Varicoceles and Male Infertility

Varicoceles are a common vascular condition that can affect sperm production, testosterone levels, and overall male fertility. These enlarged veins within the scrotum often develop gradually and may go unnoticed for years. Understanding how varicoceles influence reproductive health can help men make informed decisions about evaluation and treatment. 

In this blog, Mark Edelman, MD, DABVLM, lead vein physician at Center for Vein Restoration (CVR) vein clinics in Norwalk, Connecticut, and Stamford, Connecticut, explains what varicoceles are, how they may contribute to infertility, available treatment options, and when to seek medical care.

If you've been diagnosed with a varicocele or are exploring possible causes of infertility, it's important to work with a urologist or reproductive specialist who treats that condition. Center for Vein Restoration (CVR) does not treat varicoceles or male infertility. As the nation's largest physician-led vein practice, CVR specializes exclusively in diagnosing and treating venous disease of the legs, including varicose veins and chronic venous insufficiency. If you're experiencing leg heaviness, swelling, pain, or visible veins, our board-certified vein specialists can evaluate your symptoms and walk you through your treatment options.

What Is a Varicocele?

A varicocele is a cluster of enlarged veins within the scrotum, similar to varicose veins that develop in the legs. It occurs when valves inside the veins don’t function properly, allowing blood to pool rather than flow efficiently back toward the heart.

While some never experience symptoms, the condition has been strongly associated with reduced fertility. Varicoceles are found in 15 percent of the adult male population and approximately 35 percent of men with primary infertility, Healthline reports, making the condition one of the most common correctable causes of male reproductive challenges.

More on Varicoceles and Male Infertility

The veins surrounding the testicles form a network called the pampiniform plexus, MedicalNewsToday explains. One of its key functions is helping regulate testicular temperature. Healthy sperm production requires a temperature slightly lower than normal body temperature. When blood pools in enlarged veins, excess heat can build up around the testicles, creating an environment that may impair sperm development.

According to Johns Hopkins Medicine, varicoceles can also cause decreased testosterone production. Testosterone plays an important role in reproductive health, so hormonal changes may further contribute to fertility concerns.

How Do Varicoceles Affect Fertility?

Beyond the potential for decreased testosterone production, varicoceles can also reduce fertility by increasing scrotal temperature and disrupting healthy blood flow. Together, these changes may lower sperm count, reduce sperm movement, and impair sperm quality, making conception more difficult for some couples.

What Symptoms Can a Varicocele Cause?

Many varicoceles produce no noticeable symptoms. When symptoms do occur, they can vary in severity and may become more noticeable after prolonged standing or physical activity.

Common signs include:

• A visible or enlarged network of veins in the scrotum
• A feeling of heaviness in the scrotum
• Dull aching discomfort
• Pain that worsens after standing for extended periods
• Swelling in the scrotal area
• One testicle appearing smaller than the other
• Fertility challenges discovered during evaluation

Symptoms are often mild, so some men only learn they have a varicocele during a fertility assessment or routine physical examination.

What Causes a Varicocele to Form?

Varicoceles develop when blood flow within the testicular veins becomes inefficient. Small valves inside the veins are designed to keep blood moving in the correct direction. When those valves weaken or fail, blood can collect inside the veins instead of returning smoothly to the heart.

Over time, the increased pressure causes the veins to enlarge. Most varicoceles occur on the left side of the scrotum due to differences in the anatomy of the surrounding blood vessels. However, they can occur on either side or affect both sides simultaneously.

The exact reason some men develop varicoceles while others don’t is still unclear, but the condition is often linked to natural variations in venous anatomy.

How Are Varicoceles Diagnosed?

Diagnosis typically begins with a medical history and physical examination by a primary care physician, urologist, andrologist, or interventional radiologist, not CVR. During the exam, a physician may inspect and feel the scrotum while the patient is standing. Larger varicoceles are often detectable during this evaluation.

Imaging may be recommended to confirm the diagnosis or assess blood flow. Ultrasound is the most commonly used imaging test because it provides a detailed view of the veins and can identify abnormal blood flow patterns.

In some situations, additional imaging studies may be considered to provide further information about the affected veins.

What Treatment Options Are Available?

Treatment recommendations depend on factors such as symptoms, fertility goals, testicular health, and overall medical history:

• Catheter-Directed Embolization: Embolization is a minimally invasive outpatient procedure performed by an interventional specialist. A thin catheter is guided through the vascular system to the affected vein. The vein is then sealed so blood can be redirected through healthier pathways. No large surgical incision is required, so recovery is generally quick. Many patients return to normal activities within a few days.
• Varicocelectomy Surgery: A varicocelectomy is a surgical procedure that closes or removes the affected veins. The procedure is typically performed under anesthesia and is often completed on an outpatient basis. Recovery usually takes longer than embolization, and activity restrictions may be necessary during the healing period. 

Your fertility specialist can explain which treatment approach is most appropriate for your individual situation.

When Should You Seek Medical Care?

Prompt evaluation is important when a varicocele is causing symptoms or may be affecting reproductive health.

Consider scheduling an assessment if you experience:

• Persistent scrotal discomfort
• Visible enlarged veins
• Changes in testicular size
• Difficulty conceiving after trying to become pregnant
• Concerns about testosterone levels or reproductive health

Early evaluation can help determine whether treatment may improve symptoms, protect testicular function, or support fertility goals.

CVR Can Lead Patients Toward Relief from Vein Problems of the Leg

Varicoceles are more than a cosmetic vein condition. They can play an important role in male infertility by affecting temperature regulation, blood flow, and hormone production. Fortunately, effective diagnostic tools and treatment options are available, and many men benefit from a personalized evaluation to determine the best path forward.

If you have questions about a varicocele or male infertility, consult a urologist or reproductive specialist. Center for Vein Restoration (CVR) does not treat varicoceles or male infertility. CVR is the nation's largest physician-led vein practice, specializing exclusively in the diagnosis and treatment of chronic venous insufficiency and venous disease of the legs. If you're experiencing leg pain, swelling, heaviness, or visible varicose veins, our board-certified vein specialists are here to evaluate your symptoms and walk you through your treatment options.

Frequently Asked Questions

Can Center for Vein Restoration treat my varicocele or male infertility?

No. CVR does not treat varicoceles or male infertility. CVR is the nation's largest physician-led vein practice, specializing exclusively in the diagnosis and treatment of chronic venous insufficiency and venous disease of the legs, including varicose veins, spider veins, and related conditions. If you are experiencing leg pain, swelling, heaviness, or visible varicose veins, call CVR at 240-249-8250 or find a location near you HERE.

Can a varicocele return after treatment?

Recurrence is possible, although modern treatment techniques are designed to minimize that risk. Follow-up care helps ensure proper healing and long-term results.

Does every varicocele need treatment?

No. Treatment is usually recommended when a varicocele causes pain, affects testicular health, or is suspected of contributing to fertility concerns.

Can teenagers develop varicoceles?

Yes. Varicoceles often first appear during adolescence and may be discovered during routine medical examinations or sports physicals.