The most common cause of secondary infertility, or difficulty conceiving after birth of a previous child, is a varicocele, enlarged veins in the scrotum. This is a surgically correctable condition.
Similar to varicose veins on the legs, varicoceles are caused when valves controlling blood flow along the testicular cord fail to operate normally, causing a backflow of blood. This causes elevated temperatures that are thought to interfere with normal sperm production and inhibit the production of testosterone.
Varicoceles are a common cause of male infertility problems as they cause low sperm production and decreased sperm quality.
Symptoms of Varicocele
Most men with varicoceles have no symptoms and are often diagnosed by a reproductive specialist when they have problems conceiving. Men who do have symptoms may experience an ache or a feeling of heaviness within the scrotum or decreased size of one testicle. The enlarged veins are often visible or can be felt upon examination by Dr. Fenig.
Microsurgical varicocelectomy, or varicocele repair, performed by Dr. Fenig, is usually considered to be the best treatment for relieving pain caused by the varicocele, and also to improve semen parameters, testicular function, and pregnancy rates in couples with male factor infertility associated with varicocele.
Surgical treatment of a varicocele may improve sperm count, motility, and quality of sperm in 50-70% of patients.
Dr. Fenig will work with you to determine the best course of treatment and whether or not surgery will be of benefit to you.
The Procedure
Dr. Fenig performs subinguinal microsurgical varicocelectomies on an outpatient basis under general anesthesia. A small incision (2cm) is made just above the pubic bone. The veins are then isolated and tied off so that the varicose veins are permanently closed.
What to Expect Post-Surgery
Full recovery typically takes just five days, but light work can be resumed after one or two days. Pain medication is often prescribed for the first two days after a procedure.
Bandages are removed 48 hours after surgery, but small tape strips are usually left in place for seven to 10 days. You can shower 24 hours after surgery. Dr. Fenig recommends that you refrain from sexual activity for one week. Common complaints after surgery include minor bruising and discoloration around the groin, a sensation of hardness around and beneath the incision site from the stitches that usually resolves within three weeks.
Recent studies have shown that half of men who undergo the procedure can expect improvement in their sperm count and motility, and many are able to conceive more naturally. Patients can expect higher rates of success with natural conception and those needing IVF may only need artificial insemination.
