Varicocele Treatment Options
Comparing observation, microsurgery, embolisation and other treatments
A varicocele is an enlargement of the veins surrounding a testicle. It is similar to having varicose veins in the leg and most commonly develops on the left side of the scrotum.
Many varicoceles cause no symptoms and do not require treatment. In some men, however, a varicocele may contribute to:
A dull ache, heaviness or dragging feeling in the scrotum
Reduced sperm quality
Difficulty achieving a pregnancy
Reduced growth of the affected testicle during adolescence
Increased sperm DNA damage
Possibly reduced testosterone production
The most appropriate varicocele treatment depends on your symptoms, fertility plans, examination findings, semen-test results and personal preferences.[1–3]
How common is a varicocele?
Varicoceles are common. They affect approximately 15% of males in the general population, or about one in every seven men.[1,4]
They are more common among men being assessed for fertility problems:
A varicocele is found in approximately 35–40% of men with primary infertility. Primary infertility means that the couple has not previously achieved a pregnancy.[1,4]
A varicocele is found in up to 80% of men with secondary infertility. Secondary infertility means that the couple has previously achieved a pregnancy but is now having difficulty conceiving again.[4]
Varicoceles are also found in approximately 25% of men with an abnormal semen analysis.[1]
Most men with a varicocele are not infertile. Because varicoceles are common in the general population, finding one does not automatically mean that it is causing reduced fertility. The examination findings, semen-test results and fertility results of both partners should be considered before deciding whether treatment is appropriate.[1–4]
Varicoceles are uncommon before puberty. They become more frequent during adolescence and occur at approximately the same rate as in adults by the late teenage years.[4]
Does every varicocele need treatment?
No. A varicocele does not usually need treatment simply because it was seen on an ultrasound.
A clinical varicocele can be felt during a physical examination. A subclinical varicocele cannot be felt and is detected only by ultrasound.
International guidelines generally recommend against treating a subclinical varicocele. Treatment is also not normally recommended for an adult with normal semen results, no significant discomfort and no evidence of testicular damage.[1,2]
Observation may be appropriate when:
The varicocele is not causing symptoms
Fertility is not currently a concern
Semen-test results are normal
Discomfort is mild and manageable
It is uncertain whether the varicocele is causing the symptoms
Both testicles are developing normally
Follow-up may include another physical examination, semen testing or measurement of testicular size.
When might varicocele treatment be recommended?
Varicocele and male infertility
Treatment may be considered when a man has all or most of the following:
A varicocele that can be felt during examination
Abnormal semen-test results
Difficulty conceiving as a couple
No more important explanation for the fertility problem
American and European guidelines support considering varicocele repair in men attempting to conceive who have infertility, a palpable varicocele and abnormal semen parameters.[1,2] But it may also be considered when semen parameters are normal but there is unexplained infertility and the sperm DNA fragmentation is elevated.
Treatment may improve sperm concentration and the chance of pregnancy in appropriately selected couples. However, it does not guarantee natural conception. Fertility also depends on factors such as the female partner’s age, ovarian reserve and other reproductive findings.[1,2,5]
Sperm production takes approximately three months. Improvement is therefore not immediate and may continue for six months or longer after treatment. The need to wait should be considered carefully when there is limited time to proceed with IVF or another fertility treatment.[1]
Persistent varicocele pain
Typical varicocele pain is often described as:
Dull or aching
Heavy or dragging
Worse after standing, exercise or physical activity
Better after lying down
Other causes of scrotal pain should be considered before treatment. Supportive underwear, avoiding activities that consistently trigger discomfort and simple pain relief may be tried first.
Studies report improvement or resolution of pain in approximately 48–90% of appropriately selected patients following varicocele repair. Dull or dragging pain appears more likely to improve than sharp, burning or unusual pain.[1,8]
Treatment cannot guarantee that pain will disappear. Pain may continue even when the enlarged veins have been successfully treated.
Reduced testicular growth in an adolescent
Most adolescents with a varicocele will not develop fertility problems, so routine surgery for every adolescent could lead to unnecessary treatment.
Treatment may be considered when the affected testicle remains significantly smaller than the other testicle. The European guideline recommends offering surgery when the difference is greater than approximately 2 mL or 20%, confirmed during two follow-up assessments six months apart.[1]
Persistent pain or abnormal semen results in an older adolescent may also influence the decision.
Low testosterone
Research suggests that testosterone may increase after varicocele treatment, particularly in men who had low testosterone before treatment. However, this evidence is less certain than the evidence relating to infertility.
A varicocele should not usually be treated because of a single low testosterone result. A full hormonal assessment and consideration of other possible causes are recommended.[1]
What are the different varicocele treatment options?
1. Observation and symptom management
Observation means that no procedure is performed. Management may include:
Supportive underwear
Avoiding activities that trigger discomfort
Appropriate pain medication
Repeat semen testing when fertility is a concern
Monitoring testicular growth in adolescents
These measures may improve discomfort, but they do not close the enlarged veins.
Why might someone choose observation?
Observation may be preferred when symptoms are mild, semen results are normal, fertility is not currently being pursued or the varicocele was found only on ultrasound.
It also avoids the risks, inconvenience and recovery associated with a procedure.
Main limitation
The varicocele remains present. Further assessment may be needed if symptoms increase, fertility plans change or the affected testicle becomes smaller.
2. Microsurgical varicocelectomy
A microsurgical varicocelectomy is an operation performed through a small incision in the groin or just below the groin.
The surgeon uses an operating microscope to identify and divide the abnormal veins while preserving:
The artery supplying the testicle
The lymphatic vessels that drain fluid
The vas deferens, which carries sperm
The procedure may be called an inguinal or subinguinal microsurgical varicocelectomy, depending on the location of the incision.
Advantages of microsurgical varicocelectomy
Compared with other surgical techniques, microsurgery generally has:
The lowest reported recurrence rate
A very low risk of hydrocele formation
A low risk of testicular artery injury in experienced hands
The strongest evidence among the surgical approaches
The ability to identify small veins using magnification
The European guideline considers microsurgical varicocelectomy the most effective surgical approach overall. It generally produces fewer complications and recurrences than non-microsurgical surgery, although specialist microsurgical training is required.[1,3,5]
Possible risks
Risks may include:
Bruising, bleeding or infection
Temporary groin or scrotal pain
Numbness near the incision
Persistent or different pain
Hydrocele
Persistence or recurrence of the varicocele
Rare injury to the testicular artery
Why might someone choose microsurgery?
Microsurgery may be preferred when:
Fertility improvement is the main goal
Minimising recurrence and hydrocele risk is a priority
The varicocele is causing typical persistent pain
A trained microsurgeon is available
Embolisation is unsuitable or has previously failed
Avoiding radiation and contrast dye is important
3. Varicocele embolisation
Varicocele embolisation is a minimally invasive procedure performed by an interventional radiologist.
A thin tube called a catheter is inserted into a vein, usually through the groin or neck. The catheter is guided into the abnormal testicular vein using X-rays and contrast dye.
The vein is then blocked using materials such as:
Small coils
Vascular plugs
Medical adhesive
A medication that causes the vein to close
Blood then travels through healthier veins. No surgical incision is made in the groin or scrotum.
Advantages of embolisation
Potential advantages include:
No surgical groin or scrotal incision
Usually performed with local anaesthetic and sedation
A relatively quick initial recovery
Low risk of hydrocele
No direct handling of the testicular artery
Ability to see the abnormal veins during the procedure
Usefulness when a varicocele returns after surgery
Comparative studies suggest that embolisation and surgery can provide similar fertility outcomes in selected patients. Some studies report less postoperative discomfort and faster recovery following embolisation, although the available studies vary in quality.[5–7]
Possible risks and limitations
Possible disadvantages include:
The vein may be difficult or impossible to reach
Exposure to a small amount of X-ray radiation
Use of contrast dye
Bruising or bleeding where the catheter was inserted
Temporary pain or inflammation in the treated vein
Persistence or recurrence of the varicocele
Rare movement of a coil or other embolisation material
Limited availability in some hospitals
Why might someone choose embolisation?
Embolisation may be preferred when:
Avoiding a surgical incision is important
A faster recovery is a priority
A general anaesthetic is undesirable
The varicocele has returned after previous surgery
The venous anatomy is suitable
An experienced interventional radiology service is available
4. Laparoscopic varicocelectomy
Laparoscopic varicocelectomy is performed through several small abdominal incisions. A camera and surgical instruments are used to divide the testicular veins higher in the abdomen.
Potential advantages
Laparoscopic surgery can:
Treat both sides during one operation
Provide clear access to the veins within the abdomen
Be offered where microsurgical or embolisation services are unavailable
Possible disadvantages
Compared with microsurgery, laparoscopic repair generally has higher reported rates of hydrocele and recurrence. It also requires entry into the abdominal cavity risking potential injury to abdominal organs and it usually requires a general anaesthetic.[1,3,5]
Other risks may include bleeding, infection and rare injury to nerves or blood vessels.
5. Open non-microsurgical varicocele surgery
Traditional open operations divide the abnormal veins through an incision in the groin or higher in the abdomen without using an operating microscope.
These procedures can successfully treat a varicocele. However, without magnification, it can be more difficult to distinguish small veins from the testicular artery and lymphatic vessels.
Open non-microsurgical approaches generally have higher recurrence and hydrocele rates than microsurgical repair.[1,3,5]
They may remain appropriate when microsurgical or embolisation services are unavailable.
Is surgery or embolisation better for a varicocele?
For most men requiring surgical treatment, microsurgical inguinal or subinguinal varicocelectomy is generally regarded as the preferred surgical technique because it has low recurrence and complication rates.[1,3,5]
Embolisation is a reasonable minimally invasive alternative. It may be particularly attractive for men who want to avoid an incision, prefer a quicker recovery or have a varicocele that has returned after previous surgery.
Neither option is automatically best for everyone. The decision should consider:
The reason for treatment
Fertility plans and timeline
Previous varicocele procedures
Venous anatomy
Anaesthetic preferences
Local availability
The experience and results of the treating specialist
Does varicocele treatment improve fertility?
In men with a palpable varicocele, abnormal semen parameters and otherwise unexplained infertility, treatment may improve sperm concentration and increase the chance of pregnancy compared with observation.[1,2,5]
Benefits are less clear when:
The varicocele is found only on ultrasound
Semen-test results are normal
Another major fertility problem is present
There is non-obstructive azoospermia
The couple needs to proceed urgently with assisted reproduction
Couples should consider both partners’ fertility results before delaying IVF or ICSI to allow time for varicocele treatment to take effect.
Frequently asked questions
Can a varicocele go away without treatment?
A varicocele usually does not disappear on its own. However, many varicoceles remain stable and never cause enough difficulty to require treatment.
What is the best treatment for a varicocele?
When treatment is required, microsurgical varicocelectomy generally has the lowest reported recurrence and complication rates. Embolisation is an effective alternative for selected patients, particularly when avoiding surgery or treating a recurrent varicocele is important.[1,3,5]
Can medication cure a varicocele?
Medication cannot close the enlarged veins. Pain medication and supportive underwear may help manage mild symptoms, but they do not remove the varicocele.
How long does fertility improvement take?
Changes in semen quality are commonly assessed around three months after treatment. Further improvement may occur over six months or longer because sperm production takes several months.[1]
Can a varicocele return after treatment?
Yes. A varicocele may persist or return after any treatment. The risk is generally lowest after experienced microsurgical repair, but no technique can guarantee that recurrence will not occur.[1,3,5]
Will varicocele treatment definitely cure pain?
No. Most appropriately selected men experience improvement, but pain may continue. Treatment is more likely to help typical dull or dragging varicocele discomfort than sharp, burning or unexplained pain.[1,8]
Summary
Varicoceles affect approximately 10–20% of males, but most do not cause symptoms or infertility and do not require treatment.[1,3,4]
Treatment is most commonly considered for:
Persistent typical varicocele pain
Infertility with abnormal semen parameters and a palpable varicocele
Reduced growth of the affected testicle during adolescence
Selected fertility problems associated with raised sperm DNA fragmentation
When treatment is appropriate:
Microsurgical varicocelectomy generally has the lowest recurrence and complication rates.
Varicocele embolisation provides a minimally invasive alternative with no surgical groin incision.
Laparoscopic and open techniques may be appropriate in selected circumstances.
Observation remains the best option for many men who have no significant symptoms or fertility concerns.
The final decision should be based on your symptoms, fertility plans, examination findings and the expertise available locally.
References
European Association of Urology. EAU guidelines on sexual and reproductive health. Arnhem: EAU Guidelines Office; 2026.
Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II. Fertil Steril. 2021;115(1):62–69.
Kim DK, Kim DS, Kam SC, et al. Recent guidelines and perspectives for varicocele: a clinical consensus and recommendations from the Korean Society for Sexual Medicine and Andrology. World J Mens Health. 2025;43(4):748–757.
Alsaikhan B, Alrabeeah K, Delouya G, Zini A. Epidemiology of varicocele. Asian J Androl. 2016;18(2):179–181.
Persad E, O’Loughlin CA, Kaur S, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev. 2021;4(4):CD000479.
Liu Q, Zhang X, Zhou F, et al. Comparing endovascular and surgical treatments for varicocele: a systematic review and meta-analysis. J Vasc Interv Radiol. 2022;33(7):834–840.e2.
Bou Nasr E, Binhazzaa M, Almont T, et al. Subinguinal microsurgical varicocelectomy versus percutaneous embolization in infertile men: prospective comparison of reproductive and functional outcomes. Basic Clin Androl. 2017;27:11.
Park JH, Pak K, Park NC, Park HJ. How can we predict a successful outcome after varicocelectomy in painful varicocele patients? An updated meta-analysis. World J Mens Health. 2021;39(4):645–653.
This information is general and does not replace individual medical advice. Treatment should be selected after assessment by a suitably qualified urologist, andrologist or interventional radiologist.
