Does varicocele treatment improve fertility in men?

Photo of a doctor and patient (PantherMedia / Alexander Raths)

Some experts think that varicoceles can affect fertility in men. If men with a palpable varicocele and poor sperm quality have treatment, the chances of their partner becoming pregnant could possibly improve.

Most couples who are trying for a baby will succeed within two years. If it takes them longer, they are considered to have a fertility problem. This doesn’t necessarily mean that they can’t have children. It might just take longer for the woman to get pregnant in the usual way. Still, a lot of couples want to know why they are having difficulties getting pregnant.

Varicocele as a possible cause of reduced fertility

There is some evidence that varicoceles might reduce men’s fertility. But scientists don't yet fully understand why that may be. Some experts believe that the quality of the sperm is poorer because the varicocele reduces the blood supply to the affected testicle. Others believe that the build-up of blood in the scrotum raises the temperature of the testicle, which could affect sperm production.

Treating varicoceles

The aim of varicocele treatment is to stop the blood from building up. This can be done by either closing off the vein using minimally-invasive procedures (embolization) or by carrying out surgery to cut or tie off the vein. These procedures stop blood flowing through the affected vein. It then flows through healthy, nearby veins instead.

It usually takes about a day to recover from procedures to close off the vein. But surgical procedures can have side effects, including bruising, infections and nerve damage. The duct that carries the sperm cells from the testicles to the penis (the “vas deferens”) is only very rarely damaged. A build-up of fluid in the testicles (hydrocele) is another possible side effect. Certain kinds of embolization (sclerotherapy) can sometimes harm nearby blood vessels. Varicoceles can also come back again after treatment.

Research on the influence of surgical procedures on fertility

Dutch researchers wanted to find out whether treating varicoceles increases the chances of pregnancy. The researchers found ten randomized controlled trials (RCTs) in this area. This kind of study provides the most reliable results when assessing the benefits and harms of medical treatments.

A total of about 900 men took part in the study. None of them had fathered a child. The cause of reduced fertility wasn't clear in all of the couples. Most of the men had poor sperm quality. Some of the studies compared a varicocele treatment with no treatment, while others compared different treatments with each other. Most of the studies looked at the effects of tying the vein through surgery. Only two looked at the effects of blocking a varicocele using minimally-invasive procedures (embolization).

The researchers were interested in finding out how many women became pregnant following their partner's treatment and how often the surgery had side effects.

The researchers didn't gather information about improvements in sperm quality because it doesn't allow any reliable conclusions to be drawn about fertility. Sperm quality can vary over time in all men so, when considered alone, it is no guarantee of fertility.

Fertility might improve in some men

The researchers were careful about drawing conclusions from their analysis because of flaws in the study design. Overall, though, the studies suggest that men are more likely to father a child if their varicocele is treated. But that only applies to men who have a palpable varicocele (one that can be felt from the outside) and poor sperm quality before the procedure. The studies can only provide a rough estimate of how many men benefited from this treatment. Expressed in numbers:

  • About 16 out of 100 women became pregnant even though their partner's varicocele wasn't treated.
  • About 32 out of 100 women became pregnant after their partner's varicocele was treated.

These figures are average values taken from various studies. This means that an individual man’s chances of benefiting from treatment could be better or worse.

The treatment wasn't found to help in men who had a varicocele that could only be detected using ultrasound and who had normal sperm quality.

Unfortunately the studies don't provide any information about how common complications and side effects were.

In summary: Treatment could be worthwhile for men with varicoceles that can be felt from the outside (palpable varicoceles). In any case, it can be a good idea to seek advice from a fertility clinic if you would like to have children and are having problems.