Overview
Not every varicocele needs treatment. Whether to treat depends on its size, the semen analysis, and the female partner's age and fertility.
Signs of a varicocele
- Often no symptoms, found during a fertility check
- A dull ache or heaviness in the scrotum, worse after standing
- Veins that feel like "a bag of worms" above the testis, usually on the left
- A smaller testis on the affected side
Assessment
- Examination, standing and lying down
- Scrotal Doppler ultrasound to confirm and grade the varicocele
- Semen analysis and hormone tests
Treatment options
- Varicocele repair by a urologist, usually microsurgical, or embolisation. It may be advised for a clearly felt varicocele with abnormal semen results when the couple is trying to conceive. Improvement in semen quality takes three to six months.
- IUI, IVF or ICSI without repair, which is often the better choice when the female partner is older or there are other fertility factors, because waiting for results costs time.
We assess both partners together and plan with a urologist where repair is advised.
Questions about varicocele
Does a varicocele always cause infertility?
No. Many men with a varicocele have normal fertility. It is considered for treatment when it can be felt and the semen analysis is abnormal.
How long after varicocele surgery does sperm improve?
Usually three to six months, because that is how long new sperm take to develop.
Should we have surgery or go straight to IVF?
It depends on the female partner's age and fertility, and on the semen results. If time matters, ICSI may be the better route.
Is varicocele surgery painful?
It is done under anaesthesia. Most men return to normal activity within a few days.
