1- Varicocele is the most common and the most common cause of male infertility, with which we achieve the best results as a result of successful microsurgical surgical treatment. The diagnosis of varicocele should be made only by manual examination, not by ultrasound. Unnecessary operations are performed because varicocele is detected in many people by Doppler ultrasonography. does not provide any benefit.
2- Assisted reproductive methods such as in vitro fertilization, ICSI and vaccination should not be offered to the person with varicocele. Varicocele disrupts the chromosomal structure of the sperm cell (DNA fragmentation), reducing the fertilization power of the partner’s egg; Even if fertilization does occur, the probability of miscarriage increases. It should not be forgotten that in vitro fertilization is a method that should only be considered as a last resort, increases the risk of congenital anomalies and diseases in the baby up to 30%, and carries risks for the mother.
3- Microsurgery is the most technically successful and least likely complication of varicocele surgery. In microsurgical varicocele operation, technical success can be over 99% in our series and in the series of specialist centers in the world, the rate of serious complications can be reduced to 0% and the rate of minor complications to 3-5%. In other operation techniques, the risk of hydrocele rises to 40% and arterial damage to 5%. Embolization method, which is a radiological intervention in the treatment of varicocele, is not preferred due to low success and high serious complication rates.
4- Varicocele does not recur, this expression is used incorrectly when the surgical intervention is insufficient. If the varicocele persists as a result of inadequate surgery, microsurgical correction surgery can be applied. Due to the techniques applied in surgical methods other than microsurgery, inadequate surgery and the resulting recurrence rate can increase up to 40% and complication rates increase significantly.
5-Microsurgical varicocele operation is definitely not a simple surgical procedure! Microsurgical technique is successful only in experienced hands who have received special training on this subject. Inadequate and erroneous applications of microsurgery, like any other method, can lead to very important complications, even organ loss. After unsuccessful varicocele operations performed with microsurgery and other old techniques, I come across many patients whose varicocele continues or who have problems due to complications, and who face serious problems such as hydrocele and testicular degeneration. Although some of these patients, whose sperm quality or spermiogram results deteriorate even more, benefit from corrective microsurgery, unfortunately some of them cannot be helped.
6- With unconscious and inadequately applied microsurgical technique, varicocele may not disappear, serious complications such as hydrocele and organ loss may occur as a result of artery and lymphatic channel damage; The quality and success in which more techniques are applied than the applied technique is important. I recommend that those who are going to have varicocele surgery should do their research by giving the necessary importance to the subject and have them operated by trained and experienced specialists. For scientific and accurate results in spermiogram analysis, which is the most important test in male infertility, Andrology Laboratory and Tümlab (www.tumlab.com) at Istanbul Medical Faculty are the laboratories I trust the most.
7- Varicocele can also cause pain. Although it cannot be guaranteed that the pain will go away, the pain disappears in many cases with the application of microsurgical methods and pain-oriented operation techniques.
8- After returning from abroad in 1992, I taught microsurgery varicocele surgery, which I started in our country in more than 2500 cases, to many of our assistants at Istanbul Medical Faculty and contributed to its implementation in different regions of Turkey. Microsurgical varicocele operation has become the preferred method in recent years, especially among the faculty members of university clinics on Andrology, and the most distinguished clinics of the world have adopted the microsurgery technique in varicocele surgeries.
Male Infertility Treatment and Microsurgical Varicocele Operation
In about 15-20% of marriages, there is a problem of not being able to have children at the time they want and in the number of times they want.
In the infertility problem of couples, only male-related factors are up to 20%, and the problem in men in about 40% of couples is added to the problem in women; In 50-60% of couples who have difficulties in conceiving, it is revealed that a problem in the man partly contributes to the problem of infertility. Although most of the problems in men can be understood from the examination and sperm analysis, some situations may require special examinations.
As a result of the treatments, most men can solve their problems and have children with normal sexual intercourse. It is a common erroneous practice to switch to female infertility treatments without the man’s being examined by a urologist and his spermiogram performed in a specialized laboratory is evaluated by an experienced urologist. It should not be forgotten that male infertility may be the first sign of an underlying and life-threatening serious disease in some cases.
Evaluation in terms of male infertility is initiated with an interview with the Urologist-Andrologist at the first stage and with at least two spermiograms evaluated in the WHO (World Health Organization) criteria, by giving sperm correctly. As seen in many areas in Turkey, the fact that scientific standards are mostly not applied in laboratory examinations and especially in the field of Andrology, the examinations are not carried out with quality control practices, the sperm given under inappropriate conditions are not studied with the correct protocols, causing infertility examinations to give misleading results to a large extent. For these reasons, I only comment on the spermiogram results of the laboratories I know and trust.
I can show Istanbul Medical Faculty Andrology Laboratory and Tümlab Andrology Laboratory (www.tumlab.com) as examples of reliable spermiogram results and vaccination studies. Making comments based on spermiograms that are not in the correct format, misleading and contradictory both put the physician in a difficult situation and negatively affect the treatment process of the patient.
If a problem is determined in the examination or sperm test as a result of the first evaluations, detailed examinations will be started. These may be more detailed tests with sperm, hormone analysis, ultrasonography and some other radiological and genetic tests. As a result of the completion of the examinations, treatments are started to increase the fertilization capacity by increasing the number, mobility and quality of the sperm cells in the semen of the man.
Some of the men with infertility problems can be treated by replacing the hormones that are found to be deficient or by increasing the sperm count with drugs in patients with the appropriate hormonal structure.
Patients who do not have any sperm cells in the sperm analysis despite special examinations are evaluated with detailed examinations and it is investigated whether there is sperm production in their testicles and congestion in the semen ducts. Although there is sperm production in their testicles, some of the men whose sperm cells are not found in spermiogram examinations can be provided with normal sexual intercourse by applying special microsurgery or endoscopic methods.
Surgery with varicocele and microsurgical technique:
Varicocele (expansion in testicular veins, varicose veins), which is detected in 15% of all men and 40% of those with infertility problems, is one of the most important factors that impair sperm production. Varicocele is the most common cause of infertility in men and the most successful result of microsurgical surgery. As in the World Health Organization (WHO) researches, my personal experience approaching 2500 surgeries has scientifically revealed that varicocele causes infertility and its successful treatment contributes to infertility treatment. Varicocele impairs sperm production by affecting microcirculation after temperature increase in testicles and reflux of used blood in veins to testis; As a result of its effects on number, mobility, structure and chromosomal structure, it decreases the fertilization power and increases the possibility of miscarriage both in normal sexual intercourse and in assisted reproductive techniques such as in vitro fertilization (ICSI) and vaccination. First of all, I recommend microsurgery varicocele surgery for the infertility problem to my patients with varicocele, I do not find it appropriate to apply drug therapy or in vitro fertilization methods to those with varicocele. The diagnosis of varicocele, which can be seen in different degrees of severity, should be made by an experienced Urology-Andrology specialist with a detailed examination performed under the right conditions. Since surgery for varicoceles that can only be detected by ultrasonography is not beneficial, no other examination other than a sensitive examination should be requested for the diagnosis of varicocele, except in very special cases.
Varicocele, which can also be a cause of pain, is not a health problem in general, but is important only if it is detected in men who want to have children. Varicocele, which starts in adolescence, may prevent the development of the testicles, and its negative effects on sperm production gradually increase over time. It is a common situation in our country that men can have a child without feeling the effect of varicocele too much thanks to their marriage at a young age, and in later years, when they want to have a child again, they do not have a second child due to the varicocele effect, which continues to increase over the years.
Varicocele is the most common cause of male infertility, which can be successfully treated using microsurgical technique. In cases of varicocele treated with the successful application of microsurgical methods by correct diagnosis, a statistically significant improvement of over 80% is achieved in spermiogram results, and most of these patients can have children without any further treatment; A significant part of the rest will reach a level where they can benefit from easier and more economical methods of in vitro fertilization, such as intrauterine insemination.
Recurrence varicocele is detected in 30-40% of those who have had varicocele surgery before but have not had a positive result. In these cases, where the operation performed is insufficient due to technical reasons, positive results can be obtained by applying microsurgical correction surgery.
If varicocele is detected before in vitro fertilization (microinjection) applications, it has been determined that pregnancy rates increase when the effect on the chromosomal structure, which reduces the fertilization ability of sperm cells, is eliminated by operating with microsurgical technique.
We know that the diagnosis of varicocele in men with infertility problems is made excessively as a result of incorrect application of hand examination and ultrasonography methods, and sometimes due to commercial concerns, and unnecessary surgeries are performed. Since 1993, when I started the microsurgery technique in our country, I had to explain with difficulty to hundreds of people who applied to me for surgery, saying that varicocele was detected, even though I had performed about 2500 microsurgical operations.
The varicocele does not disappear in 40% of the patients who underwent varicocele operation as a result of the unsuccessful application of microsurgery or other techniques applied to this very sensitive surgery performed by the application of special microsurgical methods. In some of the operated patients, serious and even irreversible complications such as hydrocele (swelling as a result of the collection of large amounts of fluid between the membranes of the egg) as a result of the ligation of the lymph channels, and even the testicle deformation as a result of the ligation of the arteries may occur. As a result of unnecessary and unsuccessful applications of varicocele surgery, which has a benefit rate of over 80% for infertility, this benefit rate may decrease to 20%. For this reason, I recommend that people who are offered surgery do not take the subject lightly, but examine it in detail and discuss it with Urology-Andrology specialists who are especially interested in this subject.