Graphic: how it works
One of the commonest causes of male infertility can be treated successfully with a simple and minimally invasive surgical procedure that improves significantly the chances of fathering a child.
The new technique can correct knots of varicose veins in the scrotum, known as varicoceles, that can adversely affect a man’s sperm count and quality, research in Germany has shown.
Within six months of 173 previously infertile men with at least one varicocele receiving the therapy, a quarter of their partners had become pregnant, scientists at the University of Bonn found.
The treatment also significantly improved average sperm counts and enhanced sperm motility — a measure of its swimming ability which is critical to fertility.
Advertisement
“We found that spermatic vein embolisation combined with anti-inflammatory treatment improves sperm motility and sperm count in infertile men with varicoceles,” said Sebastian Flacke, who led the study. “Six months after treatment, 26 per cent of couples had achieved a pregnancy.”
Varicoceles are common, affecting up to 20 per cent of adult men. The networks of faulty veins usually develop between the ages of 15 and 25. They are often harmless and lead to no serious symptoms, but can at times cause pain and damage the testis.
As with varicose veins in the legs, varicoceles occur when the one-way valves inside veins that draw blood away from the testicles and back towards the heart fail. This means that blood does not circulate properly out of the testicles, causing swelling and the formation of a clump of tangled blood vessels that can be felt through the scrotum.
The reverse blood flow can both raise pressure on the testis, potentially causing tissue damage and shrinkage, and raise the temperature with adverse effects on sperm quality. About 40 per cent of infertile men have varicoceles, many more than in the general population, though the link to infertility is not universally accepted by specialists.
Traditional treatment has normally involved open surgery to remove the faulty veins, but the new embolisation process now offers a much less invasive alternative.
Advertisement
A small cut is made in the groin area, and a catheter is fed into the affected vein, using x-ray guidance to find the right place. A special fluid and tiny platinum coils are then injected, which cause the blood to clot and close off the faulty vein. Blood then cannot flow back down it towards the testicles, and instead returns towards the heart using healthy veins. The procedure is performed under local anaesthetic, it is not normally painful, and patients can usually leave hospital and even return to work the next day.
In the study, which was presented yesterday at the Radiological Society of North America conference in Chicago, Dr Flacke’s team treated 223 infertile men aged between 18 and 50 for varicoceles, using embolisation. A semen analysis was performed on 173 of them. All the men had healthy, apparently fertile female partners with whom they were trying to conceive. Of the 228 varicoceles treated in this way (some patients had more than one), 226 were cured.
Six months after treatment, 45 of the men’s partners were pregnant. “This study confirms that varicocele repair can significantly improve sperm count and motility,” Dr Flacke said.