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Men's Health: Outpatient procedure helps some infertile men

X-ray-guided technique treats swollen veins in the scrotum, but good sperm quality is also key

An outpatient procedure can safely treat swollen veins in the scrotum, a common cause of infertility in men. But not every infertile couple is able to conceive after the procedure.

These swollen veins, or varicoceles, occur when the valves that regulate blood flow in veins become defective, causing blood to accumulate. The warm blood pooling in the varicoceles is thought to increase the temperature of the scrotum and reduce sperm count and movement.

While many varicoceles cause no symptoms and are harmless, those causing problems can be treated with an outpatient procedure. In one of these techniques, called spermatic vein embolization, the doctor inserts a small tube through a nick in the skin at the groin and uses X-ray guidance to steer it into the varicocele. A tiny platinum coil is inserted through the tube in order to block the defective vein and reroute blood to normal veins.

Dr. Sebastian Flacke, an assistant professor of radiology at the University of Bonn in Germany, studied spermatic vein embolization in 223 infertile men, ages 18 to 50, with at least one varicocele. All of the men had healthy partners with whom they were trying to achieve a pregnancy.

All but two of the varicoceles were successfully treated with this technique. Three months after the embolization, a semen analysis performed on 173 men showed that on average, sperm count and movement, or motility, had significantly improved. Six months later, one-quarter of the partners reported a pregnancy.

A man with high sperm motility before the procedure was more likely to get his partner pregnant after treatment. “On the other hand, those people with really impaired semen prior to treatment might not benefit from this. But this is something we will have to assess in further studies,” Flacke says.

He adds that one of the main benefits of spermatic vein embolization is that there aren’t any major complications. “This is a procedure that is done in minutes and usually patients are discharged in the next couple of hours, which is nice, compared to surgery where you usually have a longer hospital stay.”