Questions to Ask Before Varicocele Surgery

Varicocele surgery is a medical procedure designed to treat or remove enlarged veins in the scrotum. It is typically performed by a medical doctor in a fertility clinic or other outpatient setting. The surgery is frequently sought by men who are experiencing pain due to vein enlargement. It is also becoming a treatment of choice to enhance fertility among men who have varicocele along with mild male factor infertility.  

Depending on the location and size of the varicocele, the doctor may choose to perform laparoscopic surgery, or pass an instrument through a small opening in the abdomen, or perform open surgery – also known as a varicocelectomy or microsurgery. In the latter case, surgical microscopes and ultrasounds are used to remove the affected veins.

What are the benefits of the surgery?

At a basic level, varicocele surgery provides immediate health benefits to men by facilitating blood flow in the testicular region. However, the benefits of the surgery extend well beyond improved blood flow. As outlined below, varicocele surgery offers three key benefits:

  • Reduced pain: By eliminating roughly 90% of varicocele, the surgery offers relief from the pain and discomfort due to vein enlargement
  • Improved sperm counts: Surgery can improve sperm counts by as much as 128% for many men experiencing infertility
  • Increased testosterone: Most men who have the procedure have improved testosterone levels following surgery

In addition to these benefits, many men who have the procedure find that their confidence is restored, especially if they have been struggling with pain and infertility before surgery. This can have a positive impact on relationships with significant others as well.

What are the risks and limitations of Varicocele surgery?

While the overwhelming majority of surgeries are completed without complications, there are a few risks and limitations to consider prior to moving forward with surgery. Some men report slight pain in the groin area, which typically dissipates in 3-6 weeks. Additionally, there is a small chance that you may experience the following:

  • Bruising and swelling around the site of the surgery
  • Infection
  • Artery damage
  • Testicular atrophy
  • Renal vein thrombosis 

Understanding the limitations of surgery is just as important as knowing the risks. While the surgery offers the three benefits above, sperm parameters may not improve enough to permit natural conception. The procedure will also not help resolve fertility issues among men with severe cases of poor sperm motility.

What happens after surgery?

The majority of surgeries are completed in an outpatient setting, enabling most patients to go home in a matter of hours. Unless otherwise recommended by your medical team, you can return to work within 48 hours as long as your job does not involve lifting or other strenuous activities. You can expect to fully resume your normal activities at full capacity within seven days. 

Depending on your individual case, your surgeon may prescribe pain medication that you should follow as directed. You also might be advised to take ibuprofen, acetaminophen, or another over-the-counter pain reliever to reduce any lingering pain or discomfort. As with the case of any surgical procedure, it is critical to follow all post-care instructions and attend all follow-up appointments.

Who is a good candidate for varicocele surgery? 

Before deciding that varicocele surgery is the best solution to your reproductive challenges, it is helpful to know whether you are a good candidate for the surgery. Generally speaking, men who are good candidates for surgery exhibit the following qualities:

  • Challenges with fertility: Men who report fertility difficulties but whose female partners are fertile are good candidates
  • Recurrent pain or discomfort: Men who report ongoing pain related to the varicocele should consider surgery
  • Good overall physical health: Men who are free of major health problems are good candidates for the procedure
  • Female partners who are fertile: The woman’s age is also a factor, as it could take 4-6 months for sperm to recover 
  • Realistic expectations: Realizing that the surgery is not a guaranteed path to fertility is important