Varicocele is one of the most common and correctable causes of male infertility. It refers to the abnormal enlargement of veins within the scrotum, similar to varicose veins in the legs. Varicoceles are found in about 15% of the general male population and in up to 40% of men evaluated for infertility.
What Is a Varicocele?
A varicocele develops when the valves inside the veins of the spermatic cord fail to function properly, causing blood to pool and the veins to dilate. It most often occurs on the left side due to anatomical differences in venous drainage. Varicoceles typically form during puberty and usually develop gradually over time.
How Varicocele Affects Fertility
The pooling of blood increases the temperature around the testicles, impairing the optimal environment required for sperm production. This leads to reduced sperm count, motility, and abnormal morphology. Varicocele is also associated with increased oxidative stress and higher sperm DNA fragmentation, both of which can lower natural conception rates and affect outcomes of assisted reproduction.
Symptoms
- A dull ache or heaviness in the scrotum, especially after standing for long periods
- Visible or palpable enlarged veins, often described as a “bag of worms”
- Swelling in the scrotum
- In many men, varicoceles cause no symptoms at all and are discovered only during fertility evaluation
Diagnosis
Diagnosis typically begins with a physical examination, often performed while the patient is standing and performing the Valsalva manoeuvre. A scrotal ultrasound with Doppler study confirms the diagnosis and helps grade the severity. A semen analysis is always performed to assess the impact on sperm parameters.
Treatment Options
Treatment is generally recommended when the varicocele is associated with infertility, abnormal semen parameters, or bothersome symptoms. Options include:
- Microsurgical varicocelectomy: The gold standard approach using an operating microscope to precisely ligate the dilated veins while preserving the testicular artery and lymphatics.
- Laparoscopic varicocelectomy: A minimally invasive option for selected cases.
- Percutaneous embolisation: A radiology-guided procedure that blocks the problematic veins without surgery.
Outcomes After Treatment
Studies show that varicocele repair leads to improvement in semen parameters in 60–70% of men, with spontaneous pregnancy rates improving significantly within 6–12 months. Even in men who still require IVF or ICSI, varicocele repair can improve sperm DNA quality and treatment outcomes.
If you have been diagnosed with a varicocele or are facing fertility concerns, a reproductive medicine specialist can help determine whether treatment will benefit your chances of conception.