What is the treatment of varicoceles?

Not all varicoceles need to be treated. If you are not having pain or discomfort and are not concerned about your fertility, then treatment may not be necessasry. If you experience and aching discomfort or pain, careful evaluation by your physician is needed to determine whether this symptom is actually related to the varicocele.

It is unlikely that small to medium varicoceles cause problem. Most urologists believe that only those varicoceles that are large enough to view without resorting to ultrasound are likely an issue when it comes to fertility. Then the issue is whether or not one should attempt surgical correction by either laparoscopy or whether you should choose to consider IVF with ICSI [sperm injection] to achieve a pregnancy. Varicocele repair is associated with an improvement in the semen analysis in approximately 60% of those who undergo treatment. About half those who show improvement or about 30% of those who undergo surgery will acheive a pregnancy. When the cumulative pregnancy rate per IVF retrieval [combined pregnancy rate after fresh and frozen embryo transfers] is considered, IVF may be more cost effective in the long run. If you choose to go the IVF route, please consider freezing sperm if future pregnancy is desired. In some men the damage from varicocele can be progressive over time, and while you may achieve a pregnancy now, the continued damage resulting from the varicocele may reduce future options for pregnancy.

There is certainly no one size fits all answer. Please discuss with both your fertility trained urologist and a reproductive endocrinologist prior to making any decisions. Factors such as the size of the varicocele, your age, future pregnancy plans, the semen analysis results and insurance coverage will all inform your decision making process.