A varicocele is a cluster of enlarged veins in the scrotum. It is one of the most common findings in men evaluated for fertility, and it is also common in men who have no fertility problem at all. Both are true at once, which is exactly why the topic gets confusing.
Here is what one is, how it is found, what the grades mean, and how urologists think about repair. This is general education, not medical advice. Anything about your own body belongs with a urologist.
What a varicocele actually is
Blood reaches the testicle through arteries and leaves through a network of small veins called the pampiniform plexus. Those veins have one way valves that keep blood moving upward, against gravity. When the valves do not work well, or drainage further upstream is restricted, blood pools and the veins widen. That dilated, tangled cluster is a varicocele. It is essentially a varicose vein, in a part of the body that gets talked about far less openly.
Why the left side is involved more often
Varicoceles appear on the left far more often than on the right. The usual explanation is drainage anatomy: the left testicular vein empties at a sharp angle into the left renal vein, while the right drains at a gentler angle into the vena cava. They can occur on both sides. One that is on the right only, or that appears suddenly and does not soften when you lie down, gets looked at more carefully, because occasionally it points to something further up pressing on the vein.
What it feels like
Many cause no sensation and are found only because someone examined or scanned you for another reason. Larger ones feel like a soft, irregular fullness above the testicle, often compared to a bag of worms. Where symptoms exist, they are usually a dull ache or heaviness that builds over a day of standing and eases when you lie flat.
How a varicocele is found
The physical exam
The exam is the foundation. A urologist usually examines you standing, in a warm room, because cold and lying down make the scrotum draw up and can hide the veins. You will be asked to bear down, which raises abdominal pressure and fills dilated veins so they are easier to feel. The testicles are also compared for size, which matters particularly in teenagers.
Scrotal ultrasound
A scrotal ultrasound with Doppler adds detail that fingers cannot. It measures the width of the veins, shows whether blood flows backwards when you bear down, measures the volume of each testicle, and helps rule out other causes of swelling. Centres use different criteria for calling a vein dilated, so it is fair to ask what your report was based on.
Ultrasound also detects veins too small to feel. That finding is called a subclinical varicocele, worth knowing about before you see it on a report, because it is generally not treated for fertility reasons.
What the grades mean
Grading comes from the physical exam, not the scan. It is shorthand for size, useful mainly because it says whether the varicocele can be felt at all.
| Description | How it is detected | What it means in practice |
|---|---|---|
| Subclinical | Cannot be felt; seen only on ultrasound | Generally not a target for fertility surgery |
| Grade 1 | Felt only while you bear down | Small, but palpable |
| Grade 2 | Felt without bearing down | Moderate, palpable |
| Grade 3 | Visible through the scrotal skin before touching | Large, palpable |
Where your own varicocele sits on that scale, if you have one at all, is for the clinician examining you to say rather than something to work out at home. A higher grade does not tell you your fertility is affected, and a low grade does not promise that it is not. Grade describes the veins, not your sperm and not your chances of a pregnancy.
Why a varicocele might affect sperm
Varicoceles can, in some men, be associated with reduced sperm quality. The mechanism is less settled, and the honest summary is that several plausible explanations coexist and probably overlap.
Heat
Sperm production works best slightly below core body temperature, which is part of why the testicles sit outside the body. Pooled venous blood is thought to keep the testicle warmer than it should be, and the cell divisions and enzymes involved in making sperm are temperature sensitive.
Oxidative stress
Sperm membranes are rich in fats vulnerable to damage from reactive oxygen species, normally held in balance by antioxidant defences. Stagnant flow and reduced oxygen delivery are thought to tip that balance, and markers of oxidative stress and sperm DNA fragmentation are often reported as higher in men with varicoceles. This remains an area of active research rather than settled fact.
Other proposals
- Sluggish flow reducing oxygen delivery to developing sperm cells.
- Effects on the Leydig cells, which make testosterone, one reason some men are also assessed for symptoms of low testosterone.
Plenty of men with a varicocele are fertile
This is the part that gets lost. Varicoceles are common in the general adult male population, including among men who have fathered children without difficulty. Finding one does not mean you have found the reason for a delay in conceiving.
So treat it as one data point, alongside your semen analysis, your history, your medications and exposures, and your partner's evaluation. Keeping those together with dates attached makes appointments less repetitive, and that is the kind of organising a tool like EggWise is built for. It is somewhere to keep your own records, not a treatment, and it has no influence on whether a pregnancy happens.
What the rest of the evaluation looks like
- Semen analysis. Usually more than one, weeks apart, because results vary considerably between samples in the same man. Follow the lab's instructions on abstinence and transport. Each laboratory prints its own reference ranges beside your results, so go through the actual report with a clinician and ask where your values sit against that lab's ranges, rather than measuring them against figures found online.
- History and examination. Previous surgery, infections, an undescended testicle, injury, medications including testosterone or anabolic steroids, and heat or chemical exposures. Bring a full list of what you take, prescribed or otherwise. Do not start, stop or adjust any medication or supplement on your own; that decision sits with the clinician looking after you.
- Hormone testing. Often considered when semen parameters are low or symptoms suggest low testosterone.
- Partner evaluation in parallel. Male and female workups run alongside each other, not one after the other.
When repair is considered
The usual profile
Urologists are most likely to discuss repair when several things line up: the varicocele can be felt, the semen analysis is abnormal, and the couple is having difficulty conceiving while the female partner's evaluation is reassuring or already being addressed. It is also considered for persistent pain that has not settled with conservative measures, and in adolescents when the affected testicle is meaningfully smaller.
Repair is usually not offered for a subclinical varicocele found only on ultrasound, or for a man with a normal semen analysis and no symptoms. Whether any of this describes your situation is a judgement for the urologist who has examined you and read your results, not something to settle from an article.
How repair is done
Every approach aims at the same thing: interrupting the abnormal venous drainage while sparing the artery, the vas deferens, and the lymphatic vessels.
| Approach | General idea |
|---|---|
| Microsurgical varicocelectomy | Open surgery through a small groin incision, using an operating microscope to identify and tie off the veins |
| Laparoscopic ligation | Keyhole surgery higher up, where fewer and larger veins are tied |
| Percutaneous embolisation | An interventional radiologist threads a catheter through a vein and blocks the abnormal vessels from the inside |
Each carries its own profile for recurrence, recovery, anaesthesia, and complications such as fluid collecting around the testicle. Which suits you depends on your anatomy and your centre's expertise, so ask your urologist what they recommend and why.
Why there is genuine debate
You will find strong opinions in both directions, and it is not that one side is careless. The research base is genuinely mixed. Some trials have included men with subclinical varicoceles or normal semen parameters, groups less likely to benefit, which can dilute any effect that is there. Studies have also differed in the technique used, in how long men were followed afterwards, and in what was actually measured. Better semen parameters and a baby are not the same result, and the second is the one that matters to you.
Many urologists take the view that in carefully selected men, meaning a palpable varicocele alongside abnormal semen parameters, repair can improve semen parameters for some. Outcomes differ from man to man, and nobody can honestly tell you that repair will produce a pregnancy.
If you go ahead
Return to normal activity is usually measured in days to a couple of weeks, and your surgeon's instructions take precedence over anything you read. A repeat semen analysis is typically arranged some months later, in line with how long sperm take to develop. Results range from clear improvement to no measurable change, and varicoceles can persist or come back. Ask how repair fits with any assisted reproduction you are considering, because for some couples the timing of IVF or IUI is the more pressing decision.
Questions worth bringing to the appointment
- Is my varicocele palpable, and what grade is it?
- Given my semen analyses, would you expect repair to help, and what are you hoping to change?
- Which technique do you recommend, what are the realistic risks, and when would we reassess?
- If we are also considering IUI or IVF, does repair change that plan or its timing?
When to talk to a clinician
Book an appointment with a urologist, ideally one who works in male fertility, if any of these apply:
- You have been trying to conceive without success and have not yet had a semen analysis. How long clinicians suggest trying before an evaluation depends on your circumstances, including your partner's age, so ask what applies to you rather than assuming you should keep waiting.
- A semen analysis has come back abnormal, whether or not a varicocele has been mentioned.
- You can feel a soft, irregular fullness above a testicle, or one testicle looks or feels noticeably smaller than the other.
- You have a dull ache or heaviness in the scrotum that worsens with standing and improves when you lie down.
- A varicocele has appeared suddenly, is on the right side only, or does not soften when you lie down.
- You have symptoms that can go with low testosterone, such as fatigue, low libido, or erection difficulties.
- You have been told you have a varicocele and nobody has explained whether it is relevant to your fertility.
Seek urgent care the same day for sudden severe testicular pain, rapid swelling, a hard fixed lump, fever with scrotal pain, or pain after an injury. Those point towards time sensitive conditions that are not varicoceles.
None of this is something you caused, and none of it is yours to work out alone. Bring what you have, including previous semen analyses and imaging reports, and let a urologist put the pieces together with you.
This article is general education, not medical advice. It cannot tell you whether you have a varicocele, whether it is affecting your fertility, or whether repair is right for you. Your own clinician is the person to examine you, interpret your results, decide on any medication, and set the plan with you.