Does Varicocele Surgery Improve Sperm Count and Pregnancy Rates?
A varicocele is an enlargement of the veins around the testicle. It is common and many men with a varicocele have normal fertility. However, in some men, a varicocele is associated with reduced sperm production and difficulty conceiving.
So, does fixing a varicocele improve fertility?
For appropriately selected men, varicocele treatment can improve sperm concentration and may increase the chance of pregnancy. However, not every varicocele needs treatment, and pregnancy cannot be guaranteed.[1–5] Current Australian, European and American guidelines all emphasise careful patient selection.
How can a varicocele affect sperm?
A varicocele may interfere with the environment required for normal sperm production. Proposed mechanisms include increased testicular temperature, oxidative stress and impaired testicular function.[2,3]
Varicoceles are particularly common among men being investigated for infertility, but simply finding one does not prove that it is responsible for a couple's fertility difficulty.[1,2]
You can read more on the dedicated Varicocele & Male Fertility page.
Does varicocele surgery improve sperm count?
Often, yes — when the right men are selected.
A systematic review of prospective studies involving more than 1,300 men found that varicocele treatment increased sperm concentration by an average of approximately 12 million sperm/mL compared with observation.[5] The size of the improvement varied substantially between men, so this figure should not be used to predict an individual's result.
Studies also report improvements in other semen measures after surgery, including motility and morphology, although evidence for these outcomes is less consistent.[2,5]
If your semen test shows a low count, see Low Sperm Count, or review the different measurements through the Male Fertility Patient Tools.
Does varicocele surgery improve pregnancy rates?
Evidence suggests that it may increase the chance of pregnancy in selected infertile couples.
A large Cochrane systematic review of randomised trials found that treating a varicocele may improve pregnancy rates compared with observation or delayed treatment. However, the evidence was less certain for live birth, which is an important distinction.[4]
A separate meta-analysis of prospective studies found a modest improvement in pregnancy rates after varicocele treatment compared with observation.[5]
This does not mean that varicocele surgery guarantees natural pregnancy. Pregnancy depends on many factors, including:
sperm concentration and motility
the severity of the varicocele
duration of infertility
female partner age and ovarian reserve
other male or female fertility factors
whether assisted reproductive treatment is required.
For this reason, male and female fertility assessment should usually occur in parallel.[1–3]
Who is most likely to benefit from varicocele surgery?
Current guidelines broadly support considering treatment when a man has:
infertility as a couple
a clinical varicocele that can be felt on examination
abnormal semen parameters
no more important untreated explanation for the infertility.[1–3]
Australian guidelines also allow consideration in selected couples with unexplained infertility, elevated sperm DNA fragmentation or previous unsuccessful assisted reproductive treatment.[1]
The American AUA/ASRM guideline similarly recommends considering surgical varicocelectomy in men attempting conception who have infertility, a palpable varicocele and abnormal semen parameters, apart from men with azoospermia where the evidence is less certain.[3]
When might surgery not be helpful?
Treatment is generally not recommended simply because an ultrasound detects a small varicocele.
European guidelines recommend against treating a subclinical varicocele — one that can only be seen on ultrasound — or treating an infertile man with normal semen parameters purely to improve fertility.[2]
Surgery may also not be the best first step when time is important. For example, if the female partner has reduced ovarian reserve or advancing reproductive age, waiting several months for semen parameters to improve may be less appropriate than moving directly to fertility treatment.
The decision therefore needs to consider the couple's reproductive timeline, not just the man's ultrasound result.
How long does sperm improvement take?
Sperm production takes approximately three months, so improvement is not immediate.
Repeat semen analysis is commonly performed around three months after treatment. Research suggests that significant improvement may already be present at this stage, with some men continuing to change over subsequent months.[2,6]
Natural pregnancies after successful treatment may occur over the following 6–12 months, although there is no predictable timetable for an individual couple.[2]
Is microsurgical varicocelectomy different?
Varicoceles can be treated surgically or, in selected cases, through radiological embolisation.
When surgery is chosen, microsurgical inguinal or subinguinal varicocelectomy is widely used because the operating microscope helps identify important structures while the abnormal veins are divided. Current evidence suggests microsurgical techniques have relatively low recurrence and complication rates compared with some non-microsurgical approaches.[1,2,4]
For a detailed comparison, see Varicocele Treatment Options: Surgery vs Embolisation.
Should I repair a varicocele before IVF or ICSI?
Sometimes — but not automatically.
If there is a clinical varicocele and abnormal sperm quality, repairing the varicocele may improve semen parameters enough to change the fertility options available to some couples. There is also emerging evidence that treatment before assisted reproduction may improve reproductive outcomes in selected men, although much of this evidence is observational and uncertainty remains.[2]
Conversely, proceeding directly to IVF or ICSI may be more appropriate when the couple cannot afford to delay treatment.
Take home message
Varicocele surgery can improve sperm count and may improve pregnancy rates, but the benefit is greatest when treatment is offered to appropriately selected men rather than every man with a varicocele.
The most useful assessment considers the varicocele together with repeat semen analyses, male reproductive history, examination, relevant investigations and the female partner's fertility circumstances.
For further information, explore Male Infertility & Reproductive Urology or Varicocele & Male Fertility.
Patients from Brisbane and elsewhere in Queensland can arrange assessment through the Appointment page. Interstate and overseas patients can review the International Patient Information page; where clinically appropriate, existing semen analyses and fertility investigations may be reviewed as part of planning before travel.
References
Katz DJ, O'Donnell L, McLachlan RI, Moss TJ, Boothroyd CV, Jayadev V, et al. The first Australian evidence-based guidelines on male infertility. Med J Aust. 2025;223(11):653-663. doi:10.5694/mja2.70080.
European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Male Infertility. Arnhem, The Netherlands: EAU Guidelines Office; 2026.
American Urological Association; American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. 2020; amended 2024.
Persad E, O'Loughlin CAA, Kaur S, Wagner G, Matyas N, Hassler-Di Fratta MR, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev. 2021;4:CD000479. doi:10.1002/14651858.CD000479.pub6.
Fallara G, Capogrosso P, Pozzi E, Belladelli F, Corsini C, Boeri L, et al. The effect of varicocele treatment on fertility in adults: a systematic review and meta-analysis of published prospective trials. Eur Urol Focus. 2023;9(1):154-161. doi:10.1016/j.euf.2022.08.014.
Mei Y, Ji N, Feng X, Xu R, Xue D. Don't wait any longer, conceive in time: a systematic review and meta-analysis based on semen parameters after varicocelectomy. Int Urol Nephrol. 2024;56(10):3217-3229. doi:10.1007/s11255-024-04080-y.
Medical disclaimer
This article provides general educational information and does not replace individual medical advice, diagnosis or treatment. A varicocele does not always cause infertility, and varicocele repair is not appropriate for every patient. Changes in semen parameters, natural pregnancy, assisted-reproduction outcomes and live birth cannot be guaranteed after treatment. Decisions about investigation or treatment should be made following individual assessment of both partners' reproductive circumstances by appropriately qualified healthcare professionals.
