Varicocele and male infertility: does surgery help you get your partner pregnant?

What a varicocele is

A varicocele is a group of swollen veins in the scrotum, like varicose veins in the leg. It is usually on the left side and is often described as feeling like a bag of worms above the testicle. It may be bigger when you stand and in hot weather, and smaller when you lie down. Many men have one and never know.

Most varicoceles cause no symptoms. Some cause a dull, dragging ache by the end of the day, and a large one can make the testicle on that side smaller.

Why it is linked to infertility

Varicoceles are found more often in men with fertility problems than in other men. The pooled blood may warm the testicle and affect sperm production. But being linked is not the same as being the cause. Many men with a varicocele have normal sperm and normal fertility.

In Nigeria, infertility is too often blamed on the woman alone. In practice, a male factor is common, and the man should be tested at the same time as his partner, not after years of her treatment.

Test before you operate

Before considering varicocele repair for fertility, the couple should usually have:

• A semen analysis, repeated if abnormal, from a proper laboratory
• An examination of the man by a doctor, and a scrotal ultrasound if needed
• Blood hormone tests if the sperm count is very low
• A full assessment of the female partner, including her age, ovulation and tubes

What the evidence says about surgery

Different expert bodies read the evidence differently. UK fertility guidance from NICE says men should not be offered varicocele surgery as a form of fertility treatment, because it has not been shown to improve pregnancy rates. European urology guidance supports repair in selected men: those with a varicocele that can be felt, an abnormal semen analysis, and otherwise unexplained infertility.

In practice this means: repair is worth discussing if you fit that narrower picture, especially if your partner is younger and has no fertility problem of her own. It is not worth delaying effective fertility treatment such as IVF to try it, particularly if your partner is older. It usually takes about three months or more for any change to show in the semen. No surgeon can tell you that repair will lead to a pregnancy.

Other reasons to repair a varicocele

Repair may also be offered for a varicocele causing a persistent ache that interferes with daily life, or in a teenager whose testicle on that side is not growing. The operation is usually done through a small cut in the groin, often as a day case.

See a doctor promptly if a varicocele appears suddenly, especially in an older man, is only on the right side, or does not go down when you lie flat. These can occasionally be a sign of a problem higher up, such as in the kidney, and need a scan.

Common questions