factor towards male infertility. According to the National Library of Medicine, azoospermia can be found in 1% of all males and 10-15% of men who test for infertility, which is a significant population in the field of infertility.
There are two types of azoospermia:
- obstructive (OA), where a blockage in a tube is preventing the sperm from entering the ejaculate or,
- non obstructive (NOA), where the testes are not producing enough sperm.
When a man opts to have a vasectomy, he is essentially opting to have an obstructive azoospermia, where we would purposely cut or block the tube, stopping sperm from entering the ejaculate.
Azoospermia can be diagnosed quickly and easily, by semen analysis, in which a sperm sample is analysed within a clinical laboratory. Your doctor might also find it useful to know more about your family history. Asking questions surrounding illness, fever, medication use, fertility history and so on, will help your doctor to build a comprehensive overview of your fertility.
The doctor will advise you to have a blood test and an ultrasound scan of the testes to diagnose whether you have obstructive or non-obstructive azoospermia.
The treatment will involve retrieving sperm directly from the testicles; it can be done by a simple procedure called PESA/TESA, if it is the obstructive type. In non-obstructive cases, micro-TESE will be the procedure carried out to retrieve sperm.
In case no sperm is retrieved by the micro-TESE procedure in non-obstructive azoospermia, the next option might be to consider donor sperm.
Varicocele
A varicocele is a medical term used to describe an enlarged vein near the testicle. Because of their twisted and swollen appearance, a varicocele can look similar to varicose veins which are commonly found in the leg. Such enlargement of the veins nearer to the testis causes heaviness and pain and, due to the increased temperature locally, can cause infertility issues. Varicoceles are more common than people think, around 1 in 7 men will have these next to their scrotum, bur for many, they don’t cause an issue or any pain.
Varicoceles are found to affect fertility because they can decrease the motility of the sperm as well as cause more deformed sperm. It is widely accepted that varicoceles can increase the temperature in the scrotum, which in turn, decreases sperm production.
Although medical professionals can’t be certain as to what causes varicoceles in some males and not others, many believe it is do with a faulty valve within a vein next to the scrotum. Varicoceles are usually formed after puberty, on the left side.
Fortunately, varicoceles can be treated when detected. If you are in pain, over the counter medicines should relieve your discomfort. When looking to treat varicocele for fertility purposes, an embolism or ligation can be offered, whereby the vein is briefly blocked.
There is controversy regarding the role of varicocele in male infertility. Sometimes, treating these conditions can improve the sperm parameters; however, sometimes it might not have any effect.
At Harley Street Fertility Clinic we have an urologist (Mr Asif Muneer) who sees patients with male infertility and advises accordingly. He is also able to carry out appropriate procedures for both azoospermia and varicocele.
For a male fertility check-up, please visit our website. https://hsfc.org.uk/treatments/male-checkup/
To find out more about male fertility, please watch our recorded webinar: https://hsfc.org.uk/webinar/male-fertility-webinar/
To book a male fertility check-up, please contact us today.
References:
https://www.ncbi.nlm.nih.gov/books/NBK578191/ NIH- National Library of Medicine. National Centre for Bio-Technology Information. Medhavi Sharma; Stephen W. Leslie. Updated March 20th, 2020 [Accessed 28th June 2022]
