Treatment of male infertility due to varicose veins

Nearly 50% of men with infertility have abnormal sperm. In particular, varicose veins are the most common cause and can be treated with surgery.

Frequency of varicose veins

(Photo: VNN)

According to the World Health Organization (WHO), varicose veins (ECT) occur in 11.7% of men with normal semen and in 25.4% of men have abnormal sperm. More than 80% of GTMT cases do not suffer from infertility, but 35-40% of men with primary infertility suffer from diabetes. 69-81% of men with infertility secondary to this disease. This proves that GTMT gradually decreases the spermatogenicity of the testicle and usually occurs on the left.

Effect of ECT on testicular function:

- Temperature increase has been confirmed by many studies to reduce the function of the testicles, adversely affecting spermatogenesis.

- The metabolites of kidney and adrenal. Adrenomullin - a powerful vasodilator that is normally found only in the adrenal glands, kidneys, lungs, heart, but not in the testes, is also found with abnormally high concentrations in the vein due to rebound phenomenon ( reflux) from the kidney vein and the adrenal vein into the vein. Maybe adrenomullin contributes to increase the temperature of the scrotum.

- Lack of oxygen can adversely affect testicular function.

Effect of environmental protection on the ability to have children. In 1955, Tulloch recorded an inseminated (non-sperm) patient who had a child after receiving GTMT surgery.

- Semen: In ECMT, the most common image of spermatozoa is reduced mobility (90% of cases), followed by low sperm density below 20 million / ml (65% of cases).

- Hormonal: There are studies showing that the function of Leydig cells is reduced. Because this is a cell that produces testosterone, the concentration of testosterone in the blood of patients with diabetes often decreases, and testosterone returns to normal after surgery. Sertoli cell function is also affected, manifested by reduced FSH response. Therefore, the FSH concentration of patients with metabolic syndrome is usually high.

Diagnose

ECMT is usually divided into three degrees:

- Level 1: GTMT only discovered when doing Valsalva legal career.

- Degree 2: GTMT detects standing position.

- Level 3: Metabolism see under the skin and palpable when the patient stands.

The tests that help detect GTMT that the clinical examination omitted are:

Ultrasound, which helps detect 34% of GTMT cases but clinical examination missed. Doppler ultrasound has a high value in the diagnosis of GTMT, but the drawback of this test is that it needs to have blood flow in the blood vessels to detect it.

An intravenous X-ray is the most accurate test to diagnose GTMT but this is an invasive test and has dangerous complications.

Prognostic factors

After surgery, the natural pregnancy rate of patients with T2DM and level 3 is higher than those with DM 1.

People with normal testicular volumes have higher rates of postoperative natural pregnancies than those with atrophic testes.

Treatment

The goal of ECT treatment is to improve the function of testicles and semen to increase the likelihood of having children.

X-ray interventions to make embolism have a common complication rate of 6% such as vascular perforation, embolism.

Post-retroperitoneal vein column surgery (Palomo surgery), has a lower recurrence rate and preserves the artery. Inguinal reclining surgery (Ivanisevic surgery) has a lower recurrence rate. Surgical reclining under the groin has the same advantages as inguinal surgery and less pain due to no muscle cutting, however micro surgery is required.

Laparoscopic surgery.

In short, inguinal recessive surgery or low groin incision is the surgery with the highest success rate, the least complication and the highest economic efficiency.

Most studies have shown that GTMT treatment helps improve semen and pregnancy rates. In couples who cannot have a natural baby after surgery, the combination of pumping sperm into the uterus increases the pregnancy rate.