Varicocele and Male Infertility
A varicocele is an abnormal enlargement of veins around the testis, most often on the left side. It can be associated with reduced sperm count, motility or overall semen quality in some men, but many men with a varicocele remain fertile. Treatment is therefore not based on the ultrasound finding alone. In an infertile couple, surgery is most often considered when the man has a palpable clinical varicocele, an abnormal semen analysis and otherwise reasonable reproductive potential. A small varicocele seen only on ultrasound usually does not need surgery for infertility.
What is a varicocele?
The veins draining the testis form a network called the pampiniform plexus. When these veins become enlarged and allow abnormal backward blood flow, the condition is called a varicocele. It is more common on the left because of the anatomy of testicular venous drainage.
How can a varicocele affect fertility?
The exact mechanism is not a single defect. Proposed effects include higher scrotal temperature, oxidative stress, altered testicular blood flow and impaired function of sperm-producing cells. The result can be lower sperm concentration, reduced motility, poorer total motile sperm count and, in some men, increased sperm DNA damage.
Does every varicocele cause infertility?
No. Varicocele is common in otherwise healthy men, and many men with a varicocele father children naturally. Finding a varicocele does not prove that it is the only cause of a couple’s infertility. The semen analysis, testicular examination, reproductive history and female partner’s fertility all matter.
Who is more likely to benefit from treatment?
- Men trying to conceive who have a palpable varicocele and one or more abnormal semen parameters.
- Men with a clinical varicocele and persistent infertility after other important causes have been evaluated.
- Selected men with pain attributable to a clinical varicocele that persists despite conservative measures.
- Selected adolescents with persistent testicular growth impairment require specialist assessment; this is a different indication from adult infertility.
Who usually does not need varicocele surgery for fertility?
- A man with a varicocele detected only on ultrasound but not palpable on examination.
- A man with normal semen parameters and no other indication for treatment.
- An asymptomatic man who is not currently concerned about fertility and has normal testicular findings.
- A couple in whom immediate assisted reproduction is more appropriate because reproductive time is limited.
How is varicocele assessed?
Diagnosis is primarily clinical. The urologist examines the scrotum while standing and may ask you to perform a Valsalva manoeuvre (bearing down). Scrotal Doppler ultrasound is useful when examination is uncertain, when testicular size needs documentation or when another scrotal problem is suspected.
What tests are important in an infertile man with varicocele?
- At least one properly collected semen analysis; an abnormal result is usually confirmed with another sample.
- Testicular examination and measurement of testicular size.
- Hormonal tests such as FSH and testosterone when semen findings or examination suggest impaired sperm production.
- Additional genetic testing when sperm concentration is extremely low or azoospermia is present.
- Evaluation of the couple, not only the male partner, because treatment timing depends on both partners.
Treatment options
| Option | When it may fit |
|---|---|
| Observation and fertility follow-up | Normal semen, subclinical varicocele, or no current indication for intervention |
| Microsurgical varicocelectomy | Commonly preferred surgical option for a clinical varicocele when treatment is indicated |
| Varicocele embolisation | A radiological alternative in selected men, depending on anatomy, expertise and previous surgery |
| Assisted reproduction | May be appropriate when semen impairment is severe, female factors are important or time to pregnancy is limited |
What can improve after surgery?
Semen concentration and motility can improve in appropriately selected men, but improvement is not guaranteed. Because a sperm-production cycle takes roughly three months, semen is generally reassessed after sufficient time rather than within a few weeks. Improvement may continue over two spermatogenic cycles, and natural pregnancy—when it occurs—often takes several additional months.
Can varicocele surgery replace IVF or ICSI?
Sometimes it can improve semen enough to allow natural conception or a less intensive fertility treatment, but not always. In severe male-factor infertility, IVF/ICSI may still be required. The decision to repair first or proceed directly to assisted reproduction should consider the female partner’s age and ovarian reserve, severity of semen impairment and the couple’s preferred timeline.
When should you see a urologist?
- Infertility for 12 months, or earlier when the female partner is older or there are known fertility problems.
- Abnormal semen analysis together with a known or suspected varicocele.
- Scrotal heaviness or aching that persists or affects activity.
- Noticeable testicular size difference.
- A new right-sided varicocele, a varicocele that does not decompress when lying down, or another unusual scrotal finding.
When varicocele repair has the clearest fertility rationale
The strongest fertility indication is not simply ‘a varicocele on ultrasound.’ It is a palpable clinical varicocele in a couple with infertility and abnormal semen parameters. In that setting, repair can improve semen quality and may improve pregnancy chances in selected men. A subclinical ultrasound-only varicocele is different and is not routinely treated for infertility.
The couple’s timeline matters because improvement is measured in months. A man with a reasonable chance of semen improvement and a partner with good reproductive time may choose repair, while a couple facing significant female-factor urgency may reasonably proceed directly to assisted reproduction.
Varicocele repair can improve semen parameters in selected men, but improvement is not guaranteed and pregnancy still depends on both partners. The operation should therefore be viewed as treatment of a correctable male factor, not as a promise that natural conception will follow.
Emergency warning signs
Typical varicocele discomfort is usually a dull ache or heaviness, not sudden severe pain. New intense testicular pain, rapidly increasing swelling, fever/redness or nausea/vomiting needs urgent assessment for torsion, infection or another acute scrotal cause.
What to bring for consultation
Bring these if available:
- Semen analysis reports, preferably all previous reports.
- Scrotal Doppler ultrasound report/images if already done.
- Hormone reports such as FSH, LH and testosterone if available.
- Previous fertility treatment records.
- Any prior scrotal, groin or hernia surgery records.
- Wife/partner’s basic fertility evaluation if available.
- Current medicines and supplements, including testosterone or gym steroids.
FAQs
Can varicocele cause low sperm count?
Yes, it can be associated with reduced sperm concentration and motility in some men. But not every man with a varicocele has impaired fertility.
Does Grade 1 varicocele need surgery for infertility?
Not because of grade alone. A clinical varicocele, abnormal semen parameters, the couple’s infertility history and reproductive timing are considered together.
Can a man with varicocele get his wife pregnant naturally?
Yes. Many men with varicocele remain fertile, and some couples conceive naturally even when semen parameters are mildly abnormal.
Does varicocele surgery guarantee sperm improvement?
No. Proper patient selection improves the chance of benefit, but no operation can guarantee a specific semen result or pregnancy.
How long after surgery should semen be checked?
A repeat semen analysis is commonly planned at about three months, with further testing depending on the result and fertility plan.
Should an ultrasound-only varicocele be operated for infertility?
Current major guidelines generally do not recommend treatment of a non-palpable subclinical varicocele solely to improve fertility.
Related reading
- Varicocele Symptoms and Treatment
- Varicocele Grade 1, 2 and 3 Explained
- Varicocele Ultrasound Report Explained
- When Does Varicocele Need Surgery?
- Microsurgical Varicocelectomy Explained
- Urologist in Latur
References
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Male Infertility. 2026 https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
- American Urological Association/American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020; Amended 2024) https://www.auanet.org/documents/Guidelines/PDF/2024%20Guidelines/Male%20Infertility%20Unabridged%20Final.pdf
- World Health Organization. Guideline for the prevention, diagnosis and treatment of infertility. 2025 https://www.who.int/publications/i/item/9789240115774