Got differently sized testicles? It may be Varicocele

Varicoceles are enlarged veins in the testicles, similar to varicose veins in the legs. Varicoceles do not generally cause symptoms, but they are a common cause of low sperm production and reduced sperm quality because they tend to raise the temperature around the testicles. The development of varicoceles usually starts during puberty and can last for several years. Although they may cause discomfort or pain, they rarely result in symptoms or complications. A varicocele may cause poor development of a testicle, low sperm production, or other problems that may lead to infertility. Surgery to treat a varicocele may be recommended to address these complications.

A varicocele usually occurs on the left side of the scrotum. Possible signs and symptoms may include:

• Pain: A dull, aching pain or discomfort is more likely when standing or late in the day. Lying down often relieves pain.
• A mass in the scrotum: If a varicocele is large enough, a mass like a "bag of worms" may be visible above the testicle. A smaller varicocele may be too small to see but noticeable by touch.
• Differently sized testicles: The affected testicle may be noticeably smaller than the other testicle.
• Infertility: A varicocele may lead to difficulty in becoming a father, but not all varicoceles cause infertility.

“Almost all males are born with this condition, but it does not become apparent until puberty when blood flow to the genitals increases. It might be caused by a problem with blood flow in the spermatic cord, which transports blood to and from the testicles. If the valves inside the veins in the cord don’t work as they should, the blood backs up and the veins get wider. This condition is relatively common, occurring in about 15% of adult areas,” says Dr. Puja Singh, Consultant, Birla Fertility & IVF.

Varicoceles are found by physical examination while the man is standing. Varicocele is much less prominent and may disappear while lying down. In order to diagnose a varicocele, an ultrasound is not needed. A varicocele that is shown on ultrasound but cannot be felt by a physical examination is called a subclinical varicocele.

According to Dr Singh, additional factors that one must consider before deciding the therapeutic approach to Varicocele in an infertile couple include:

1. If the wife is over 35 years of age and has high serum FSH levels, then ICSI should be chosen rather than Varicocele repair.
2. In the case of chronic presence of Varicocele in advanced male age, surgery should be avoided.
3. Surgical repair of Varicocele is recommended in case of secondary male infertility. On the other hand, if the patient has primary infertility, azoospermia, small testicular size and high serum FSH levels, the presence of varicocele should be ignored and surgery should be avoided, as the diagnosis, in this case, pleads towards primary testicular failure.

There is an association between varicoceles and infertility. The incidence of varicocele increases to 30% in infertile couples. Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm are related to varicoceles. Some experts believe that blocked and enlarged veins around the testes, called varicoceles, cause infertility by raising the temperature in the scrotum and decreasing sperm production. Evidence suggests that VC is associated with anti-sperm antibodies (ASAs), spermatogenesis and testosterone secretion abnormalities, and testicular cytokine production. In a study conducted by the World Health Organization (WHO), it was shown that men with varicocele had lower sperm concentration and motility than men without varicocele. Another study carried out in healthy men in Europe identified deterioration in sperm quality even in men with a grade 1 varicocele.

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