A varicocele is one of the most common — and most correctable — causes of male infertility. Fellowship-trained in andrology and reproductive microsurgery, Dr. Deebel offers precise microsurgical repair to help protect and restore fertility, relieve discomfort, and, in some men, support testosterone production.
A varicocele is an abnormal enlargement of the network of veins (the pampiniform plexus) that drains the testicle — similar to a varicose vein in the leg. Varicoceles are common, occurring in roughly 15% of men, and most men who have one remain fertile.
However, a varicocele is the most common identifiable and correctable cause of male infertility, found in about 40% of men evaluated for a fertility problem. The backup of blood (venous reflux) and the resulting rise in testicular temperature are believed to impair sperm production and quality. In some men — particularly with larger varicoceles — a varicocele can also affect testosterone production.
Varicoceles can reduce sperm count and movement (motility).
Venous reflux and elevated testicular temperature are thought to be the main drivers of testicular stress.
Left untreated, a varicocele may cause a gradual decline in semen quality over time.
Larger varicoceles may lower testosterone, and repair can improve levels in some men.
In adolescents and young men, a varicocele can slow growth of the affected testicle. Early screening with potential intervention may be recommended on a case-by-case basis.
Some men experience a dull ache or heaviness, especially with standing or activity.
Many varicoceles cause no symptoms at all and are found during a fertility evaluation. When symptoms do occur, they may include:
Scrotal discomfort that tends to worsen with standing, exertion, or over the course of the day and eases when lying down.
A soft, lumpy fullness above the testicle that can sometimes be seen or felt, usually more prominent on the left side.
For many men, an abnormal semen analysis during a fertility work-up is the first sign. Couples may also experience recurrent pregnancy loss, which can be associated with elevated sperm DNA fragmentation from an untreated varicocele.
A size difference on the affected side, which is an important finding in adolescents and young men.
A review of your history and reproductive goals, with at least two semen analyses when fertility is a concern.
The scrotum is examined both standing and lying down, and during a Valsalva (bearing-down) maneuver — the most important step in diagnosis.
Palpable (clinical) varicoceles are graded 1 to 3. Only clinically palpable varicoceles have been clearly linked to infertility.
A scrotal ultrasound is used only when the physical exam is inconclusive — not for routine screening of subclinical varicoceles.
For couples trying to conceive, varicocele repair is generally considered when most or all of the following are present: a varicocele that is palpable on exam, known infertility as a couple, a female partner with normal or treatable fertility, and abnormal semen parameters. Repair is also an option for men with varicocele-related pain, adolescents and young men with reduced size of the affected testicle, and, in select cases, men with low testosterone. Treatment is not recommended for a varicocele found only on ultrasound (subclinical) or when semen quality is already normal. Dr. Deebel reviews your individual situation — and your partner's — to recommend the right path using the shared decision-making process.
The goal of repair is to interrupt the abnormal veins while preserving the testicular artery and lymphatics.
Dr. Deebel's approach. Through a small subinguinal or inguinal incision, the dilated veins are precisely tied off under the operating microscope while the testicular artery and lymphatic vessels are carefully preserved. This microsurgical technique offers the lowest recurrence (about 1–2%) and complication rates of any approach and is performed as an outpatient procedure.
Performed by an interventional radiologist, the refluxing veins are blocked with tiny coils or a sclerosing agent through a small catheter. It avoids an incision and can be an option for select patients, but it has a higher recurrence rate (around 15%) and is not always technically possible.
Older "high ligation" and laparoscopic techniques are still used in some settings but carry higher recurrence rates than the microsurgical approach.
Microsurgical repair successfully eliminates more than 90% of varicoceles, and most men see improvement in semen quality — typically over 3 to 6 months, matching the body's sperm-production cycle. For some couples, this improvement is enough to move from IVF/ICSI to simpler treatment such as intrauterine insemination (IUI), or even to natural conception, and studies show higher spontaneous pregnancy rates after repair. In many cases, semen parameters may decline in the short term before they improve. Given this, Dr. Deebel may recommend proceeding with IVF/ICSI with plans to repair your varicocele once pregnant. This will help with parameters for future pregnancy efforts and will not delay you and your partner's current family planning efforts.
No. Many varicoceles are harmless and never need treatment. Repair is reserved for specific situations — most often infertility with abnormal semen parameters, bothersome pain, reduced testicular growth in adolescents, and, in select cases, low testosterone.
In many men, semen quality improves over 3–6 months after repair, and studies show higher natural pregnancy rates. Results aren't guaranteed and depend on factors like varicocele size and starting semen parameters — Dr. Deebel reviews what to expect with you individually.
Microsurgical subinguinal varicocelectomy is considered the gold standard, with the lowest recurrence (about 1–2%) and complication rates. Percutaneous embolization by an interventional radiologist is a non-surgical alternative for select patients.
Yes. Microsurgical varicocelectomy is performed as an outpatient procedure, and most men return to light activity within a few days, avoiding strenuous activity for a short period as directed.
While the data is inconclusive on this subject, we think it potentially can. This is one of several factors considered when deciding whether treatment is appropriate.
At this time, the current data does not support varicocele repair as a treatment for men with azoospermia. Dr. Deebel will review your individual situation and discuss the options best suited to your goals.
Yes. An initial telemedicine visit is a convenient way to review your history and any prior testing. A physical examination, however, is essential to confirm and grade a varicocele.
Schedule an evaluation to understand your options for fertility and comfort. In-person and telemedicine visits are available.