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The Varicocele Myth

If a man is sent to a urologist because of a low sperm count, he is very likely to receive a diagnosis of varicocele. A varicocele is a varicose vein of the testicle normally found in 15 to 20 percent of all men. That is, 15 to 20 percent of all males on this planet have a varicose vein of the testicle, and it is almost always on the left side. The reason for this is that the testicular vein draining blood back from the testicle on the right side drains directly into the major vein of the body, the vena cava, but on the left side the testicular vein drains into the kidney’s vein. This type of anatomy on the left is much more likely to lead to a defect in the valves that normally prevent blood from flowing back down the veins because of the effect of gravity when one stands up. A varicose vein of the testicle is no different from a varicose vein in the leg. When you are lying down, you notice nothing abnormal. However, when you stand up, blood (which would normally be prevented from flowing backward by valves) will fill up and dilate these veins so that they become readily apparent under the skin, even to the naked eye.

Mistaken Notion That Varicocele Lowers Fertility

The enthusiasm for varicocelectomy continued to grow to extremes in the early 1980s. Some urologists in Europe recommended that every postpubertal boy be examined for a varicocele, and if he had one, that it should be operated on at an early age, before it had time to hurt his sperm production. This would mean an automatic operation for at least 15 percent of the world’s teenagers. Other urologists recommended that even if a patient did not have a varicocele, the operation to tie off the testicular vein (the same operation one would perform to correct the varicocele) would increase the sperm production of any male with oligospermia, whether or not he had a varicocele. If these studies and claims were to be taken seriously, there would not be enough urological surgeons to do all of these operations. I am sorry to say that may be just how such an outrageous epidemic of varicocele surgery for male infertility got started in the first place.

The fact is, many urologists who treat male infertility depend heavily on varicocelectomy for their income. I used to perform varicocelectomy routinely myself, many years ago. I was fooled by a “scientific” literature that was filled with enthusiasm, and by the intrinsic variation in sperm count from month to month in various patients that led to the false impression that one third of them had an improvement as a result of the operation. However, there have now been hard, scientifically controlled studies performed by nonsurgeon endocrinologists with a special interest in male infertility, but with no strong preexisting need to find varicocelectomy surgery beneficial.

There was no improvement in pregnancy rate whatsoever in the couples in which the man had a varicocelectomy, and there was no improvement in the semen analysis either. This finding was further strengthened in 1994 by Dr. Eberhard Nieschlag, from Germany, who showed that in men with varicocele, psychologic counseling resulted in as high a pregnancy rate as having a varicocelectomy. Despite the overwhelming evidence that Dr. Gittes’s statement in 1978 challenging the role of varicocele in male infertility was correct, urologists still go on performing varicocelectomies on at least 30 percent or more of men whose wives’ gynecologists refer them to a urologist. This is stuoid

Although a varicocelectomy should be a relatively simple, innocuous operation, it can also be tricky at times because in an effort to get every single vein tied off (which would be necessary to prevent any blood from flowing back into the testicles), a surgeon can accidentally tie off the spermatic artery, which is extremely small and delicate. This destroys the blood supply to the testicle. A clumsy surgeon might even tie off the vas deferens. Many of these busted myths will not win me friends among certain infertility doctors. But on so many of these issues related to “male infertility” enough is enough. Drugs and hormones do not increase sperm count in oligospermic or azoospermic men, and neither does varicocele surgery.