First of all, what is varicocele? Varix means that any dilatation of the vein. Now vein is supposed to pump blood anti-gravity towards the heart. So any dilatation, dilatation means ballooning of the vein will cause the blood to stay there and the veins, already being thin structures, they lose the pumping mechanism. Testis, it requires the temperature to be lower than the body temperature. Blood being warmer will increase the body temperature. Second, the bad blood or the non-oxygenated blood has toxins which affect fertility and cause what is called as disruption of spermatogenesis. Now this has a bearing on not only fertility as the vein size increases , some men may experience pain. Thirdly there will be a reduction in the size of the testis over a period of time because cells die because they are less oxygenated. Fourthly in large veins, they can develop minor degrees of erectile dysfunction or inability to maintain their erection. So yes, varicocoele is known to cause, but not all men with varicocoele has fertility issue. It’s the pressure effect. Some testises are able to withstand this pressure, some are not. So only by evealuation, when we do a mass screening for varicocoele in 10 men, 7 will have varicocoele, 4 will have fertility problems, 3 may not have. So that’s the key. Not all men with varicocoele will have fertility, but some do have or 50% - 60% of men will have fertility issues and these are correctable.

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