Patient: My doctor recently recommended a scrotal Doppler ultrasound to check for a varicocele, and I’ve been told that I might need surgery if it’s diagnosed. I’m confused and a bit worried. Is this really necessary?
Dr. Malpani: I’m glad you brought this up. Let me start by saying that a varicocele is one of the most misunderstood and overdiagnosed conditions in male infertility. Unfortunately, many infertile men are routinely advised to get a scrotal Doppler ultrasound to check for it, but in most cases, this is a completely pointless test. Let me explain why.
Patient: Pointless? But I was told it’s important to identify if a varicocele is affecting my fertility.
Dr. Malpani: That’s what many doctors say, but here’s the truth: many fertile men also have varicoceles, and they father children without any issues. In fact, there’s no clear correlation between the presence of a varicocele and male fertility. Just because you have one doesn’t mean it’s causing your infertility. This is why routine testing for varicoceles often leads to unnecessary treatments.
Patient: So, what happens after a varicocele is diagnosed?
Dr. Malpani: Once a varicocele is diagnosed, the man is usually referred to an andrologist. The andrologist often advises surgery to treat it, claiming that it will improve fertility. However, this advice is problematic because the surgery rarely delivers the promised results. While it’s true that surgery might increase sperm count in some men, it’s equally true that it can decrease sperm count in others. There’s no guarantee it will improve fertility, and in many cases, it’s completely unnecessary.
Patient: That’s troubling. Why do doctors recommend this surgery if it doesn’t reliably help?
Dr. Malpani: There are a few reasons. First, varicocele surgery has become a standard treatment protocol in many clinics, even though it’s not evidence-based. Second, some doctors believe that fixing a visible issue, like a varicocele, is better than addressing the bigger picture of infertility. Unfortunately, financial incentives also play a role. Surgery is expensive, and recommending it can be profitable for clinics and doctors.
Patient: That sounds unethical. What’s the risk if I choose to skip the surgery?
Dr. Malpani: Skipping the surgery is often the wisest choice. If the primary goal is to improve fertility, there are far more effective and less invasive options, like IVF or ICSI, which directly address the root cause of infertility. The risk of not having surgery is minimal, especially if your sperm parameters are within a range that allows for advanced reproductive treatments.
Patient: But what if the varicocele is causing discomfort or pain? Should I still avoid surgery?
Dr. Malpani: That’s a valid concern. If a varicocele is causing significant pain or discomfort, surgery might be justified for symptomatic relief. However, for fertility purposes, it’s usually not worth it. Pain is a separate issue, and the decision to operate should be based on how much it’s affecting your quality of life, not your fertility.
Patient: So, how can I make an informed decision if I’m being pressured to go through with the surgery?
Dr. Malpani: Start by asking your doctor some key questions. For example:
How will the surgery improve my fertility outcomes?
Are there less invasive alternatives?
What’s the evidence supporting this recommendation? If the answers are vague or unsatisfactory, consider seeking a second opinion. Remember, you’re not obligated to proceed with any treatment you’re uncomfortable with.
Patient: That’s good advice. I’ve already had a semen analysis done. Shouldn’t that be enough to guide treatment?
Dr. Malpani: Exactly. A semen analysis is often more informative than a Doppler ultrasound when it comes to evaluating fertility. If your semen analysis shows issues like low sperm count or poor motility, these can be addressed directly with advanced treatments like IVF or ICSI. You don’t need a varicocele surgery to improve these parameters.
Patient: Thank you for clarifying all this, Dr. Malpani. I feel much more confident now about avoiding unnecessary procedures.
Dr. Malpani: I’m glad to hear that. My goal is to empower patients like you to make informed decisions. Remember, surgery should always be a last resort, not a default option. If you’d like a second opinion, you can fill out the form on our website with your reports, and I’ll provide a free second opinion here.
You can also get answers from Dr. Malpani instantly at https://www.drmalpani.com/chat-w-chatbot/index.html