From the Guidelines
Small hydroceles typically do not affect fertility, as they do not interfere with testicular function or sperm production. A hydrocele is a fluid-filled sac that surrounds the testicle, causing swelling in the scrotum, but it generally doesn't impact the testicle's ability to operate normally 1. However, very large hydroceles might potentially cause issues by creating excessive heat around the testicle due to the insulating effect of the fluid, as optimal sperm production requires temperatures slightly below body temperature.
Some key points to consider in the context of male infertility include:
- Azoospermia, or the absence of sperm in the ejaculate, can be caused by obstructive or non-obstructive factors 1
- Low semen volume, acidic pH, and azoospermia can indicate distal obstruction in the genital tract 1
- Karyotype testing is recommended for males with primary infertility and azoospermia or sperm concentration <5 million sperm/mL when accompanied by elevated FSH, testicular atrophy, or a diagnosis of impaired sperm production 1
- The World Health Organization reference limits for human semen characteristics provide a framework for evaluating semen quality, including parameters such as semen volume, total sperm number, and sperm concentration 1
In the case of a small hydrocele, it is unlikely to cause significant impact on fertility, unless it is secondary to another condition that may affect testicular function or sperm production. If you're concerned about fertility and have a hydrocele, it's advisable to consult with a urologist who can evaluate your specific situation and determine if the hydrocele poses any risk to your reproductive health. The urologist can assess the hydrocele and provide guidance on any necessary treatment or further evaluation, taking into account the latest guidelines and recommendations for male infertility, such as those outlined in the AUA/ASRM guideline 1.
From the Research
Effect of Small Hydroceles on Fertility
- Small hydroceles may not have a direct impact on fertility, as suggested by a study published in 1990 2.
- The study found that hydrocele seems to be more of a symptom than an actual pathological entity and has no direct effect on later fertility.
- However, in the presence of certain associated pathological findings, the testes are significantly altered, which may affect fertility.
Management of Hydroceles
- Hydroceles can be managed by conservative treatment, fluid aspiration, or hydrocelectomy 3.
- Aspiration and sclerotherapy is a minimally invasive treatment option for hydroceles, with a success rate of 97.62% and few side effects 4, 5.
- Sclerotherapy with alcohol can be performed without difficulties and is cost-effective, with few side effects, and may be performed in patients who wish to preserve fertility 5.
Considerations for Fertility
- In younger men, the wish for children must be taken into account when considering treatment for hydroceles, as surgical procedures may lead to infertility 6.
- Fertility preservation procedures, such as cryopreservation of semen, may be considered before surgery 6.
- Post-sclerotherapy spermograms have shown a reduction in sperm parameters, but these parameters return to normal 12 months after the procedure 5.