Varicocele induced oligospermia – a case report

Dr R K Singh                                             

Varicocele is dilatation of pampniform plexus of the spermatic cord. Severity is graded as follows:-

• Grade-0     Only demonstrable on technical investigation.
• Grade-1     [Small] palpable only on Valsalva maneuver [straining].
• Grade -2    [Moderate] Palpable but not visible at Room          Temperature.
• Grade-3     [Larger] Visible when standing upright at Room temperature. 

Varicocele may be present in 15-20% of normal fertile male population.   However, 40% of infertile men may have them.

Aetiology
Varicocele is much more common [80-90%] in left testicle than in right because of several anatomical features, including:-

1. Angle at which the left testicular vein enters the left renal vein.
2. Lack of effective antireflex valves at the junction of the testicular vein and renal vein.
3. Increased renal vein pressure due to its compression between the superior mesenteric artery and the arota.[nut cracker effect]

Varicocele can often affect opposite testicle. Up to 30-40% of men with palpable left varicocele may actually have bilateral varicocele.

Pathophysiology
Despite large number of animal and human studies, the exact mechanism pointing towards varicocele is poorly understood. Theories include—

1. Abnormal high scrotal temperature.
2. Hypoxia due to venous stasis.
3. Dilution of inter testicular substrates [   eg.Testosterone]
4. Imbalance of the hypothalamic-pituitory-gonadal axis.
5. Reflux of Renal and adrenal metabolites down the spermatic vein. 

Most studies support theory of increased testicular temperature. It has long been observed that even minor fluctuation in temperature can affect spermatogenesis.

Diagnosis
Varicoceles are defined as dilatation of veins of Pampniformplexus. Most often it is recognized by clinical examination but sonographic evaluation is definitive.

Sperm analysis- This is most important test to evaluate fertility in male.

Colour USG is advised to evaluate varicocele.

Clinical
A patient with varicocele is usually asymptomatic and often seeks care for male factor infertility. Some times, he may also report scrotal pain or heaviness in testicles.  Careful physical examination remains the primary method of varicocele detection.

An obvious varicocele is often described as feeling like bag of worms in testicles.

Case
Mr. S.Singh aged 34, married 6 years ago, and reported for treatment of infertility. Couple wanted issue. He was advised for surgery by urologist. , as his USG revealed   varicocele.  His semen analysis showed 1.2million/ml sperm count.

The case was repotorised using Synthetic repertory.

 Symptoms included:-

1. Ailment from disappointed love.
2. Ailment from anxiety.
3. Dream of feasting.
4. Dreams of being pursued.
5. Decreased sexual desire.
6. Fear of impending disease.
7. Aversion to company.

Medicine given : 10/10/2006

• NATRUM.MUR 10M/3 DOSE
• Followed by acid phos30
• For next one month.
• 12/11/2006 :  Feeling better.
• NAT.MUR10M /3doses
• Followed by hammamelis 30.
• For next one month.

Semen analysis dated 10/12/2006 showed marked increase in semen count ie; 31.5 million/ml. Patient is still under follow up.

Conclusion
Homoeopathy is quite effective in male infertility.

Randomized controlled trials found that surgical ligation or scelrisation (surgical technique that stop blood flow through affected blood vessels) of subclinical or clinical varicocele did not improve pregnancy rate (LANCET 2003; 361:1849-52).

In the light of above study of Lancet and outcome of present case, it can be concluded that homoeopathy offers best possible treatment for varicocele induced oligospermia  , leading to male infertility.

NOTE- This paper was presented in National seminar organized by Asian homoeopathic medical league at Lucknow on 28^th October 2007

Dr R K Singh
Email:- dr_ravindrasingh31@rediffmail.com