The association between varicocele and male infertility has long been recognized. Descriptions of varicocele with concomitant testicular atrophy go back as far back as the first century A.D. At present, many questions regarding this problem still remain to be answered. What is known, however, is that early diagnosis followed by varicocelectomy may improve patient's fertility.
Varicocele may be defined as "an abnormal dilation of the pampiniform plexus that surrounds the spermatic cord" (1:253). Unilateral or bilateral varicoceles occur in about 15% of the adult male population. Moreover, their incidence increases between the ages of 10 and 14 years. Of affected men, 78 93% occur on the left side and 7 22% are bilateral. Solitary, right sided lesions occur more rarely, and are usually secondary to situs inversus (1:253).
The prevalence of male infertility in the general population is 5%. Among persons with varicocele, however, 19 41% (33% is a generally accepted figure) suffer from primary infertility. Typically, these patients' semen samples show diminished sperm counts, decreased motility, and immature cellular morphology.
The precise pathophysiologic mechanisms responsible for such phenomenon currently remain unknown (3:861). Various hypotheses for the alteration of spermatogenesis have included the following: reflux of toxic metabolites from either adrenal or renal origins; disturbed hormone status; spermatic venous hypertension; testicular hypoxia secondary to stasis; and abnormal temperature regulation (2:149). Various investigations have examined the possibility that toxic metabolic byproducts--such as prostaglandins--may reach the testicles through changes in venous circulation. In addition, researchers have postulated that infertility could result from alteration of the hypothalamic pituitary gonadal hormone axis. A third pathophysiologic mechanism might involve the "nutcracker p
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