Varicocele repair for infertility

Surgery Overview

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Varicoceles are enlarged varicose veins that occur in the scrotum. They are fairly common, affecting 15% of men overall, and 40% of men with known infertility.¹ Varicoceles occur most often in the left testicle.

Varicocele repair is performed to improve male fertility. It can usually be done surgically on an outpatient basis using local or general anesthetic. A small incision is made in the abdomen close to where the testicles originally descended through the abdominal wall. The veins that produce the varicocele are identified and cut to eliminate blood flow to the varicocele.

Alternatively, a nonsurgical procedure called percutaneous embolization can be done to repair a varicocele. A small catheter is inserted through a large vein in the groin or neck and advanced to the varicocele, which is then blocked off by a balloon, coil, or medication.

What To Expect After Surgery

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Varicocele repair typically is done on an outpatient basis. You can expect to go home within 4 hours of a routine varicocele surgery. Pain medicine is prescribed for a few days after surgery.

You should be able to resume light work duties 1 to 2 days after surgery and full strenuous activities within 1 week.

Why It Is Done

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Varicoceles are thought to raise the temperature of the testicles or cause blood to back up in the veins supplying the testicles. Although the mechanism by which varicoceles affect fertility is poorly understood, varicoceles seem to help damage or kill the sperm.¹ Varicocele repair is typically performed to improve the fertility of men who have both a varicocele and impaired sperm.

Varicocele repair is a controversial practice. Many infertility experts express concern that it is not effective as an infertility treatment.²

How Well It Works

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While some researchers have observed that varicocele repair produces favorable pregnancy rates, others have noted that these pregnancy rates are the same as the rates of couples who have chosen not to have a varicocele repaired.^{3, 4}

A recent review of research has found no benefit of varicocele repair for male or unexplained infertility.²

Risks

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• Infection at the site of surgery
• Fluid buildup in the scrotum (hydrocele) that requires draining
• Injury to the arteries or nerves in the pubic area

What To Think About

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There is no proof that fertility rates improve after this surgery. However, some doctors think that larger varicoceles are linked to sperm problems. It is also possible that varicocele surgery would improve the semen quality, making other fertility treatments easier.⁴

Small varicoceles that are only apparent with ultrasound testing do not require repair.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. American Urological Association and American Society of Reproductive Medicine (2001). Report on Varicocele and Infertility (AUA Best Practice Policy/ASRM Practice Committee Report), pp. 1–5. Baltimore: American Urological Association.

2. Evers JLH, Collins JA (2003). Assessment of efficacy of varicocele repair for male subfertility: A systematic review. Lancet, 361: 1849–1852.

3. Cayan S, et al. (2002). Can varicocelectomy significantly change the way couples use assisted reproductive technologies? Journal of Urology, 176: 1749–1752.

4. Speroff L, Fritz MA (2005). Male infertility. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1135–1173. Philadelphia: Lippincott Williams and Wilkins.

Credits

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Author	Shannon Erstad, MBA/MPH
Author	Lila Havens
Editor	Kathleen M. Ariss, MS
Associate Editor	Michele Cronen
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Joy Melnikow, MD, MPH - Family Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Kirtly Jones, MD - Obstetrics and Gynecology
Last Updated	April 7, 2006