In addition to many hormonal, physical and metabolic causes of male infertility, the most common and easily treatable cause of infertility is varicocele pathology.
Varicocele testicle (egg) veins expand and folds to increase and make packages in the scrotum (bag). The patient perceives these packs as swelling in his hand and says that when he is standing too much, his testicle hurts, and when he lies down, he relaxes. Varicocele occurs after puberty after the age of 15-16. It is rare to see it before these ages. In a study of 4000 primary school boys at Gazi University, it was found 1%. However, the rate of occurrence after puberty is 15%. 50-60% of this causes infertility. So every varicocele does not cause infertility.
Varicocele is 90% on the left and 10% on both sides. When the patient has varicocele, it should be seen that abdominal ultrasound is performed, especially in bilateral patients, and there is no pathology or tumor in the abdomen that compresses the vessels.
The reason why varicocele is seen on the left side is that the left testicle vein travels much longer than the right in the back wall of the abdomen to pour into the left kidney vein, and the valves that prevent blood from escaping inside the vein do not work well.
The testicles stand at 35-35.5 degrees in the scrotum (bag) lesser than the body. Therefore, in winter, the bags contract and keep the testicles close to the body. In the summer, the bags relax and keep the testicles in the serie away from the body. In the varicocele, the testicles or testicles reach the temperature of 37 degrees, as blood runs back and lakes. This temperature increase disrupts the work of the testicles and adversely affects sperm production. Oxygen decreases in the blood in the testicles and sperm production is disrupted because the cells producing sperm remain oxygen-free. The left adrenal gland metabolic residues, damaging the testicles due to leakage in the left testicular vein opening to the left kidney vein, disrupt sperm production. In the left varicoceles, the left testicle begins to shrink over time, in the bilateral varocele both testicles. In this case, it decreases the sperm count and quality.
With such harmful effects, the mobility of the sperm first decreases. Then the number and morphology (normal image) decreases, thereby leading to varicose infertility.
The pronounced varicocele is diagnosed by manual examination. These are prominent varicoceles of 1,2 and 3 degrees. The diagnosis of the lowest grade subclinical varicocele is made with scrotal color doppler ultrasound. Here, the diameter of the testicle veins increases, blood flows back, leakage rate and flow rate are measured. In the Valsalva maneuver performed by pulling the patient while standing, in the presence of varicocele, the vessels become more pronounced and the amount of blood leakage increases.
In spite of unprotected sexual intercourse for one year, pregnancy does not occur and if there is no child, infertility (infertility) should be accepted and research should be started. Infertility occurs in 10% of the society. 1/3 of this is responsible for men, 1/3 for women and 1/3 for both. Since male examination is easy in infertile couples, examination should be started on male. Two sperm examinations are performed on the third day with one month interval before emptying for two days. If possible, it should be done in two different laboratories. If both examinations are normal, the examinations of the lady can be started. If the sperm tests are broken, the man must be treated first. Normally there should be over 20 million sperm in a 1cc semen, A movement should be 25%, A + B movement 50%, above 4% of normal Kruger morphology, especially 14%. If the sperm count is below 10 million, pituitary and testicular hormones should also be examined to determine whether there are hormonal disorders.
In sperm disorder, varicocele is first investigated. In the presence of varicocele, it is corrected by surgery. Since the construction of a sperm cell takes 86-90 days, it is necessary to wait three months for the sperm to recover after surgery. After 40% of the operation, the patient becomes pregnant after three months. If pregnancy does not occur, it is expected to treat with three to three groups of medication three months old while waiting. Thus, success is achieved in 20-30% more patients. In the remaining patients, treatment is left to obstetricians and IVF centers.
We wish you healthy days.
Prof. Ibrahim BOZKIRLI, M.D.