Doppler flow studies, venography and thermography in the evaluation of varicoceles of fertile and subfertile men.

The varicoceles of 39 men of proven fertility and 57 husbands of infertile marriages were assessed by the Doppler technique and classified according to venous activity. Retrograde left renal venography in 17 subjects showed that Doppler grading was unable to distinguish between 7 patients with competent internal spermatic veins and 10 with internal spermatic vein reflux. Patients whose varicoceles were associated with internal spermatic vein reflux had a significant reduction in sperm density and these may be implicated as a cause of male infertility. The remaining varicoceles were probably the result of incompetence of other venous tributaries of the spermatic cord and were associated with higher sperm densities. The Doppler was able to identify accurately those varicoceles with significant elevation of scrotal temperature as determined by computer assisted infra-red scrotal thermography. The sperm densities of these patients were similar to the values found in patients with normal scrotal temperatures. The varicoceles of infertile men were found to have a greater incidence of spontaneous venous activity than the varicoceles of fertile men and this suggests that any reduction of fertility caused by elevation of scrotal temperature may be via an effect other than a reduction in sperm density.