Varicocele

Varicocele and Male Fertility: What You Need to Know

Varicocele is one of the most common and treatable causes of male infertility, yet many men have never heard of it until they are trying to conceive. In some cases, a varicocele causes no obvious symptoms, while in others it can affect sperm quality and hormone levels This guide explains what a varicocele is, how it affects male fertility, how it’s diagnosed, and what treatment options are available, helping you understand when specialist assessment may be beneficial.

What is a Varicocele?

A varicocele is an enlargement of veins within the scrotum, specifically those in the which drain blood from the testicles. It is similar to varicose veins that occur in the legs.

Varicoceles develop when valves inside the veins fail to work properly, allowing blood to pool and increasing pressure in the scrotal veins. This can raise the temperature around the testes and interfere with normal sperm production because they like to stay cool.

Varicoceles are:

• Present in around 15% of all men
• Found in up to 40% of men with primary infertility
• More common on the left side, due to anatomical differences in blood drainage

How Does a Varicocele Affect Male Fertility?

The testes are highly sensitive to temperature. They sit outside the body to remain slightly cooler than core body temperature, which is essential for healthy sperm production.

A varicocele can impact fertility by:

• Raising testicular temperature, reducing sperm quality
• Reducing sperm count
• Affecting sperm movement (motility)
• Increasing abnormal sperm shape (morphology)
• Potentially lowering testosterone levels in some men

Not all men with a varicocele will experience fertility problems, but when conception is taking longer than expected, it is an important condition to investigate.

Symptoms of Varicocele

Many men with a varicocele have no symptoms at all and only discover it during fertility testing or a physical examination.

When symptoms do occur, they may include:

• A dull ache or dragging sensation in the scrotum
• Discomfort that worsens after standing or physical activity
• A feeling of heaviness in the testicle
• Visible or palpable enlarged veins, often described as feeling like a “bag of worms”
• Differences in testicular size (testicular atrophy)

Pain is not always present, and lack of discomfort does not mean the varicocele is insignificant.

What Causes a Varicocele?

The exact cause of varicocele formation is not always clear, but contributing factors include:

• Faulty or weakened vein valves
• Increased pressure in the veins supplying the testes
• Anatomical differences in blood flow, particularly on the left side

Varicoceles usually develop during puberty but may not be detected until adulthood.

How is a Varicocele Diagnosed?

Physical Examination

A clinician or Urologist may be able to detect a varicocele during a scrotal examination, particularly when standing or performing a Valsalva manoeuvre (bearing

Scrotal Ultrasound

An ultrasound scan is the most accurate way to confirm a varicocele. It can:

• Measure vein size
• Assess blood flow
• Identify subclinical varicoceles not felt on examination

Semen Analysis

If fertility is a concern, a semen analysis is essential. This assesses:

• Sperm count
• Motility
• Morphology
• Semen volume

Abnormal results may indicate that the varicocele is affecting sperm production.

Many men trying to conceive benefit from a Trying fertility assessment, which may then point to further hormone analysis, and ultrasound as part of a structured evaluation. You can explore fertility testing options via Acorn Andrology’s
fertility packages.

Treatment Options for Varicocele

Treatment is not always necessary. The decision depends on:

• Whether fertility is affected
• Presence of symptoms
• Semen analysis results
• Age and reproductive plans

Conservative Management

If semen parameters are normal and there are no symptoms, monitoring may be recommended.

Varicocele Repair (Varicocelectomy)

Surgical or radiological repair aims to redirect blood flow away from the affected veins. Common approaches include:

• Microsurgical varicocelectomy
• Laparoscopic repair
• Percutaneous embolisation

The goal is to improve the testicular environment and support sperm production.

Does Varicocele Treatment Improve Fertility?

Evidence suggests that varicocele repair can, but not always:

• Improve sperm count and motility in many men
• Improve semen quality within 3–6 months
• Increase the chances of natural conception in selected cases
• Improve outcomes alongside assisted fertility treatments where appropriate

However, outcomes vary, and not all men will see improvement. This is why individual assessment is essential before deciding on treatment.

When Should You Seek Specialist Advice?

You may benefit from further investigation if:

• You’ve been trying to conceive for 12 months or more (or 6 months if your partner is over 35)
• A varicocele has been diagnosed and fertility is a concern
• You have abnormal semen analysis results
• You experience persistent scrotal discomfort
• There is a noticeable change in testicular size

Early assessment can prevent delays and help identify the most appropriate next steps.

Frequently Asked Questions (FAQs)

In Conclusion

Varicocele is a common, often overlooked condition that can affect male fertility. While not every varicocele requires treatment, proper assessment is crucial when conception is delayed or semen parameters are abnormal.

A structured fertility evaluation — including semen analysis, imaging, and hormonal testing — allows for informed decisions and personalised care. If you are concerned about varicocele or male fertility more broadly, exploring professional fertility assessment packages can be a valuable first step.