Varicocele and Fertility

Varicoceles, an enlargement of the veins within the scrotum surrounding the testicles, are a common cause of male infertility.  

Background

In addition to symptoms such as dull aching pain and testicular shrinkage, varicoceles impair sperm production and function by increasing testicular temperature. As mentioned in the “Understanding Semen Analysis” blog, ideal sperm production occurs at around 93.2 degrees Fahrenheit. This is about 5 degrees cooler than the normal body temperature of 98.6 degrees.

The negative effects of increased testicular temperature on spermatogenesis (sperm production) in man have been investigated and established for many years. For example, a meta-analysis study published by the Iranian Journal of Public Health in 2022, looked at the impact of high ambient temperature on human sperm parameters. The study concluded by saying that:

“ High ambient temperature negatively affects sperm quality, including decreased semen volume, sperm count, sperm concentration, motility and normal morphology.”

Introduction

Similar to varicose veins in the legs, varicoceles develop when valves in the testicular veins fail to function properly. These valves normally help push blood upward toward the heart. When they fail, blood can flow backward and pool in the veins, leading to enlargement. As seen earlier, varicoceles increase testicular temperature, which can impair sperm production and function, making them a significant concern for fertility.

What causes varicocele

Several anatomical and physiological factors contribute to the development of varicoceles. About 85–90% occur on the left side, mainly because of differences in vein anatomy. The left testicular vein drains at a right angle into the left renal vein, which creates higher pressure. In contrast, the right testicular vein drains directly into the vena cava, resulting in lower pressure (see image above).

Another documented cause is anything that increases pressure in the abdominal or pelvic veins, such as chronic constipation, heavy lifting, straining, prolonged standing, and obesity. These factors can increase venous pressure and worsen valve dysfunction, leading to blood pooling in the testicular veins.

Lastly, a small percentage of men have a genetic predisposition. These men naturally have weaker vein walls, and less effective valve. In addition to varicocele, these men may also have varicose veins elsewhere, hemorrhoids, family history of vein problems, etc.

A systematic review published in 2016 by the Asian Journal of Andrology states that while the mechanisms have been discussed for nearly five decades, it is still not fully understood how varicocele leads to infertility. The primary theories suggest that venous reflux, which leads to elevated testicular temperature and oxidative stress, is the main cause.

Western Treatment

Treatment options range from microsurgical incision to injecting a solution to close off the affected veins. A microsurgical varicocelectomy, which involves making a small incision in the groin to tie off the affected veins, is considered the gold-standard procedure.

Another well-recognized option is embolization. This is a minimally invasive treatment where a catheter is guided by X-ray into a vein. Once the area is identified, an embolic agent—such as metal coils, liquid glue, or gels—is delivered to create a blockage.

A retrospective review published by the Canadian Urology Association in 2012 compares the two most popular methods; microsurgical and embolization. The study indicates that while both options have high success rates, outcomes vary depending on whether the varicocele is unilateral or bilateral. The authors concluded that bilateral varicoceles are best managed with a microsurgical approach, which has a technical failure rate of less than 5%. Conversely, for men with unilateral left-sided varicoceles, both options offer similar failure rates, though embolization may provide specific advantages to the patient.

“This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach, where technical failure rates are expected to be less than 5% based on published data. Men with unilateral left-sided varicoceles should be offered both options as they have similar failure rates, but with embolization offering some clear advantages to the patient.”

TCM Treatment

In traditional Chinese medicine (TCM), the root cause of varicocele is often identified as Spleen Qi Deficiency. If left untreated, this condition can lead to Blood Stagnation. One of the primary functions of the Spleen is "holding"—specifically, keeping blood contained within the vessels. When Spleen Qi is deficient, it cannot properly manage circulation, which may result in a "leaky" system where blood pools.

Research suggests that using acupuncture and herbal medicine to resolve Blood Stagnation and tonify Spleen Qi can lead to improvements in semen quality, a reduction in pain, and enhanced overall fertility.

A case report published by Explore in 2022 describes the successful treatment of a 40-year-old man suffering from left-sided scrotal pain and heaviness caused by a varicocele. After ten acupuncture treatments, the patient was symptom-free, and a follow-up ultrasound showed no abnormalities in the bilateral spermatic veins.

“ This case suggests that acupuncture is effective not only in resolving varicocele-related pain but also in slowing or even reversing subclinical varicocele progression. Thus, acupuncture may be an effective alternative therapy for the clinical treatment of subclinical varicocele."

Conclusion

Varicocele is a leading cause of male infertility, often resulting from faulty valves within the testicular veins. While both Eastern and Western medicine offer solutions for this condition, Traditional Chinese Medicine (TCM) provides a more holistic and less invasive approach.