Does varicocele treatment improve fertility in men?

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.

Researchers from the Cochrane Collaboration (an international network of researchers) wanted to find out whether treating varicoceles increases the chances of pregnancy and the birth of a living child. The researchers found 33 randomized controlled trials (RCTs). This kind of study provides the most reliable results when assessing the benefits and harms of medical treatments.

A total of over 4,000 men took part in the study. None of them had fathered a child before. 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 one looked at the effects of blocking a varicocele using minimally-invasive procedures (embolization).

The researchers were interested in finding out how many women gave birth following their partner's treatment, how many became pregnant, 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.

The researchers were careful about drawing conclusions from their analysis because of flaws in the study design. Overall, though, the studies suggest that women are more likely to become pregnant if their partner’s 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 21 out of 100 women became pregnant even though their partner's varicocele wasn't treated.
• About 26 to 64 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.

It is not possible to say whether more women give birth if their partner’s varicocele is treated. Too few studies looked into this outcome.

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.

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

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.