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Varicocele, an enlargement of a vein in the scrotum, is the most commonly cited cause of male infertility. It is also the most controversial. Here are five myths about varicocele and male infertility exposed.

About 20% of all men have a vascular condition known as varicocele. About 40% of all infertile men have varicocele.

A varicocele is a problem with the "plumbing" of the circulatory system that leads to the testicles. It is essentially a varicose vein in the scrotum.

Unlike varicose veins in the legs, a varicocele can appear to come and go. It is more visible, and more likely to give a man a feeling of "swollen balls," when he is standing up. Both the visible vein and the feeling of fullness may disappear when he lies down.

Like any other kind of varicose vein, a varicocele sends blood in the wrong direction. Unlike other kinds of varicose veins, a varicocele is not usually the result of aging and weakening blood vessels. 

Varicocele and the "Nutcracker"

That is because a blood vessel called the renal vein, carrying blood back to the heart from the testicles, is compressed in what anatomists sometimes call the "nutcracker" position. It is squeezed in between two major arteries, the aorta and the superior mesenteric artery.

The renal vein connects to the testicular vein, which carries blood away from the testicles. Because there are only weak antireflux or "back up" valves protecting the testicular vein, blood flow becomes stagnant in the testicles and, supposedly, sperm production may be diminished.

Many sources say that varicocele is caused by the absence of valves in the testicular vein, but in almost all cases the valves are just "leaky." Because of the angle at which the testicular vein and the renal vein meet, varicocele is usually visible on the left side rather than the right, but circulation is reduced to both testicles.

Surgical Correction of Varicocele

Varicocele is corrected by a surgical procedure called a varicocelectomy. Unlike the "stripping" procedure used to correct varicose veins in the legs, varicocelectomy usually involves blocking the flow of blood through the testicular vein so circulation drains out of the testicles through other channels.

Typically the procedure involves embolization. The surgeon introduces a tiny pipe called a catheter into a vein easily accessible from the outside of the body and threads it to the testicular vein. A small amount of boiling iodine solution or alcohol, or a metal coil is inserted into the vein to block blood flow.

Varicocele results in shrinkage of the varicose vein about 90% of the time. When blood flow is blocked, there is no longer an accumulation of blood in an area called the pampiniform plexus and the temperature of the testicles is slightly lowered.

What Is the Problem with Varicocelectomy?

The problem with the procedure is that the best estimate of the chances of success for the operation is the age of the female partner. If the age of the female partner is not taken into consideration, about 33% of couples in which the male partner has the procedure become pregnant within one year. About 36% of couples in which the male partner receives counseling only become pregnant within one year.

Surgical correction of this relatively common "nutcracker" condition is no guarantee for men to become fathers, but that does not keep thousands of doctors from recommending the procedure to tens of thousands of infertile men every year.

Varicocelectomy is a procedure that some specialists believe is performed on men who don't need it without any real guarantee of success. There usually are ways for men who are not completely infertile to become fathers, but precious years and huge amounts of money can be wasted before more effective procedures are tried. 

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