Condition & Treatments
/ Varicocele
Varicocele: the most common treatable cause of male infertility
A varicocele is a group of swollen veins above the testis, like varicose veins in the leg. It is found in around 1 in 7 men [1], and in up to 4 in 10 men with fertility problems [1, 2]. Repairing the right varicocele can improve sperm and the chance of natural pregnancy.
I N S H O R T
Swollen veins warm the testis and reduce its blood flow, which can harm sperm production and sperm DNA.
Not every varicocele needs treatment. The ones worth repairing are those you can feel, in men with abnormal semen results.
Microsurgical repair is a day case with a quick recovery and a low chance of the varicocele coming back.
Signs
Many men have no symptoms. Others notice a dull ache, a feeling of heaviness, or veins that feel like "a bag of worms", usually on the left side and worse after standing.
Treatment options
Microsurgical varicocelectomy: the gold standard. Through a small cut in the groin, Prof Raheem ties off the swollen veins under an operating microscope, while sparing the testicular artery and lymph vessels. It is a day case, and most men return to desk work the next day. This approach has the lowest recurrence and complication rates of any technique: the varicocele comes back in about 1 in 100 men, and fluid around the testis (hydrocele) is very rare [7].
Embolisation. A radiologist blocks the veins from inside, through a vein in the groin or neck, using X-ray guidance and contrast dye. The varicocele comes back more often than after microsurgery, in around 1 in 8 men [7]. It is mainly an option if a varicocele returns after surgery, or if surgery isn't suitable.
No treatment. If your semen results are normal, or the varicocele is only seen on a scan, repair is usually not needed
What to expect
Most men return to desk work within 1 day. Sperm takes around three months to be made, so improvement is usually seen 3 to 6 months after repair.
Why this matters to your care
Prof Raheem only recommends surgery where the evidence says it helps, and performs the microsurgical repair himself. Many of his patients who were told IVF was their only option have gone on to conceive naturally after microsurgical varicocelectomy. Repair can also improve pregnancy and live birth rates in couples who go on to IVF [5, 6], bring sperm back into the semen in some men with azoospermia [3], raise testosterone levels [3], and relieve the ache some men feel.
Common questions
Will it definitely improve my sperm?
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Not always, but most men benefit. Semen quality improves significantly in around 60–80% of men after repair [3, 4], usually within 3 to 6 months. Prof Raheem's own results are in line with these published figures.
Should we repair it if we are about to start IVF?
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It can improve sperm quality and DNA for IVF, but it means waiting around three months. Prof Raheem will weigh this with you, including your partner's age.
Can it come back?
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Rarely after microsurgical repair. In a review of 36 studies, it came back in about 1 in 100 men after microsurgery, compared with up to 15% after some older techniques [7].
Prof Raheem's published work on this topic
References
1. Epidemiology of varicocele. Asian Journal of Andrology, 2016. Link
2. The significance of clinical practice guidelines on adult varicocele detection and management. Asian Journal of Andrology, 2016. Link
3. Weill Cornell Center for Male Reproductive Medicine. Varicocele: results of treatment. Link
4. Machen GL, et al. Time to improvement of semen parameters after microscopic varicocelectomy. Andrologia, 2019. Link
5. Kirby EW, et al. Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele. Fertility and Sterility, 2016;106(6):1338–1343. Link
6. Esteves SC, Roque M, Agarwal A. Outcome of assisted reproductive technology in men with treated and untreated varicocele. Asian Journal of Andrology, 2016;18(2):254–258. Link
7. Cayan S, Shavakhabov S, Kadioglu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. Journal of Andrology, 2009;30(1):33–40. Link