Around 15% of men have a varicocele — when the veins in the scrotum become enlarged. Varicoceles are common and don’t usually cause issues, but in some cases, they can affect male fertility. A varicocele is found in up to 40% of men being investigated for infertility. Here’s what you need to know about the link between varicocele and male infertility, how to find out if you’re affected and your treatment options.
What is a varicocele?
A varicocele occurs when the veins in the scrotum (the pouch of skin that holds your testes) become abnormally enlarged. A varicocele may look or feel like ‘a bag of worms’. They form during puberty and they can grow larger or you may notice them more over time.
Varicocele symptoms
Usually, you won’t notice any symptoms of a varicocele. You might be able to feel it, depending on its size.
Pain is a rare symptom of varicocele — you might feel a dull ache or ‘heavy’ sensation in your scrotum. Some people find a varicocele can be uncomfortable after exercising or standing for a long time.
Varicoceles are more common on the left side of the scrotum. Varicoceles can exist on both sides at the same time, but this is also rare.
Causes of a varicocele
A varicocele is caused by a problem with the veins that drain blood from your testes. There’s nothing you can do to prevent varicocele. Varicoceles are more likely to occur in men with varicose veins in their legs, or those whose fathers or brothers have a varicocele.
How is varicocele diagnosed?
Your doctor can diagnose varicocele by performing a physical examination of your scrotum. The doctor will ask you to stand, take a deep breath, hold it and bear down — this is called the Valsalva manoeuvre, and it can help them find any enlarged veins.
A clinical varicocele is one that can be detected during a physical examination — the doctor can feel or see the enlarged veins. A subclinical varicocele is one that isn’t felt or seen on physical exam, but is picked up incidentally on imaging, like an X-ray or ultrasound. Subclinical varicoceles very rarely cause testicular impairment or discomfort.
What is male infertility?
Infertility is typically defined as not conceiving a pregnancy after 12 months or more of regular, unprotected sex.
Male infertility contributes to one in four cases of assisted reproductive treatment in Australia but could be a factor for up to 50% of all infertile couples. Male infertility can be caused by issues with sperm, including:
How does varicocele affect male fertility?
Clinical varicoceles may affect sperm development in your testes, causing or contributing to abnormal semen parameters, sperm DNA fragmentation, recurrent pregnancy loss and poor assisted reproductive technology (ART) outcomes.
You might have no idea you have a varicocele until it’s picked up during a fertility assessment. Around 40%of infertile men, and up to 80% of men with secondary infertility (the inability to conceive after previously doing so) have a varicocele.
If you’re seeking help for infertility and you have a varicocele, you’ll be sent for a semen analysis to see if it’s affecting your sperm and determine your treatment options.
How is varicocele treated?
Having something described as a ‘bag of worms’ in your ball bag sounds worrying, but a varicocele isn’t always an issue that requires treatment. In most cases, surgery to repair a varicocele is only performed when the varicocele is causing discomfort, could be impacting on your testis or to treat infertility. Surgery for subclinical varicocele is not recommended.
When treatment is suggested, there are two main approaches.
Microsurgical varicocelectomy: A surgeon makes a small incision in the groin or just below it and uses a high-powered microscope to identify and tie off the affected veins, while carefully preserving the testicular artery and lymphatic vessels. It requires a general anaesthetic and a short recovery period. Around 49% of patients undergoing microsurgical varicocelectomy will successfully achieve spontaneous pregnancy after the operation.
Percutaneous embolization: A minimally invasive option in which an interventional radiologist guides a thin catheter through a vein in the groin or neck and blocks blood flow to the varicocele using tiny coils or a scar-forming solution. There’s no surgical incision, recovery is typically a day or two. Around 36% of men undergoing embolization will achieve pregnancy after the procedure. Varicocele repair modestly increases spontaneous pregnancy rates and clearly improves semen quality and sperm DNA integrity in men with abnormal semen parameters, but there is no proven benefit for men with a subclinical varicocele or normal semen analyses. Microsurgical varicocelectomy has the strongest support for higher pregnancy rates and the lowest recurrence and complication rates.
Is varicocele harmful or dangerous?
Most varicoceles are not dangerous, but some can cause pain, testicular shrinkage, or infertility if left untreated. Many men live with one their whole life without any significant consequences.
If you have genital pain or notice any change in the appearance of your genitals, you should see your doctor. Varicoceles may not pose a threat to your health, but it’s worth asking your doctor to help you keep an eye on it.
People also ask
Can varicocele cause low testosterone?
Whether or not testosterone production by the testes is affected is not known for sure, but if it is the effect is likely to be very small. Surgical correction of varicocele can reverse these problems.
Hydrocele vs varicocele
A varicocele is an enlargement of the veins within the scrotum caused by faulty valves that prevent blood from returning efficiently to the heart, while a hydrocele is a fluid-filled sac that forms when excess fluid accumulates around the testicle. Both cause scrotal swelling, but unlike hydroceles — which are most common in newborns and have no direct impact on fertility — varicoceles are linked to impaired sperm production and are the most common correctable cause of male infertility.
Can a man with varicocele get a woman pregnant?
Yes. Just because clinical varicocele is linked to male infertility, doesn’t mean it’s impossible to conceive.
Will varicocele go away? Can a varicocele be treated without surgery?
Once a varicocele is present, it will not go away on its own and may get larger or more noticeable over time. It can’t repair itself naturally. And there are no drugs to treat or prevent varicoceles.
How long does varicocele surgery take to work?
It takes around three months to see improvements in sperm health after a varicocelectomy — that’s how long it takes for new sperm to develop.
