Vol.3, No.8, 504-506 (2011) Health
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Psychological effects of infertility in clinical varicocele
Ali Asghar Ket abchi*, Mahsa Ketabchi
Kerman Univ ersit y of Med ical S ciences , P hysiology R es earch C ent er, K erm an, Ir an; *Corresponding Author: dr.ketabchi@gmail.com
Received 12 April 2011; revised 16 May 2011; accepted 27 May 2011.
Objective. The general objective of this study
was to analyze the perception and attitude of
Clinical varicocele patients treated for infertility
at the Shafa Hospital of Kerman, Iran. Method.
This is a case control study of 62 infertile pa-
tients with Clinical varicocele, they invited to
participate to a survey by demographic and
Hamilton Depression Rating Scale (HDRS)
questionnaires prior to the surgical procedure
and compared the results with a control group
(50 age matched healthy men), from April 2009
to May 2010 at the Shafa Hospital of Kerman,
Iran. Results. In the study group 45% of patients
(28/62) said that they used to isolate themselves
from the public. 32% (n = 20) patients have
doubt about the results of operation, 20% (n =
12) believed operation will cause erectile dys-
function; 16% (n = 10) declared that their infer-
tility problem is mainly due to their wife infertil-
ity not themselves; 17.7% (n = 11) of them di-
vorced (regarding to infertility). Hamilton De-
pression Rating Scale were respectively (28.8
+/– 6.5) and (15.6 +/– 1.7) in the study and con-
trol groups (p = 0.001). Conclusions. Clinical
varicocele patients have a very negative per-
ception about their condition specially whose
primary infertility and in comparing to general
population have more depression grades. So, it
is strongly recommended that for improve their
psychological status by detailing their problem
and changing negative perception and attitude
to encourage them to follow and continue treat-
ment options.
Keywords: Clinical Varicocele; Infertility; Attitude
Although psychologic aspects of infertility that affect
physiology of potency and reproduction by neuroendo-
crinologic factors like reported oligospermia in emo-
tional stress status [1], but the emotional stress itself also
result from well-known organic infertility factors as va-
ricoceles,so both emotional factors and infertility can act
as vicious cycle .
Clinical varicoceles cause some problems from cos-
metically to erectile dysfunction and infertility [2,3].
According to clinical evidences occasionally infertility
in clinical varicocele patients results severe social and
familial consequences, these men with Clinical varico-
cele are often solitary, sen sitive, without incentiv e, alone,
and simply getting tired. Th e social isolation compounds
the Clinical varicocele man’s sense guilty and humility
especially against his family and his wife. The general
purpose of th is study was evaluation and get a better un-
derstanding of the perception and attitude of Clinical
varicoceles that treated for infertility and describe and
detail of their problems for access of best treatment re-
sult on them.
We performed a case control study in the urology
Ward, Shafa Hospital of Kerman. This ward is the first
level referral hospital for urology patients in the south-
east region of Iran. After the diagnosis of clinical vari-
cocele was confirmed in the study group (n = 62) and
selecting an age matched control group (n = 50), all of
them invited to participate to a survey (prior to the sur-
gical procedure in study group ), from April 2009 to May
2010. After convinced them verbally, consent was ob-
tained; we explained the purpose of the survey to both
groups. Data about demographic characteristics, the re-
sults of Hamilton Depression Rating Scale questioner
(both groups); previous treatment histories, the percep-
tion and attitude of patients about their condition and
their life style in the study group were collected. Statis-
tical analysis was performed using SPSS-15.
Hamilton Depression Scale was higher in infertile va-
A. A. Ketabchi et al. / Health 3 (2011) 504-506
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
ricocele patient than control group (28.8 +/ 6.5 vs.15.6
+/1.7, P = 0.001). While 53 (85%) patients in study
group reported no previous attempt of operating his va-
ricocele, 9 (15%) patients had been operated in the past.
In our study group duration of infertility had not signifi-
cant difference between primary and secondary infertil-
ity (7 +/2.7 VS. 9 +/2.5 years respectively). In
study group Forty-five percent of patients (28/62) said
that they used to isolate themselves. 32% (n = 20) of
patients had doubt about operation results, 20% (n = 12)
have been believed operation will cause erectile dys-
function; 16% (n = 10) declared tha t thi s prob lem ( inf er-
tility) is mainly due to his wife and finaly 17.7% (n = 11)
of them divorced (Table 1).
Psychological problems and Depression rates among
infertile couples is high ,which related to some risk fac-
tors of depression and anxiety in infertile couples in-
clude: female sex, age over 30, lower lev el of education,
lack of occupational activity, diagnosed male infertility
and high infertility duration [4]. In fact, couples under-
going fertility therapy often experience to some degree
of depression similar to those battling chronic illnesses,
such as can cer and AIDS [5].with con sidering the above
mentioned risk factors, we think the main risk factors in
our study group were prolonged infertility duration(4 -
12 years) and high lower level of education (n = 47,
75.8% under high school vs. n = 15, 24.2% high school
or higher education) witch both may have effect on men-
tality and opinion of them. Men who aren’t receiving
Table 1. Results.
Patients with
clinical vari-
N = 62
Control group
N = 50 P-value
Age(years) 25+/– 3.6 27+/–2.8 Non-significant
grade 28.8 +/– 6.5 15.6 +/– 1.7 P = 0.001
isolation 28 (45%) 2(4%) P < 0.001
divorced 11(17.7) 5(10%) P < 0.05
results ED 12(20%) - -
due to wife 10(12%) - -
Doubet about
results 20(32%) - -
infertility 53(85%) - -
infertility 9(15%) - -
ED = erectile dysfunction.
any type of emotional support from their partners, family,
or professionals are at greatest risk for experiencing in
fertility-related depression, in this study 28 (45%) of in-
fertile men sense isolation and so are unsupported.
Among our study infertile patients, 24 (38.7%) said they
did not believe that the varicocele causes infertility,
showing that there is a lack of information about the
possibility of infertility cure after v aricocelectomy. Nev-
ertheless, complete cure with good semen analysis and
infertlity at primary surgery of up to 80% and 45% re-
spectively [6,7]. This means that in addition to making
care accessible, an information campaign regarding the
varicocele condition and its treatment is needed. 29 pa-
tients think that varicocelectomy cause impotency, while
according on some recent studies the clinical varicoceles
by effecting on Hypothalamic-pituitary-gonadal ax is and
leiydig cells may causes impotency, Whereas operation
of varicocele do not effect on male potency [8,9]. Twenty
four patients (57%) believe that his infertility is not due
to themselves, while their wives were healthy.
According to the results of this study, the varicocele
patients with infertility like other infertile patients are
usually depressed. They have very negative perception
and attitude about their condition, and also these emo-
tional factors and stress probably cause alteration in se-
cretion of catecholamines, prolactin, adrenal steroids,
endorphins, and serotonin which all affect on hypota-
lamic-gonadal axis and worsening their fertility condi-
tion [1]. So we strongly recommend to detailing their
problem for changing their negative perception and atti-
tude to encourage them to follow and continue treatment
[1] De Gennaro, L., Balistreri, S., Lenzi, A., Lombardo, F.,
Ferrara, M. and Gandini, L. (2003) Psychosocial factors
discriminate oligozoospermic from normozoospermic
men. Fertility and Sterility, 79, 1571-1576.
[2] Ketabchi, A.A. and Ahmadinejad, M. (2008) Premature
ejaculation in the varicocele patients. Shiraz E-Medical
Journal, 9, 30-34.
[3] Younes, A.K. (2003) Improvement of sexual activity,
pregnancy rate, and lowplasma testosterone a f t er bilateral
varicocelectomy in impotence and male infertility pa-
tients. Archives of Andrology, 49, 219-228.
[4] Drosdzol, A. and Skrzypulec, V. (2009) Depression and
anxiety among Polish infertile couples—An evaluative
prevalence study. Journal of Psychosomatic Obstetrics
and Gynecology, 30, 11-20.
[5] Gregory, E.S. (2001) Treating depression in patients with
chronic disease. The Western Journal of Medicine, 175,
A. A. Ketabchi et al. / Health 3 (2011) 504-506
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
292-293. doi:10.1136/ewjm.175.5.292
[6] Pontonnier, F., Mansat, A., Mieusset, R., Malonga, G.,
Gautier, J.R. and Ioualalen, A. (1986) Varicocelectomy
for infertility is more effective in cases of sperm count
less than 5 million/ ml.jur. Urology Annals, 20, 249-251
[7] Zorba, U.O., Sanli, O.M., Tezer, M., et al. (2009) Effect
of infertility duration on post varicocelectomy sperm
counts and pregnancy rates. Urology, 73, 767-771.
[8] Ozden, C., Ozdal, O., L.Bulut, S., Guzel, O., Koyuncu,
H.H. and Memis, A. (2008) Effect of varicocelectomy on
serum inhibin B levels in infertile patients with varico-
cele. Scandinavian Journal of Urology and Nephrology,
42, 441-443. doi:10.1080/00365590802028141
[9] Ben, B., Khaled, M.K. and Armand, Z., et al. (2004)
Does the gonadotropin-releasing hormone stimulation
test predict clinical outcomes after microsurgical varico-
celectomy? Urology, 63, 1143-1147.