Varicoceles are dilated veins in the scrotum surrounding the testis. Approximately 15 percent of all men have varicoceles, and for most men they do not seem to impair testicular function. However, about 40 percent of all men with fertility problems do have varicoceles, and it is generally believed that their presence either directly or indirectly impairs sperm production. Although the precise mechanism by which the varicocele has this effect has not been found, many investigators believe that a secondary testicular temperature causes impaired spermatogenesis. Whatever the cause, many studies have demonstrated that 40 percent to 70 percent of men undergoing varicocele repair will have an improvement in semen quality, and about 40 percent will subsequently initiate a pregnancy.
Many urologists now prefer an operative approach that employs the use of an operating microscope. The use of this higher magnification better ensures preservation of important spermatic cord structures (e.g., artery and lymphatics) with effective ligation of those veins contributing to the varicocele.