What is a varicocele?
A varicocele is a group of swollen veins above the testis, much like varicose veins in the leg. It is found in about 15 in 100 men, and in about a third of men being checked because a couple has not been able to conceive. Nine in ten are on the left side, because of the way the left vein drains.
How a varicocele can affect sperm
The testes work well only when slightly cooler than the rest of the body. Blood pooling in a varicocele warms the testis and is thought to cause oxidative stress, which can lower sperm count and movement and damage sperm DNA. Over years, the testis on that side can become smaller. But this does not happen in every man: plenty of men with a varicocele have normal semen and normal fertility.
Grades of varicocele
- Subclinical: seen only on ultrasound, not felt on examination
- Grade 1: felt only when you strain or bear down while standing
- Grade 2: felt while standing, without straining
- Grade 3: visible through the skin of the scrotum
The grade matters for the decision. A varicocele found only on a scan usually does not need treatment for fertility.
Who is likely to benefit from repair
Urology guidelines suggest considering repair when all of these apply:
- The couple is trying to conceive and has not been able to
- The varicocele can be felt on examination
- The semen analysis is abnormal, on more than one report
- The female partner has normal fertility or a problem that can be treated
Repair may also be advised for a teenager whose testis on the varicocele side is getting smaller, and for a man whose ache does not settle with simple measures.
Who usually does not need surgery
- Men with a normal semen analysis
- Men whose varicocele is seen only on ultrasound
- Men who are not trying for a child and have no pain or shrinking testis
If the couple will need IVF for another reason, such as blocked tubes in the woman, the doctor discusses whether repair is likely to add anything, so time is not lost.
Time and the woman's age
Sperm take about three months to develop, so improvement after repair is usually seen in semen tests at three to six months, and a pregnancy may take up to a year. When the woman is over 35, or there are other fertility problems, waiting that long may not be wise, and assisted reproduction may be the better first step. This is a decision for the couple, the urologist and the gynaecologist together.
How a varicocele is repaired
- Microsurgical repair through a small cut in the groin, using an operating microscope to tie the swollen veins while protecting the artery and lymph vessels. It has a low rate of the varicocele returning and of fluid collecting afterwards.
- Laparoscopic repair through small cuts in the tummy.
- Embolisation, where a radiologist blocks the vein from inside through a small tube in a vein.
Operations are done in hospital, usually as a day-care procedure. Most men return to desk work within a few days and avoid heavy exercise for two to three weeks. Read more on our page on varicocele treatment in Gomti Nagar Extension.
Questions to ask before deciding
- Can the varicocele be felt, and what grade is it?
- Are my semen reports consistently abnormal?
- Has my wife been checked, and how does her age affect the plan?
- Which method do you advise, and why?
- When should I repeat the semen test after repair?
Things that help sperm meanwhile
- Stop smoking and gutka, and keep alcohol low
- Keep the testes cool: loose underwear, no laptop on the lap, breaks from long sitting
- Move towards a healthy weight
- Avoid testosterone injections and bodybuilding supplements
Varicocele care in Gomti Nagar Extension
Swastik Urology Clinic is in Sector-5, Gomti Nagar Extension, near Sadar Tehsil, a short ride from Gomti Nagar, Shaheed Path and Chinhat. Dr. Aditya P.S. Sengar (MBBS, MS (General Surgery), DNB (Urology)) sees men and couples in the morning OPD, Monday to Saturday, 9:30 AM to 11:30 AM, and speaks Hindi, English, Bhojpuri and Gujarati. Bring your semen reports and any scrotal ultrasound. Request an appointment.
This article gives general information and does not replace examination, diagnosis or treatment by a qualified doctor.
