Varicocelectomy: Effect on Fertility

  • David P. Gentile
  • Abraham T. K. Cockett
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 286)


The varicocele is the single most commonly identified, correctable form of male infertility1. It occurs in approximately 15% of the normal male population and in 40% of those presenting for the evaluation of infertility1. A marked left sided predominance exists. This is most probably secondary to a combination of factors. First, the spermatic vein on the left side is 8–10 cm longer than the right, predisposing it to greater hydrostatic pressures, particularly in the erect position. Second, the entry of the spermatic vein into the renal vein on the left compared to its entry into the inferior vena cava on the right leads to relatively elevated pressures on the left for two reasons. The pressure gradient at the spermaticorenal junction is lower than at the spermaticocaval junction, in so far as the pressure in the renal vein is higher than in the vena cava2. In addition, the Bernoulli principle of fluid dynamics dictates that in any horizontally moving fluid, pressure increases as the velocity of flow decreases. The lower flow rate through the renal vein as compared to the vena cava produces less “forward draw” on blood traveling in the left spermatic venous system. The end result is elevated pressures in the left system. Therefore, man due both to anatomic considerations as well as evolutionary, in that he has assumed an erect posture, is predisposed to the formation of varicoceles.


Renal Vein Testicular Volume Spermatic Vein Internal Spermatic Vein Total Sperm Count 
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  1. 1.
    Cockett, A.T.K., Urry, R.L. and Dougherty, K.A. The varicoceles and semen characteristics,J. Urol., 121:435 (1978).Google Scholar
  2. 2.
    Shafik, A., Moftakh, A., Olfat, S., Mohi-El-Din, M. and El Sayed, A. Testicular veins: Anatomy and role in varicocelogenesis and other pathological conditions.Urol., 35(2): 175 (1990).PubMedCrossRefGoogle Scholar
  3. 3.
    Segal, S., Sadovske, E., Palti, Z., Pfeifer, Y. and Polishuk, W.Z. Serotonin and 5-Hydroxyindole acetic acid in fertile and subfertile men.Fertil. Steril., 26: 314 (1975).PubMedGoogle Scholar
  4. 4.
    Urry, R.L., Dougherty, K.A. and Cockett, A.T.K. Correlation between follicle stimulating hormone, luteinizing hormone, testosterone, and 5-Hydroxyindoleacetic acid with sperm cell concentration.J. Urol., 116:322 (1976).PubMedGoogle Scholar
  5. 5.
    Urry, R.L. and Cockett, A.T.K. Elevated urinary levels of 5-Hydroxyindole acetic acid and its relationship among levels of plasma follicle stimulating hormone, testosterone, and testicular pathology in patients with severe oligospermia and/or azoospermia.J. Urol., 118:591 (1977).PubMedGoogle Scholar
  6. 6.
    Zorgniotti, A.W. and MacLeod, J. Studies in temperature, human semen quality, and varicocele.Fertil. Steril., 24:854 (1973).PubMedGoogle Scholar
  7. 7.
    Cockett, A.T.K., Al-Juburi, A., Altebarmakian, V., Vergamini, R.F. and Caldamone, A.A. The varicocele: New experimental and clinical data. Urol., 15(5):492 (1980).PubMedCrossRefGoogle Scholar
  8. 8.
    Kay, R., Alexander, N.J. and Baugham, W.L. Induced varicoceles in Rhesus monkeys,Ferti l. Steril., 31:195 (1979).Google Scholar
  9. 9.
    Turner, T.T. Varicocele: Still an enigma.J. Uro l., 129:695 (1983).Google Scholar
  10. 10.
    Nagler, H.M. Varicocele: Adult. In: “Common Problems in Infertility and Impotence” Chapt. 7, pp. 51–59. A.J. Wein and J. Rajfer (eds), Year Book Medical Publishers, Chicago (1990).Google Scholar

Copyright information

© Plenum Press, New York 1991

Authors and Affiliations

  • David P. Gentile
    • 1
  • Abraham T. K. Cockett
    • 1
  1. 1.Department of UrologyThe University of RochesterRochesterUSA

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