Should You Have Varicocele Surgery?

Benefits of Varicocele Surgery (Science is Lacking & Inconclusive)

Even though there is a 20-40% improvement in semen parameters, that is not at all associated with successful pregnancy. The science  supporting varicocele surgery is both lacking, and low quality[1], and the best results state that for every 17 people undergo surgery, only 1 additional pregnancy will be attained. You're more likely to suffer from negative side-effects than to have any benefit from varicocele surgery.

Value	Varicocelectomy (Varicocele Surgery)
Pregnancy	NNT: 1 in 17 (helps only 1 in 17)
Semen Improvement	20-40%
Testosterone	None to mild improvement (No established NNT)
Pain Relief	None to mild improvement ​(No established NNT)
Swelling Reduction	Likely effective (No established NNT)

Risks of Varicocele Surgery (Risks Are Very Real)

There are many severe risks associated with varicocele surgery. I advise that you carefully consider the pros & cons before making your decision. You can also learn more about how surgery is likely not effective at all.

Value	Varicocelectomy (Varicocele Surgery)
Pre-Operative Risks (Before Surgery): ​General Anesthetic	​Hypotension Hypoxia Arrhythmia CO2 Embolus Acidosis Hypercarbia​
Intra-Operative Risks (During Surgery)	Bleeding Injury to the pubic arteries Arterial ligation Nerve damage Failure at attempt (1%-5%) Loss of testicle on side of the surgery (1%) Injury to a nerves in the pubic area
Post-Operative Risks  (After Surgery)	Hematoma Shrinking of the testicle on the side of the surgery (1%) Hydrocele (5-10%) Persistent/recurrent varicocele (5-10%) Pain pills (2-6 weeks) Genitofemoral Nerve Injury Scrotal Emphysema Umbilical Granulomas Infection at site of surgery (1%) Deep venous thrombosis (DVT) (5%) Pulmonary embolus (PE) (1%) Onset of pain where there was none before (1%) Failure to relieve pain (15%) Continued infertility (86%) ​Decreased fertility Permanent scarring at incision site  ​​Lowered testosterone levels

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More to Consider

In order to repair a varicocele the following criteria should be fulfilled [2]:

1. Involuntary infertility of at least one year.
2. Presence of a palpable varicocele at the upright position and during a Valsalva maneuver.
3. No detectable or at least no irreversible cause of female infertility.
4. Normal testicular size (> 15 cm3) or small reduction of the ipsilateral testis [3].
5. Evaluation of at least two semen analyses at three months interval. The presence of normal semen analysis excludes varicocele as the cause of infertility. The usual effects of varicocele on sperm parameters include mild and moderate asthenospermia, teratospermia or astheno- teratospermia. Initially, sperm concentration is not seriously affected, though later all three semen parameters can gradually deteriorate, resulting in azoospermia in very few cases [4].
6. Normal values or slight increase (less than the double of the upper normal range) f serum FSH levels, as very high levels of serum FSH denote primary testicular failure.

Additional factors that must be considered before deciding the therapeutic approach of varicocele in an infertile couple include [5]:

1. The advanced age of the wife (older than 35 years) and high serum FSH levels should drive the decision towards the ICSI solution rather than repair of varicocele [6].
2. In case of chronic presence of varicocele and advanced male age, surgery should be avoided.
3. Surgical repair of varicocele is recommended in case of secondary male infertility [7, 8]. On the other hand, if the patient has primary infertility, azoospermia, small testicular size and high serum FSH levels, the presence of varicocele should be ignored and surgery should be avoided, as the diagnosis in this case pleads towards primary testicular failure.
4. The diagnosis of SCOS or maturation arrest in FNA or open testicular biopsy denotes primary testicular failure. Thus, the presence of varicocele should be ignored. On the contrary, the presence of mild or moderate hypospermatogenesis can be attributed to varicocele in which case surgery can be a reasonable therapeutic approach.

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Varicocele Natural Treatment (Home Treatment)

When I started, there was no alternative to varicocele surgery.  But, a safe and natural alternative needs to exist. So, I have been working diligently for the past 5 years to make natural treatments more of a viable option for everyone. There is still no cure for varicocele, but, my treatments are very good, and I'm constantly improving them. Now, I can say that my natural treatments are not only a viable, but likely the best treatment option to date for varicocele.

• Varicocele Natural Treatment Products & Services
• 100 Free Varicocele Natural Treatment Tips
• Varicocele Natural Treatment Blog

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​Science Sources

1. Polyvalent Proteins, a Pervasive Theme in the Intergenomic Biological Conflicts of Bacteriophages and Conjugative Elements Lakshminarayan Iyer-A. Burroughs-Swadha Anand-Robson Souza-L. Aravind - Journal of Bacteriology - 2017
2. The Male Infertility Best Practice Policy Committee of the American Urological Association and The Practice Committee of the American Society for Reproductive Medicine. Report on varicocele and infertility. Fertil Steril. 2004;82(suppl. 1):S142–S145. [PubMed]
3. ​​Νieschlag E, Hertle L, Fischedick A, et al. Update on treatment of varicocele: counseling as effective as occlusion of the vena spermatica. Hum Reprod. 1998;13:2147–2150. [PubMed]
4. ​Papadimas J, Mantalenakis S. Hormonal profile in infertile men. Arch Androl. 1983;11:73–80.[PubMed]​​
5. The Male Infertility Best Practice Policy Committee of the American Urological Association and The Practice Committee of the American Society for Reproductive Medicine. Report on varicocele and infertility. Fertil Steril. 2004;82(suppl. 1):S142–S145. [PubMed]
6. ​Νieschlag E, Hertle L, Fischedick A, et al. Update on treatment of varicocele: counseling as effective as occlusion of the vena spermatica. Hum Reprod. 1998;13:2147–2150. [PubMed]
7. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993;59:613–616.[PubMed]
8. Witt M, Lipschultz L. Varicocele: A progressive or static lesion? Urology. 1993;42:541–543. [PubMed]
9. In men with varicocele, does surgery improve fertility? Ashleigh Wilkerson-Mike Linder-Carrie Gray-Nick Prylinski-Bilal Islam - https://mospace.umsystem.edu/xmlui/handle/10355/61604, 2017
10. Parrilli, Alejandra; Roberti, Agnese; Escolino, Maria; Esposito, Ciro (2016-10). "Surgical approaches for varicocele in pediatric patient".Translational Pediatrics. 5 (4): 227–232. ISSN 2224-4344. PMC 5107384 . PMID 27867844.doi:10.21037/tp.2016.09.11.
11. Cochetti, Giovanni; Barillaro, Francesco; Cottini, Emanuele; D’Amico, Francesco; Pansadoro, Alberto; Pohja, Solajd; Boni, Andrea; Cirocchi, Roberto; Grassi, Veronica (2015-04-09). "Pneumoscrotum: report of two different cases and review of the literature". Therapeutics and Clinical Risk Management. 11: 581–587. ISSN 1176-6336.PMC 4399391 . PMID 25914539. 
12. Marmar, Joel L (2016). "The evolution and refinements of varicocele surgery". Asian Journal of Andrology. 18 (2): 171–178. ISSN 10
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14. "Six years’ experience of laparoscopic varicocelectomy using bipolar electrosurgery and its effect on semen parameters". Urology Journal. 13 (4). 2016-08-25.​
15. "Deep vein thrombosis and intraperitoneal hemorrhage after thrombolysis: rare complication of laparoscopic varicocelectomy". Int J Clin Exp Med 2016;9(10):20319-20323
16. Chi, Amanda C.; Hairston, John C. (2015-05-01). "Acute Right Varicocele: A Clue to Congenital Vascular Anomaly". Urology. 85 (5): e39–e40.doi:10.1016/j.urology.2015.02.005.
17. ​"Treatment of male varicoceles by transcatheter polidocanol foam sclerotherapy: evaluation of clinical success, complications, and patients' satisfaction with regard to alternative techniques - ProQuest". search.proquest.com. Retrieved2017-07-04.
18. ​Halpern, Joshua; Mittal, Sameer; Pereira, Keith; Bhatia, Shivank; Ramasamy, Ranjith (2016)."Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications". Asian Journal of Andrology. 18 (2): 234–238. ISSN 1008-682X. PMC 4770492 .PMID 26658060. doi:10.4103/1008-682X.169985.
19. Zampieri, N.; Castellani, R. L.; Zampieri, G.; Camoglio, F. S. (2014-10-01). "PS-067 Treatment Of Varicocele In Paediatric Patients With Contraindication For Open Surgery With Transfemoral Retrograde Sclero-embolization Under Local Anaesthesia".Archives of Disease in Childhood. 99 (Suppl 2): A136–A136. ISSN 0003-9888. doi:10.1136/archdischild-2014-307384.363.
20. Favard, Nicolas; Moulin, Morgan; Fauque, Patricia; Bertaut, Aurélie; Favelier, Sylvain; Estivalet, Louis; Michel, Frédéric; Cormier, Luc; Sagot, Paul (2015-12). "Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate".Quantitative Imaging in Medicine and Surgery. 5 (6): 806–814. ISSN 2223-4292. PMC 4700243 .PMID 26807362. doi:10.3978/j.issn.2223-4292.2015.10.10.
21. Ramasamy, Ranjith (2014-06-02)."Percutaneous embolization: a viable treatment option for varicocele". Basic and Clinical Andrology. 24: 10.ISSN 2051-4190. PMC 4345412 . PMID 25741442.doi:10.1186/2051-4190-24-10.
22. Choi, Woo Suk; Kim, Soo Woong (2013-04-01). "Current Issues in Varicocele Management: a Review". The World Journal of Men's Health. 31 (1).ISSN 2287-4208. PMC 3640148 . PMID 23658861.doi:10.5534/wjmh.2013.31.1.12.
23. Godbole, Prasad P.; Wilcox, Duncan T.; Koyle, Martin A. (2015-07-20). Pediatric Urology: Surgical Complications and Management. John Wiley & Sons.ISBN 9781118473313.