According to the NHS, around one in seven couples experience difficulty conceiving. While discussions often center on women's health, experts are increasingly advocating for greater awareness of male fertility challenges. One common condition affecting male fertility is varicoceles, which occurs in 15 to 20% of all men.
What Are Varicoceles?
A varicocele is an enlargement of veins within the scrotum, similar to varicose veins in the legs. This enlargement disrupts the optimal environment for sperm production. Urologist Professor Suks Minhas describes varicoceles as a 'collection of dilated veins around the testicle.' While many men experience no symptoms, common signs include pain or discomfort in the left testicle, with 90% of cases occurring on the left side. Other symptoms may include a dull ache, swelling, or testicular atrophy. Larger varicoceles can feel like a 'bag of worms.' However, not all varicoceles cause harm or fertility problems.
How Do Varicoceles Impact Fertility?
Professor Ramsay, a urologist with over 30 years in male fertility, explains that varicoceles primarily affect fertility by heating the testicle. The dilated veins allow warmer blood from the abdomen to pool around the testicle, raising its temperature. Testicles function best at about 3°C below core body temperature. This warming causes oxidative stress, where certain chemicals reduce sperm quality. Large varicoceles may also disturb testosterone production, though levels typically return to normal after treatment.
Updated Guidelines
Until recently, NICE guidelines stated that treating varicoceles did not improve a couple's chance of pregnancy. However, in March 2026, the guidelines changed. Doctors are now advised to 'consider radiological or surgical treatment for individuals with male reproductive organs who have varicocele detected on clinical examination.' This update is welcomed by experts who believe treating varicoceles could help couples avoid IVF.
Causes and Diagnosis
The exact cause of varicoceles remains unknown, making them one of the biggest conundrums in urological practice. Some men with large varicoceles remain fertile, while others with small ones experience infertility. Professor Ramsay encourages men visiting fertility units to ask whether a varicocele has been considered, as IVF is often presented as the only solution when treating the underlying condition might be more effective.
Treatment Options
Varicoceles do not resolve on their own. The updated NICE guidelines recommend radiological or surgical treatment for those wanting to conceive. Options include microsurgery or embolisation, a less invasive procedure where a radiologist inserts a tube into the vein and injects a plug to block it. When performed correctly, embolisation is nearly as effective as surgery with fewer complications.
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