Turek on men's health
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Award-winning urologist - and pioneer in Men's Health - Dr. Paul Turek blogs weekly about issues such as infertility, vasectomy and vasectomy reversal, sexual and hormonal dysfunction and more. Keep up with the latest on this fascinating field of medicine.

Meet Mr. Varicocele

This is no unicorn
Varicocele: Unicorn or workhorse?

How can something so soft and warm and blue, and no wider than a pencil, have such a devastating effect on your ability father children? Meet the varicocele (veri-ko-seal), the unicorn of male fertility.

The Inimitable Varicocele

As posted previously, the varicocele is unique to humans and is a consequence of our upright posture. It is a bag of veins in the scrotum that, except if it caused low-grade discomfort, you probably would never know you have.

Varicocele as Unicorn

Yet, as I live and breathe the nuances of this field daily, the varicocele never ceases to amaze me.  Although first recognized in the first century AD, it gained modern notoriety when a Dr. Tulloch surgically repaired one in the 1950s in a man who had no sperm in his ejaculate. Lo and behold, sperm returned to the ejaculate and the patient’s wife conceived naturally. Is this the story of a unicorn?

Not really. Unlike the ephemeral unicorn, the varicocele exists and is, in fact, quite common. Look hard and you will find them in 15% of healthy men and in 40% of men having trouble conceiving their first child. It is even more common in men having trouble having a second child. Having said this, it is also true that most men with varicoceles are normally fertile. So how does this work?

A Susceptibility Thing

No one really knows why varicoceles affect the fertility of some men but not others. Maybe it’s the size of the lesion or maybe it’s the exposure time (time from their onset at puberty to the age at which men try to conceive) that matters. As a consequence, some clinicians don’t believe in them and others, like me, do. In fact, I have spent a great deal of time pondering them in infertile men. Because of this, I feel I know their personality quite well.

The Varicocele Personality

Having read, studied and published on the varicocele over the last 2 decades, here is my letter of recommendation about varicoceles:

Dear Parent to Be:

I am delighted to write this letter of support about Mr. Varicocele, someone whom I have known well for the last 20 years and feel comfortable commenting on his personality and future potential.

      1. In most men, he coexists peacefully and never bothers anybody.
      2. In some men, he disturbs sperm production and can wreak havoc on fertility.
      3. Fixing him can help couples conceive naturally
      4. Fixing him can help eliminate scrotal pain
      5. Fixing him fixes a problem and can help couples build entire families (i.e. have several children)
      6. Fixing him can help couples considering IVF for family building to avoid IVF and conceive naturally
      7. Fixing him can help couples considering IVF to have children to use less invasive technology (i.e. IUI) instead of IVF to conceive
      8. Fixing him in men who fail to conceive with IVF can help with IVF conceptions
      9. Fixing him in men with genetic causes of infertility will not help them conceive naturally
      10. Fixing him in men with no ejaculated sperm counts will generally not help them conceive naturally but can help them conceive with IVF

In summary, I believe in Mr. Varicocele has the potential to have a great impact on the world of human fertility. Please consider him seriously whether you are simply contemplating, or actually building, your family as he can be invaluable in these situations. Personally, I recommend him highly to as one of the most common correctable conditions associated with infertility. Please call me if you have any questions about this rather strong recommendation.

Sincerely yours,

Paul Turek MD

Director, The Turek Clinic

23 Responses to “Meet Mr. Varicocele”

  1. Al

    Hi Dr Turek,
    I find this blog very interesting. My husband had a uncessessful TESA about six months ago and we were told that the found no sperm cells or cells that can become sperm and therefore he will never father his own child. At the time I asked our doctor about a varicocele that another specialist had pointed out in a recent visit and was told that this had would have nothing to do with his azoospermia. Just wondering your thoughts on this or should we get a second opinion?

  2. Al

    I guess what I’m asking is can a varicocele cause total NOA? I know it can decrease sperm count but can it stop production entirely?

  3. Samson

    I recently had a left side varicocele repaired by Interventional Radiology hoping that it would boost my testosterone levels. I didnt have any problems with fertility, but lowT and scrotal pain. Unfortunatly after 3 months my T levels did not increase, but what did occur was remarkable. Within 1 week of the surgery I went from being practically an insomniac to sleep soundly through the night. I havent seen this published anywhere, but I have a hunch many men with unidentified sleep problems may be related to undiagnosed varicoceles.

    • Paul Turek, MD Paul Turek, MD

      Samson, interesting. Maybe the scrotal pain was preventing you from getting good sleep and now that is gone. Either way, better sleep may also increase your testosterone levels.

    • Paul Turek, MD Paul Turek, MD

      Dear Al, Anything that reduces the pain/discomfort of a varicocele is good. The real question is whether the varicocele is potentially affecting your future fertility (if that is an issue at all!). A semen analysis may be of help here. As long as the discomfort is under control and the semen analysis remains normal, you should be good to go.

  4. rahul

    Sir,I suffering from grade-1 left sided varicocele,Sir I consult the andrlogist,he suggested me to operation,is neccesary operation for grade1 varicocele,if operation is necessary which operation method is best with low complications,and reaccurence and formation of hydrocele.please suggest me sir.my sperm count is 52 millions/no,progressive motility is65 and non progressive motility is 20.what I do.my left sided scrotum is swelled.is swelling can decrease after surgery.and I have also back pain.Please suggest me sir.is embolization good,or micro surgery .please suggest me sir.iam praying you sir please suggest me.iam in dialama

    • Paul Turek, MD Paul Turek, MD

      Dear Rahul, there are two and maybe 3 reasons to fix varicoceles: 1) infertility with an ABNORMAL semen analysis (sounds like yours is fine) b) scrotal pain that goes away when lying down (sounds like you have back pain which is not typical) and 3) maybe low testosterone. Not looking good that a varicocele repair will help you… I prefer the microsurgical subinguinal repair because of very high reliability and low recurrence.

  5. ALEX

    I m married fro 3 yra now but have no children yet. \my sperm analysis is low and Doctor said I had varicocele. He is suggesting surgery which I don’t want. Pls is there any other remedy?. What do I do?. Thank you sir.

    • Paul Turek, MD Paul Turek, MD

      Dear Alex, often, fixing the problem (ie. varicocele) is the best way to solve the fertility issue. Much cheaper than alternative (IVF, IVF-ICSI) and allow you to have a lot more fun trying to have a baby at home and not in the laboratory. The average time to conceive in our practice after repairing a varicocele is 6-7 months.

  6. Joe

    Dr. Turek,

    I had a microsurgical varicocele repair on both testicles two years ago, and I am a little self conscious and embarrassed about the scars. I was wondering if you had any recommendations as to how to improve or diminish the appearance of these. Is is safe to try a silicone gel? I just want to make sure that this wouldn’t negatively impact my sperm or testosterone levels. Any advice you could provide would be greatly appreciated. Thanks so much.


    • Paul Turek, MD Paul Turek, MD

      Joe, at this point, 2 years after surgery, silicone gel is not likely to help for keloids. Surgical scar revision is relatively simple and then using silicone gels immediately afterwards for several weeks would probably be best way to improve things. There are no concerns about sperm or testosterone levels with simple scar revisions.

  7. shilparoy

    Good post!! My uncle suffered from varicocele with heavy pain in testicles. Last month after a great research we came to know about non surgical varicocele embolisation treatment by Dr. Abhilash at http://www.interventionsinradiology.com/. It was a good treatment with in a month he was completely cured.

  8. Kareem

    Dr., i have a left side grade 3 varicocele, no pain (just slight discomfort after a long day of standing), no testicular atrophy and I’m doing semen analysis this week as determined by my andrologist, can you please tell me about my chances that it would come out to be normal, I’m much curious about this please give me your opponion

    • Kareem

      Oh, I’m 21 and unmarried, if it was recommended for me to undrego varicocelectomy, would you advise me to have it now or after marriage (around 5-6 years from now)

      • Paul Turek, MD Paul Turek, MD

        Dear Kareem, Great Question and hard to answer! Most men with varicoceles will never have a problem with pain and infertility, and some will. Problem is there is no way to predict but in general large varicoceles associated with smaller testicles are more worrisome.

    • Paul Turek, MD Paul Turek, MD

      Dear Kareem, hard to say the chances of it being normal. I would say that with a smaller testis on the side of the varicocele and a large varicocele that the chances of having a low sperm count are higher.

  9. Jack

    Doc, It’s been recommended to me to get a varicocelectomy as I have a grade 3 varicocele and my wife and I are having trouble conceiving. However, I do menial labor for a living and I was just wondering if after this repair I might be at an increased risk for a hernia? Is there any truth to that? Thank you

    • Paul Turek, MD Paul Turek, MD

      Jack, I love the microscopic, subinguinal approach which does not lead to any increased risk of hernia afterwards. Never seen it. You must ask your surgeon what kind of repair he/she does (inguinal, retroperitoneal) and what the chance of hernia is.

  10. Ahli

    Dr. I had a sperm analysis and found no sperm count.
    Blood tests FSH 24
    No microdeletions found on chromosome Y
    And I have a varicocele on the left of 2.3mm diameter
    Can you tell me the chances of conceiving a child? Is there hope to find sperm through microTESE?

    • Paul Turek, MD Paul Turek, MD

      Dear Ahli, This picture is typical of non obstructive azoospermia with a small (possibly inconsequential) varicocele. In our publication of results using FNA mapping, 63% of men had pockets of sperm in the testis. Once sperm are found, the chances of conceiving a child depend almost entirely on your partner’s fertility potential.

  11. mwang

    Dr, i have been married for 6 months now without conceiving, i did semen analysis twice and both had no sperm found and i was told its azoospermiam i did some tests, my hormone and testosterone is normal but i was told i have a mild left varicocele. i went to the ulologist and he told me to have surgery in mid august. he suggested that it could the reason i have azoospermia but he assured me that he is not 100% if thats the cause. advise please

    • Paul Turek, MD Paul Turek, MD

      Dear MWang, In the setting of azoospermia that is not caused by obstruction, there is a 30-40% chance that a varicocele repair will lead to ejaculated sperm. This might take 6-8 mos to occur. Generally, the ejaculated sperm counts achieved will not be sufficient for at-home conception, but will generally need IVF to work. If obstruction is present, then varicocele repair will not result in ejaculated sperm. So, in general, azoospermia is NOT due to the varicocele. Genetic causes (Y deletion and karyotype) should be looked into first as we have published that fixing varicoceles in the setting of genetic infertility does not improve semen quality or lead to natural pregnancies. Genetics generally drives things.


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