Varicocele repair for fertility should be considered generally when the following conditions are met:
When the varicocele can be felt during a physical examination.
- When the male partner has abnormal semen quality or abnormal sperm function test results.
- When the couple has known infertility and the female is either fertile or can be treated for her infertility.
- (Young men not in partnerships but who may want to have children later on may also be candidates if they meet the other two qualifications.)
Although many urologists favor varicocele repair, evidence is mixed on whether surgery improves the chances of a successful pregnancy. In a review of 12 studies, pregnancy rates after a year were 33% in couples in which the men were treated compared to 16% in untreated couples. Of two well-designed studies, however, one showed no higher pregnancy rate while the other reported significant improvement.
Some studies report that repair may improve the success rate of assisted reproductive technologies, such as intrauterine insemination (IUI). Still, the overall benefits remain uncertain, and additional rigorous trials are needed. The procedure does not appear to be at all beneficial for improving fertility in men whose varicoceles are very small.
Repair of a Varicocele
Varicocelectomy- Repair of a varicocele (varicocelectomy) in men with infertility problems is a common surgical practice. The procedure involves tying off the swollen and twisted veins. Recovery takes six days and most men cannot resume full activity for about three weeks. This technique eliminated 90% of varicoceles.
Recent techniques use laparoscopy, which employs tiny incisions (less than an inch). This approach allows for quicker recovery, although the procedure itself takes longer. It also has a higher rate of complications than the standard approach.
Varicocele Embolization– A nonsurgical technique called varicocele embolization may eventually prove to be an effective and less painful treatment for varicoceles. It involves inserting a narrow tube (catheter) through a small incision in the neck or leg. Tiny steel plugs are passed through the catheter to block off the affected veins. It takes 15 to 45 minutes under local anesthetic. This is not yet widely available and it may not be appropriate in some men.