Varicocele

Posted on by Matthew Wosnitzer, M.D.

Are your testicles hot? Probably not the way you might be thinking, and certainly not good for your health!

The Issue: Varicocele (pronounced varik-o-seal) is an abnormal dilation or englargement of testicular veins. These veins normally drain blood from the testicles and send it back toward the heart. Pooling of blood in these enlarged veins causes the testicle to become hotter temperature than normal (think of your car’s engine!) and this affects the cells in the testicle. Varicoceles become an issue if you are a man with low testosterone, difficulty having children, or testicular pain.

Varicocele is the most frequent cause of infertility in a male, occurring in up to 15% of the general adult male population, and in up to 40% among men with infertility (difficulty having a child when the female partner has no fertility issues). With increased heat in the scrotum, the testicles and their cells (Sertoli cells play a key role in sperm production and the Leydig cells in testosterone production) start to have major issues and do not perform well. The significance of acting early to diagnose and treat varicocele is that the testicle function (sperm and testosterone production) decreases more and more over time when a varicocele is present (more). Therefore, an undiagnosed varicocele can result in abnormalities in a man’s sperm count, sperm shape, sperm movement, or even sperm genetic code (DNA), and decreased testosterone in the blood (more).

Diagnosis: The varicocele may not have been bothersome or noticed by the patient before, but your urologist can often detect these just by examining the scrotum. There is a grading system (1 = smallest, to 3 = largest) that is used and the varicocele can also be confirmed on ultrasound imaging (no radiation and painless, completed in less than 30 minutes). A varicocele is considered significant if can be detected on physical exam or if the veins are >2.7 millimeters on ultrasound imaging). Once confirmed by exam and or imaging, discuss further with your physician regarding your semen analysis (checks for sperm abnormalities) and blood total testosterone level.

Treatment: If a patient has sperm abnormalities or low testosterone, or less commonly dull aching pain in the testicle, then varicoceles are most commonly eliminated with a surgery called varicocelectomy. This surgery takes the dilated veins (again, the blood vessels that drain the testicle) and these are pinched off, and blocked permanently. This can be done on one or both testicles. There are other veins that carry the necessary blood away from the testicle so this does not cause any issue. For more in-depth information about varicocelectomy, see our article.

Varicocelectomy will stop additional testicular damage from the varicocele and in many men lead to improved semen parameters, increased Leydig cell function, and subsequently increased testosterone especially if your testosterone was low before the surgery (more). During this surgery, it is ideal for the artery (vessel that supplies blood from the heart to the testicle) to be spared, although sometimes the artery is eliminated. There are multiple ways to perform this surgery, but the outcomes have been shown to be the best (with the fewest varicocele recurrences) when the surgeon uses a microscope (microsurgical subinguinal approach) (more). Feel free to read more about microsurgical varicocelectomy or ask your urologist who specializes in this procedure.

For more information on microsurgical varicocelectomy treatment, click here. For more information on low testosterone, see our blog posts on hypogonadism.

We are pleased to discuss the varicocele diagnosis and treatment further with you. Please contact CMHR for additional information and to schedule a consultation. We welcome our patients from Connecticut, New York, New Jersey, Rhode Island, Massachusetts, Pennsylvania, Delaware, Maryland, Washington DC, throughout the United States, and internationally.

Vasectomy Reversal and male infertility treatment by leading urologist Matthew Wosnitzer in Connecticut

Male Infertility: The Background

Posted on by Matthew Wosnitzer, M.D.

Male infertility can occur due to many causes such as obesity, prescription medications, tobacco, alcohol, marijuana, environmental toxins, and genetics. Additionally, genital defects, sperm transport blockage, erection and ejaculation dysfunction, deficient sperm production and function, and prior surgery can affect male fertility.

Male infertility requires a coordinated effort for couples trying to have children. One of every five couples seeks treatment for infertility, and in up to 50% of cases, the male partner is identified to be a cause of infertility. Male infertility may occur when there are abnormalities in sperm identified by abnormal semen analysis testing.

Semen analysis describes sperm count, sperm concentration, sperm shape (morphology), sperm movement (motility), acidity (pH), and quantity (volume). Normal reference values are defined by the World Health Organization (WHO) criteria and include total sperm count of 39 million sperm per ejaculate, sperm concentration of 15 million/ml, 40% total motility, 4% morphologically normal, 1.5 ml volume. Infertility may occur may occur above these values or when there is decreased sperm number (oligospermia, <20 million sperm per milliliter), decreased quality of sperm (abnormal shape, movement, sperm DNA), or complete absence of sperm (azoospermia). For more information about the male infertility workup, click here.

Oligozoospermia (low sperm count) can have many causes, often unknown, and is usually identified along with abnormalities in the sperm (movement, shape, or DNA issues). Azoospermia (no sperm in the ejaculate) is identified in 15% of infertile men. There are two general categories which explain the cause of having no sperm in the ejaculate: obstructive azoospermia (OA, 40% of all cases of azoospermia) and non-obstructive azoospermia (NOA) which includes the rest of men with azoospermia. These are exactly what they sound like: obstructive azoospermia (OA) results from a blockage along the genital tract somewhere between the testicle (where sperm are produced) and the ejaculatory duct (where the semen enters the urethra during ejaculation) to leave the body. Other parts of the genital tract can also be blocked (the technical names include the rete testis, efferent ducts, epididymis (sperm maturation takes place here), vas deferens, and ejaculatory duct). Non-obstructive azoospermia (NOA) involves impairment or absence of sperm production (spermatogenesis) due to a variety of causes. For more detail see our blog posts on specifics of OA and NOA.

Please continue reading for more details about semen analysis, obstructive azoospermia or non-obstructive azoospermia.

We are pleased to discuss the workup of male infertility further with you. Please contact CMHR for additional information and to schedule a consultation. We welcome our patients from Connecticut, New York, New Jersey, Rhode Island, Massachusetts, Pennsylvania, Delaware, Maryland, Washington DC, throughout the United States, and internationally.

Tomatoes and antioxidants can benefit male fertility

Tomatoes- Prostate Cancer and…Sperm Quality

Posted on by Matthew Wosnitzer, M.D.

Background:

Anti-oxidants such as pomegranate are often in the news for possible health benefits. Lycopene is another anti-oxidant known as a carotenoid, which is most often found in tomatoes and tomato-based products.

Some older studies have identified decreased risks of various types of cancer (prostate, lung, stomach) with increased lycopene intake, while others did not show such a benefit. Recently, however, multiple studies show that there is a likely benefit to including lycopene in your diet: a decreased risk of prostate cancer as well as improved sperm shape (morphology).

Semen quality and antioxidants:

You can read more about the effects of antioxidants such as lycopene on sperm quality in our blog post here.

Prostate cancer and lycopene:

In terms of prostate cancer risk, let ‘s discuss the evidence for this finding. Specifically, a Harvard and Ohio State University study noted that increased dietary lycopene intake is associated with decreased risk of prostate cancer (10-25% decreased risk), including lethal forms (highest intake group had 28% decreased compared to lowest lycopene intake) of prostate cancer in a recent study of nearly 50,000 male health professionals. Earlier and higher lycopene intake is associated with improved outcomes including decreased blood vessel (angiogenic) growth in tumors.

A systematic review from China in 2013 identified that the greatest raw tomato intake had a 19% decreased risk of prostate cancer vs. those with the lowest intake. Cooked tomato intake also had benefit with a 15% decreased risk.

Another recent study from 2014 from Italy indicated that low lycopene levels in the prostate are most frequently associated with prostate cancer. In this study, 32 men took 20-25 mg/day of lycopene for six months, and then had prostate biopsy. Prostatic lycopene level was significantly lower among men with prostate cancer than in men with prostatitis (inflammation) or HGPIN (which is a pre-cancerous prostatic tissue). Nearly 78% of the men with prostate cancer had a lycopene level <1 ng/mg, while only 6% of the HGPIN men and none of the men with prostatitis had such a low lycopene level in the prostate.

While increased lycopene consumption seems to be beneficial, additional study of prostatic levels and intake should be studied in a variety of populations to confirm these findings.