Varicocele: What It Is, How It Affects Fertility, and When to Treat It
By Dr. Christopher Vendryes, MD · Board-Certified Urologist · · 4 min read
Quick answer: A varicocele is an enlargement of the veins in the scrotum, similar to a varicose vein in the leg. It's found in about 15% of men and in about 35% to 40% of men with primary infertility. Many varicoceles cause no symptoms and need no treatment. Repair is recommended for men with a varicocele they can feel, abnormal semen results, and a couple trying to conceive, or for those with pain or a shrinking testicle. Options include microsurgical varicocelectomy and embolization.
What causes a varicocele?
Valves inside the veins normally keep blood flowing toward the heart. When they don't work well, blood pools and the veins enlarge. Varicoceles are much more common on the left side because of how the left testicular vein drains.
How does a varicocele affect fertility?
The pooled blood raises the temperature around the testicle and may increase oxidative stress. Both can lower sperm count, movement, and quality. Not every varicocele affects fertility, which is why semen analysis guides decisions.
What are the symptoms?
- Often none
- A dull ache or heaviness in the scrotum, often worse after standing or exercise and better lying down
- Veins that feel like a "bag of worms" above the testicle
- A smaller testicle on the affected side
When should a varicocele be treated?
Treatment is typically recommended when:
- The varicocele can be felt on exam, and
- Semen analysis is abnormal, and
- The couple is trying to conceive and the female partner has normal or treatable fertility
It may also be treated for persistent pain or for testicular shrinkage, especially in adolescents.
What are the treatment options?
| Microsurgical Varicocelectomy | Embolization | |
|---|---|---|
| Who performs it | Urologist | Interventional radiologist |
| How it works | Small incision in the groin; veins tied off under a microscope | Catheter through a vein; coils or agents block the vein |
| Recovery | A few days to a week | A few days |
| Recurrence | Low with microsurgical technique | Low to moderate |
What results can I expect?
Sperm are produced over about three months, so semen improvements typically appear three to six months after repair. Many men see improved counts and motility. Repair may also raise testosterone in some men.
Frequently Asked Questions
Talk to a Board-Certified Urologist
Dr. Vendryes sees patients in Plantation and across Broward and Palm Beach Counties for men's health, fertility, kidney stones, urologic cancers, and bladder problems.
References
- American Urological Association / ASRM. Diagnosis and Treatment of Infertility in Men Guideline. 2020, amended 2024.
- Urology Care Foundation. Varicocele.
- American Society for Reproductive Medicine. Report on Varicocele and Infertility.