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Articles By Dr. Praveen Joshi

A varicocele is an enlargement of the veins that transport oxygen-depleted blood away from the testicle. A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum). These veins transport oxygen-depleted blood from the testicles.

The Abnormal dilatations of the veins of pampiniform plexus has a range of effects.

They include

  • Testicular growth
  • Histological changes
  • Endocrinopathy
  • Semen analysis

An enlargement of the veins within the scrotum.

A varicocele may develop as a result of poorly functioning valves that are normally found in veins. In other cases, it may occur from compression of a vein by a nearby structure.

Varicoceles often produce no symptoms but can cause low sperm production and decreased sperm quality, leading to infertility.

Varicoceles that cause no symptoms typically require no treatment. Cases in which symptoms occur can be repaired surgically.

Disease Burden

  • 15% overall male population
  • 35-50% primary infertility
  • 69-81% secondary infertility

Successful Pregnancy for Couple with Non-obstructive Azoospermia

Authored by Dr. Praveen Joshi


Non-obstructive azoospermia is a condition characterized by absence of sperms in the ejaculate semen sample due to either very little or no sperm production. Non-obstructive azoospermia was traditionally considered as impossible to biologically father a child. But the advent of advanced fertility procedures, technologies and advancements in medical knowledge have proven effective for sperm restoration and or retrieval in many cases.

Typical Treatment

Once considered the end of road, advanced treatments for non-obstructive azoospermia have demonstrated high success rates for sperm restoration/ retrieval. For some patients, small pockets of sperm production in the testicles allows sperm extraction for use by assisted reproductive techniques. Some treatments for the condition include lifestyle changes, oral medications, decreased exposure to toxins, hormone therapy and varicocelectomy. For men with compromised fertility following chemo or radiation therapy, time can be the best healer. Often, the reproductive system may resume sperm production following which ART might be helpful.

Case Showcase

Summary: Pregnancy against all odds for couple with non-obstructive azoospermia

A couple who had undergone 2 unsuccessful cycles of intrauterine insemination (IUI) visited me to discuss their options. The husband was 40 years old and suffered from non-obstructive azoospermia. The couple explained that they had used donor sperm in prior IUI cycles, but still had not seen success. Upon closer examination of their fertility profiles, I advised the couple to consider using biological gametes extracted via microsurgical testicular sperm extraction (micro TESE). Despite being skeptical from their previous experiences, they agreed to give the treatment a go. We performed the sperm extraction on the same day as the oocyte pick-up. Using micro TESE, we identified quality sperm and employed IVF protocols to create healthy embryos. The couple chose to freeze their surplus embryos and conceived on their second frozen embryo transfer cycle. The pregnancy is now well along, healthy and stable.

Obstructive azoospermia is a condition in which normal sperm production occurs, but the flow of sperm through the reproductive tract is hampered by one or more blocks. Effectively, this means the semen contains no detectable sperm. Causes of obstructive azoospermia include prior infections, inflammation, scrotal trauma, previous surgeries like hernia repair and rare genetic conditions like congenital absence of vas deferens.

Typical Treatment

Obstructive azoospermia can usually be corrected through surgery (microsurgery or endoscopic surgery), which seeks to reverse blocks in the reproductive tract, or achieve connections that could allow passage of the sperms through normal reproductive tract. If surgical correction is deemed impossible, sperm extraction from the testicles, epididymis or vas deferens is done and in vitro fertilization (IVF), may be considered.

Case Showcase

Summary: Successful sperm augmentation for couple with obstructive azoospermia

A couple who had undergone a series of failed fertility treatments – primarily comprising testicular sperm aspiration, intracytoplasmic sperm injection and two frozen embryo transfer cycles – consulted me to determine their next steps. The wife was 26 years of age, and the husband was 32 years of age and had a prior diagnosis of obstructive azoospermia. I performed a few clinical, hormonal and radiological checks to confirm the condition. Upon confirmation in January 2019, I proposed and performed a vasoepididymal anastomosis procedure. The procedure facilitated a remarkable rise in sperm count in the ejaculate sample, from Azoospermia to 3-4 million/ ml in April 2019 to 31 million/ml in May 2019. Now, with the sperm count in the normal range, the couple are attempting to conceive naturally.

Successful Sperm Augmentation for Couple with Obstructive Azoospermia

Authored by Dr. Praveen Joshi


Oligoasthenoteratozoospermia is a condition defined by an abnormally low sperm count (oligozoospermia), poor sperm motility (asthenozoospermia) and abnormal sperm morphology (teratozoospermia). Only when all these three criteria are fulfilled, is a patient deemed to have oligoasthenoteratozoospermia. The condition may be caused by genetic factors, medication, testicular trauma or injury, abnormal hormone levels, autoimmune disorders, infections, or lifestyle factors like smoking or drinking.

Typical Treatment

Treatment options for oligoasthenoteratozoospermia include medication (for hormonal imbalances and infections), varicocelectomy, percutaneous surgical sperm extraction and ICSI.

Case Showcase

Summary: Healthy pregnancy after 5 failed IUIs for oligoasthenoteratozoospermia-affected couple

A couple – wife aged 36 years and husband aged 45 years – came to seek my help on their fertility journey. They had previously experienced 2 failed intracytoplasmic sperm injection (ICSI) cycles and 5 failed intrauterine insemination (IUI) cycles. After reviewing both their fertility profiles, I diagnosed the husband with oligoasthenoteratozoospermia; his semen reflected low sperm count, poor motility, and abnormal morphology. Also, there was evidence of high DNA fragmentation and bilateral varicocele. I suggested surgical correction of the varicocele and devised a medicated treatment plan to augment sperm quality. The couple spontaneously conceived 4 months after varicocele ligation and are now pregnant with their first child.


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