Varicocele — does it affect fertility?

Medical author: Jakub Krukowski, MD, PhD, urologist and andrologist — subject to authorisation before publication · Editorial preparation: Wyspa Medycyny Przyjaznej Editorial Team · Medical review: Jakub Krukowski, MD, PhD — to be confirmed before publication · Date created: 10 July 2026 · Review date: to be completed after authorisation · Updated: 10 July 2026

This article is educational and does not replace a urology or andrology consultation. Sudden severe testicular pain, rapidly increasing scrotal swelling, redness, fever, a hard lump in the testicle, suspected testicular torsion or sudden-onset right-sided varicocele require urgent medical assessment.

Key information at a glance

• Varicocele means enlarged veins in the scrotum, most commonly on the left side.
• Varicocele may be asymptomatic or cause heaviness, a dull testicular ache or discomfort after standing or physical exertion.
• Varicocele can affect fertility, but not every man with varicocele has abnormal semen or difficulty conceiving.
• A semen analysis is crucial in fertility assessment. A single result is not always sufficient; an abnormal result usually needs to be repeated.
• Scrotal Doppler ultrasound helps assess the veins, venous reflux, testicular volume and other scrotal abnormalities, but treatment decisions should not be based on ultrasound alone.
• Treatment is considered especially in men trying to conceive who have clinical varicocele, abnormal semen parameters and no other clear cause of infertility.
• Routine treatment of subclinical varicocele detected only on ultrasound is not recommended, particularly when semen analysis is normal.
• Treatment may improve semen parameters in some patients, but it does not guarantee pregnancy.
• Semen improvement after treatment is not immediate. Spermatogenesis takes time, so results are usually assessed after several months.
• Infertility assessment should involve the couple, not only the man. The female partner’s age, ovarian reserve and health must be considered at the same time.

Learn more about the specialist

Jakub Krukowski, MD, PhD, is a urologist and andrologist at Wyspa Medycyny Przyjaznej in Gdańsk. In everyday practice, he diagnoses and treats conditions of the urinary and genital systems, provides andrology care, and manages sexual-function and intimate-health problems that may affect comfort, fertility and quality of life.

Meet Jakub Krukowski, MD, PhD

Does this topic make sense for SEO, AI and Google Search?

Yes. Patients often search for questions such as: “varicocele and fertility”, “does varicocele cause infertility”, “varicocele symptoms”, “pain in the left testicle”, “varicocele semen analysis”, “varicocele treatment”, “should varicocele be operated on”, “varicocele and IVF”, “andrologist Gdańsk” and “urologist male fertility”. This is an educational topic with a clear diagnostic intention and major importance for patients trying to conceive.

In this field, E-E-A-T is especially important: an andrologist/urologist as medical author, update date, sources, explanation of treatment limitations, no promises of pregnancy, discussion of semen analysis and a clear statement that infertility assessment concerns the couple, not only the man.

What is varicocele?

Varicocele is enlargement of the veins of the pampiniform plexus that drain blood from the testicle. It most commonly occurs on the left because of the anatomy of venous drainage. A patient may feel soft, enlarged vessels in the scrotum, sometimes described as a “bag of worms”, although in some men the abnormality is detected only during a medical examination or ultrasound.

Varicocele may increase scrotal temperature, disturb microcirculation, increase oxidative stress and adversely affect testicular function. These mechanisms may result in poorer sperm production, reduced motility, abnormal morphology or increased sperm DNA fragmentation. This does not mean that every man with varicocele will have a fertility problem.

What symptoms can varicocele cause?

Varicocele often causes no symptoms. A patient may learn about it incidentally during a scrotal examination, ultrasound or infertility assessment. When symptoms occur, they are usually chronic and worsen in certain situations.

The most common symptoms include:

• a feeling of heaviness in the scrotum, usually on the left side,
• a dull pain in the testicle or scrotum that worsens after standing, physical exertion or towards the end of the day,
• a pulling sensation in the groin or scrotum,
• palpable enlarged veins above the testicle,
• scrotal asymmetry,
• reduced testicular volume on the affected side, especially in adolescents,
• abnormal semen parameters on semen analysis,
• difficulty achieving pregnancy in the female partner despite regular intercourse.

Pain caused by varicocele is usually not sudden or sharp. Sudden severe testicular pain is a different situation and requires urgent assessment, including exclusion of testicular torsion.

Does varicocele affect fertility?

It can, but it does not always do so. Varicocele is one of the more common abnormalities found in men assessed for infertility. It may be associated with lower sperm concentration, reduced motility, abnormal morphology and greater oxidative stress in semen.

At the same time, many men with varicocele have a normal semen analysis and become fathers without treatment. The presence of varicocele alone is not enough to establish the cause of infertility. Several pieces of information must be considered together: physical examination, semen analysis, duration of attempts to conceive, the female partner’s age and fertility, testicular volume, Doppler ultrasound and, when appropriate, hormone tests.

The safest approach is not to ignore varicocele, but also not to operate on every case simply because it “appears on ultrasound”.

Semen analysis — why is it essential?

A semen analysis is the basic test used to assess male fertility. In varicocele, it is particularly important because it helps determine whether the enlarged veins have a real functional effect.

A semen analysis assesses, among other things:

• ejaculate volume,
• sperm concentration,
• total sperm count,
• total and progressive motility,
• sperm vitality,
• sperm morphology,
• the presence of inflammatory cells or other abnormalities.

If the result is abnormal, major decisions should usually not be made on the basis of a single test. Semen parameters may change over time due to fever, infection, medicines, stress, stimulants, overheating, sleep, body weight and lifestyle. Therefore, an abnormal result often needs to be repeated after an appropriate interval in a reliable laboratory.

Scrotal Doppler ultrasound — when is it needed?

Diagnosis of varicocele is based mainly on physical examination while standing and during the Valsalva manoeuvre. Scrotal Doppler ultrasound is very helpful when palpation is inconclusive, the patient is overweight, the testicles are difficult to assess, testicular volume needs to be measured or other scrotal abnormalities need to be excluded.

Ultrasound can assess:

• the diameter of enlarged veins,
• the presence of venous reflux,
• the severity of changes during the Valsalva manoeuvre,
• testicular volume,
• testicular asymmetry,
• hydrocele, epididymal cysts or other scrotal abnormalities,
• recurrence or persistence of varicocele after previous treatment.

Ultrasound alone should not replace clinical assessment. This is particularly relevant to so-called subclinical varicocele, meaning changes visible on ultrasound but not palpable on examination. Such a finding does not always affect fertility and is usually not, by itself, an indication for treatment.

When is varicocele worth treating?

Treatment of varicocele is not automatic. The decision depends on symptoms, test results, reproductive plans and risk. In adult men, treatment is most often considered in several situations.

• Couple infertility — when the couple is trying to conceive, the man has clinical varicocele, abnormal semen parameters and no other clear cause of infertility.
• Pain or discomfort — when symptoms are typical of varicocele and persist despite conservative management.
• Reduction in testicular volume — particularly in adolescents when the difference in testicular volume persists over time.
• Recurring problems despite observation — when symptoms or semen parameters worsen at subsequent follow-up visits.
• Selected situations with increased sperm DNA fragmentation — after individual assessment, particularly after failed infertility treatment or recurrent miscarriage when other causes have been excluded.

Treatment should not be offered solely because ultrasound describes mild venous enlargement if the patient has normal semen, no pain and no fertility problem.

Does varicocele treatment improve semen?

In some men, yes. Research and guidelines indicate that treatment of clinical varicocele in infertile men with abnormal semen parameters may improve semen-analysis results, particularly sperm concentration and some measures of semen quality. Benefits in motility and morphology may be less predictable, and the response varies between patients.

However, treatment should not be presented as certain to improve semen or ensure a natural pregnancy. Fertility depends on many factors: the female partner’s age and health, ovarian reserve, duration of attempts, semen quality, ovulation, tubal patency, lifestyle, chronic diseases and other causes of infertility.

Semen improvement after treatment does not happen from one day to the next. The sperm-production cycle takes several months, so follow-up semen analysis is usually planned after enough time has passed to assess new spermatogenesis.

Varicocele and sperm DNA

A standard semen analysis assesses sperm count, motility and morphology, but it does not show everything. In some men with varicocele, sperm DNA fragmentation—damage to the genetic material in sperm—may also be relevant. Increased DNA fragmentation may be associated with poorer outcomes from natural conception, insemination, IVF or recurrent miscarriage.

However, this is not a first-line test for every man. It may be useful in selected situations such as unexplained infertility, failed assisted-reproduction procedures, recurrent miscarriage or abnormal semen parameters with clinical varicocele. The decision should be made with an andrologist.

Methods of treating varicocele

Varicocele treatment aims to close abnormal venous drainage. Different methods are used in practice, and the choice depends on the centre’s experience, anatomy, recurrence, symptoms and treatment goals.

The methods most often discussed are:

• microsurgical varicocelectomy — an operation performed with magnification, allowing precise ligation of veins while preserving structures important to the testicle,
• laparoscopic varicocele repair — a surgical method used in selected cases,
• percutaneous embolisation or sclerotherapy — a radiological method that closes abnormal vessels from inside the vascular system,
• observation — appropriate for patients without pain, fertility problems or abnormal semen when the doctor sees no indication for intervention.

Each method has possible limitations and complications, such as recurrence, hydrocele, haematoma, pain, infection, injury to vascular structures or the need for repeat intervention. The choice of treatment should therefore follow proper qualification and discussion of realistic expectations.

Can varicocele be treated with medicines?

Painkillers, anti-inflammatory medicines, scrotal support, limiting prolonged standing or modifying activity may relieve pain in some patients. They do not, however, remove the anatomical cause: enlarged, incompetent veins of the spermatic cord.

“Fertility supplements” are not a treatment for varicocele either. They may support lifestyle changes or antioxidant management in selected patients, but they should not replace diagnostics, semen analysis and andrology assessment. When a couple is trying to conceive, time matters—especially if the female partner is older or has reduced ovarian reserve.

Varicocele and testosterone

Varicocele may be associated not only with semen quality but, in some men, also with the hormonal function of the testicle. This does not mean that every patient with varicocele has low testosterone or that treatment will always improve libido, energy or erections.

If a patient reports reduced libido, fatigue, erectile dysfunction, low mood, loss of muscle mass or fertility problems, the doctor may consider hormone tests such as total testosterone, SHBG, LH, FSH, prolactin or other parameters. Interpretation should take account of age, sleep, body weight, medicines, chronic diseases and semen-analysis results.

When should you see an andrologist or urologist?

It is worth seeing a urologist or andrologist if the patient feels enlarged veins in the scrotum, has chronic testicular pain, heaviness, testicular asymmetry or if the couple has been unable to conceive.

Consultation is particularly recommended when:

• the couple has been trying to conceive for 12 months without success,
• the female partner is over 35—in that case assessment should not be postponed for a full 12 months,
• the semen analysis is abnormal,
• varicocele is palpable on examination,
• the testicle on the affected side appears smaller,
• scrotal pain worsens after standing, exertion or towards the end of the day,
• varicocele appears suddenly or on the right side,
• the patient notices a lump, testicular hardness or a change in testicular size,
• there are libido or erection problems, or suspected testosterone deficiency,
• the patient is considering treatment before assisted-reproduction procedures.

When are symptoms urgent?

Varicocele is usually not an emergency, but not every scrotal pain is caused by varicocele. Urgent assessment is required for:

• sudden severe testicular pain,
• a testicle positioned higher than usual or in an unusual position,
• rapidly increasing scrotal swelling,
• redness, fever or chills,
• nausea and vomiting with testicular pain,
• a hard lump in the testicle,
• sudden right-sided varicocele,
• varicose veins that do not reduce when lying down,
• pain after scrotal trauma,
• enlarged groin lymph nodes, blood in the urine or unintended weight loss.

It is particularly important to exclude testicular torsion, which requires very rapid treatment. Sudden severe testicular pain should not wait for a routine appointment.

Infertility assessment — the man and his partner in parallel

A common mistake is to assess only one partner. If a couple is trying to conceive without success, both the man and the female partner should be assessed at the same time. In the man, semen analysis and an andrological examination are fundamental; in the female partner, gynaecological assessment, ovulation, ovarian reserve, fallopian tubes and other factors are evaluated according to age and medical history.

This has practical importance. Varicocele treatment may require several months before its effect on semen can be assessed. If the female partner has reduced ovarian reserve or age significantly affects reproductive chances, the couple may need to decide more quickly whether to treat the varicocele or plan assisted-reproduction methods in parallel.

Common myths about varicocele

• “Every varicocele causes infertility.” No. Many men with varicocele have normal semen and become fathers without treatment.
• “If it is visible on ultrasound, it must be operated on.” No. The decision depends on clinical examination, symptoms, semen analysis and reproductive plans.
• “Surgery will definitely improve fertility.” This cannot be guaranteed. Semen parameters improve in some patients, but pregnancy depends on many factors.
• “A normal semen analysis means varicocele will never matter.” It is usually a good sign, but with pain, reduced testicular size or reproductive plans, a follow-up plan is worth establishing.
• “Testicular pain is always caused by varicocele.” No. Testicular pain has many possible causes, including emergencies.
• “Supplements will remove varicose veins.” No. They may support overall semen quality in selected patients, but they do not remove anatomical varicose veins.
• “Infertility assessment is mainly a woman’s issue.” No. Male-factor infertility is common and should be assessed in parallel.
• “The effect will be visible immediately after treatment.” No. Assessing the effect on semen takes time, usually several months.

Do you have varicocele, testicular pain or an abnormal semen analysis?

Not every varicocele needs treatment, but it should not be ignored when fertility problems are present. An andrology and urology consultation helps determine whether the varicocele is clinically significant.

Diagnosis of varicocele and male fertility at Wyspa Medycyny Przyjaznej

At Wyspa Medycyny Przyjaznej, Jakub Krukowski, MD, PhD, sees patients with urological and andrological problems, including scrotal pain, suspected varicocele, fertility disorders, abnormal semen analysis, erection or ejaculation problems, and symptoms involving the testicles and scrotum.

Depending on the situation, the doctor may discuss physical examination, scrotal Doppler ultrasound, semen analysis, repeat semen testing, hormone tests, lifestyle assessment, the need to assess the female partner and indications for observation, further diagnostics or procedural treatment at an appropriate centre.

The purpose of the consultation is not to refer every patient automatically for surgery. It is to answer whether varicocele is genuinely affecting pain, testicular function or fertility—and whether treatment may provide a real benefit.

Learn more about Jakub Krukowski, MD, PhD Urology Contact

What should you ask an andrologist about varicocele?

• Is my varicocele palpable on examination or visible only on ultrasound?
• What grade is my varicocele?
• Do I need a scrotal Doppler ultrasound?
• Are my testicular volumes normal and symmetrical?
• Are my pain symptoms typical of varicocele?
• Should I have a semen analysis?
• Does the semen analysis need to be repeated?
• Do I need hormone tests?
• Could varicocele be contributing to our infertility?
• Could treatment improve my semen parameters?
• Is observation, surgery or embolisation more appropriate?
• How long after treatment should I wait before assessing the effect on semen?
• Should my female partner undergo fertility assessment at the same time?
• Which symptoms require urgent help?

FAQ — varicocele and fertility

Does varicocele affect fertility?

It can affect fertility, especially when it is clinically significant and accompanied by an abnormal semen analysis. However, not every man with varicocele has fertility problems.

Does every varicocele require surgery?

No. Treatment is considered, among other situations, in couple infertility with clinical varicocele and abnormal semen parameters, pain that persists despite conservative treatment, or reduced testicular size in adolescents.

Does varicocele detected only on ultrasound require treatment?

Usually it is not, by itself, an indication for treatment, especially when varicocele is not palpable, semen analysis is normal and the patient has no symptoms.

Which tests should be performed for varicocele when trying to conceive?

The basis is an andrological examination and semen analysis. Depending on the result, the doctor may order repeat semen testing, scrotal Doppler ultrasound, hormone tests, sperm DNA fragmentation testing or other investigations.

Does varicocele treatment improve semen analysis?

In some men with clinical varicocele and abnormal semen, treatment may improve semen-analysis parameters. Improvement or pregnancy cannot, however, be guaranteed.

When are the effects of varicocele treatment visible?

Effects on semen are usually assessed after several months because sperm production takes several months. The doctor determines the follow-up timing.

Can varicocele cause testicular pain?

Yes. It may cause a dull ache, heaviness or a pulling sensation in the scrotum, usually worsening after prolonged standing or exertion. Sudden severe testicular pain requires urgent assessment because it may have another cause.

Can varicocele lower testosterone?

In some men, varicocele may be associated with impaired testicular function, including hormonal function. Symptoms of testosterone deficiency require separate assessment and hormone tests.

Will supplements remove varicocele?

No. Supplements do not remove enlarged veins. They may support semen quality in selected patients but do not replace diagnostics and andrological qualification.

Who provides varicocele consultations at WMP?

At Wyspa Medycyny Przyjaznej, patients with urological and andrological problems are seen, among others, by Jakub Krukowski, MD, PhD, urologist and andrologist.

Sources for medical and editorial verification

• Wyspa Medycyny Przyjaznej, Jakub Krukowski, MD, PhD: https://www.wyspamedycynyprzyjaznej.pl/en/jakub-krukowski-urolog-gdansk
• EAU Guidelines on Sexual and Reproductive Health — Male infertility, varicocele: https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
• AUA/ASRM Guideline, Diagnosis and Treatment of Infertility in Men: https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-aua-asrm-guideline-part2/
• NICE CKS, Varicocele — management: https://cks.nice.org.uk/topics/varicocele/management/management/
• Mayo Clinic, Varicocele — symptoms and causes: https://www.mayoclinic.org/diseases-conditions/varicocele/symptoms-causes/syc-20378771
• Mayo Clinic, Varicocele — diagnosis and treatment: https://www.mayoclinic.org/diseases-conditions/varicocele/diagnosis-treatment/drc-20378772
• WHO Laboratory Manual for the Examination and Processing of Human Semen — 6th edition: https://www.who.int/publications/i/item/9789240030787
• European Academy of Andrology, Andrological guidelines and male infertility resources: https://www.andrologyacademy.net/
• Google Search Central, Creating helpful, reliable, people-first content: https://developers.google.com/search/docs/fundamentals/creating-helpful-content
• Google Search Central, Article structured data: https://developers.google.com/search/docs/appearance/structured-data/article
• Google Search Quality Rater Guidelines: https://guidelines.raterhub.com/searchqualityevaluatorguidelines.pdf