Geetha M.
· Google
She prescribes only the very necessary investigations and medications, maintaining high standards and ethics.
Home › Conditions › Varicocele
HIS FERTILITY · VARICOCELE
Repair helps some men, not all. We tell you which.
A varicocele is a set of widened veins in the scrotum, like varicose veins in the leg. It can warm the testicle and lower sperm quality, but in many men it changes nothing.
- Common, often no symptoms
- Found by examination and scan
- Repair only if it is likely to help
- Semen analysis decides, not the vein
- Subclinical — Seen only on a scan, cannot be felt
- Grade 1 — Felt only when you bear down (strain)
- Grade 2 — Felt when standing, without straining
- Grade 3 — Visible through the skin
Urgent: same-day care
Sudden, severe pain in a testicle is not a varicocele
- Sudden severe pain or swelling in the scrotum can be a twisted testicle, which needs surgery within hours. Call 108 or go to the nearest emergency department now. If you are unsure, call us on +91 89399 94244 during clinic hours (Mon to Sat, 9am to 5pm. Sunday closed.), but do not wait for a reply to go.
01What is a varicocele?
A varicocele is a group of swollen veins in the scrotum, above the testicle, caused by weak valves that let blood pool.
It is usually on the left, because of the way the left testicular vein drains. It often starts in the teenage years and causes no symptoms. Some men feel a dull ache or heaviness that gets worse after standing and eases when lying down.
02Does a varicocele cause infertility?
A varicocele can lower sperm count, movement and shape, but many men with one have normal semen and father children without help.
The pooled blood warms the testicle, and sperm are made most easily slightly below body temperature. It can also raise sperm DNA damage. Whether yours is doing harm shows in the semen analysis, not in the size of the vein.
03How is a varicocele diagnosed?
A varicocele is diagnosed by examining the scrotum standing up, then confirmed with a Doppler ultrasound scan if needed.
The doctor feels the veins while you stand, then while you bear down. That gives the grade, from 1 (felt only when straining) to 3 (visible). A semen analysis, repeated if abnormal, and sometimes hormone tests and a sperm DNA test in selected cases, show whether sperm are affected.
04Should a varicocele be operated on for fertility?
Repair is worth considering when the varicocele can be felt, the semen analysis is abnormal, and the couple has not conceived.
Repair is done by microsurgery through a small cut in the groin, or by embolisation, where a radiologist blocks the vein from inside. It is not advised for a varicocele seen only on a scan, or when the semen is normal. If the woman's age or tests mean IVF is needed anyway, ICSI is often the shorter road.
Honest note
Repair does not help every man. Guidelines advise it only for a varicocele that can be felt, with abnormal semen, and advise against surgery for one seen only on a scan. Sperm take about three months to form, so any benefit shows in a semen test three to six months later. (What the evidence says)
05What can you do now?
Get a semen analysis before deciding anything, and bring your partner's test results to the same consultation.
Loose underwear, not smoking, less alcohol and a healthy weight help sperm in every man, with or without a varicocele. If you have had repair, recheck the semen at three to six months. If the count is very low, freezing a sample first is a sensible safety net.
Sperm freezingDoes this sound like you?
Any of these?
- A doctor felt swollen veins above my testicle
- A scan report says 'varicocele'
- My sperm count or motility came back low
- A dull ache in the scrotum after standing all day
- Someone told me I need surgery before we can try
No varicocele, but a low count? Start with what the semen analysis means.
What we try, in order.
- 1
Semen analysis and examination
Two semen tests if the first is abnormal, the grade of the varicocele, and her tests alongside.
- 2
Leave it alone
If the semen is normal, or the varicocele shows only on a scan, no surgery. Keep trying and recheck.
- 3
Repair
For a varicocele that can be felt, with abnormal semen, when there is time to wait three to six months for the result. [CONFIRM: surgeon or referral]
- 4
IUI or IVF with ICSI
When sperm are too few, or her age and egg reserve mean waiting costs more than it gains.
His first visit
1
Talk
How long you've tried, any ache, past scans and semen reports, and her history.
2
Test
Examination standing up, semen analysis, scan if needed. Her egg reserve and tubes too.
3
Plan
Repair, no repair, or straight to treatment, with the reason in plain words.
4
Treat
Repair with a recheck at three to six months, or IUI or ICSI. [CONFIRM: repair in-house or referral]
Questions men ask
Still unsure? Ask us on WhatsApp — a real person replies.
Can a man with a varicocele father a child naturally?
Yes, many men with a varicocele father children naturally, because most varicoceles do not harm sperm enough to matter. A semen analysis tells you whether yours does.
Which grade of varicocele needs surgery?
No grade needs surgery on size alone; what matters is that it can be felt and the semen analysis is abnormal. A grade 3 varicocele with normal semen may need nothing, and one seen only on a scan is not operated on for fertility.
How long after varicocele surgery does sperm count improve?
Any improvement usually shows three to six months after repair, because sperm take about three months to form. A semen test at that point shows whether it worked.
Is varicocele surgery better than IVF?
Neither is better for everyone: repair suits a younger couple with time to wait, while IVF with ICSI suits a couple where her age or egg reserve makes waiting costly, or where the count is very low. We decide it with both of your results in front of us.
Does a varicocele come back after surgery?
A varicocele can come back after repair, less often after microsurgery than after older open methods. If an ache or a low count returns, it is checked again.
Is a varicocele dangerous?
A varicocele is not dangerous and is not cancer. A new varicocele on the right side, or one that does not go down when lying flat, should be checked by a urologist.
In their words, not ours.
Patient from USA
· Practo
We found Dr Vani to be straightforward about the course of treatment we should take without mincing words or making false promises.
Sources (4)
- American Urological Association and American Society for Reproductive Medicine: Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline
- European Association of Urology: EAU Guidelines on Sexual and Reproductive Health
- World Health Organization: WHO laboratory manual for the examination and processing of human semen, 6th edition (2021)
- Milton Keynes University Hospital NHS Foundation Trust: Varicocele (patient information)
CONDITION
Male infertility
Every cause we check for, and what helps sperm.
TESTSemen analysis
The test that decides whether a varicocele matters.
TREATMENTTREATMENT · One sperm per egg, when the count is low.
One sperm per egg, when the count is low.
TREATMENTSperm freezing
A safety net before surgery or treatment.
Ask before you book surgery.
Send us your semen report and scan, or just tell us what you were told. A real person from Dr Vani's team replies privately on WhatsApp, usually within minutes during clinic hours (Mon to Sat, 9am to 5pm. Sunday closed.).