Varicocele: Who Actually Needs Surgery?
Enlargement of the veins around the testicle is common, but not every varicocele needs an operation. The real question is this: is this varicocele doing you harm?
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
Where surgery is indicated, the microsurgical technique is used here: the vessels are separated one by one under the operating microscope. Go to the microsurgical varicocelectomy page
Private Online Consultation
A private, one-to-one video consultation by appointment, without visiting the clinic. Especially for patients who value privacy.
- Procedure time
- 45–90 minutes
- Anesthesia
- General or spinal anaesthesia
- Hospital stay
- Day case
- Stay in Türkiye
- 4–6 days
- Return to work
- 3–7 days
- Flight clearance
- 3–5 days
About the condition
A varicocele is an enlargement of the veins that carry blood from the testicle back to the heart, with some of that blood flowing backwards. It is much like varicose veins in the legs. It is present in a considerable proportion of men and most of the time causes no symptoms at all.
IT IS USUALLY ON THE LEFT. The reason is anatomical: the left testicular vein joins the left kidney vein at a right angle, and this makes backward flow easier. A varicocele on the right side alone is less common.
The main way a varicocele harms the testicle is through heat. For healthy sperm production the testicle needs to be slightly cooler than the body, which is why the testicles sit outside it. Blood pooling in the enlarged veins raises the temperature around the testicle and can affect sperm production adversely.
THE MOST IMPORTANT MISUNDERSTANDING IS THIS: not every man found to have a varicocele needs an operation. Varicoceles are very common, and the great majority of men who have one father children without difficulty. The decision to operate rests not on the presence of a varicocele but on evidence that it is doing harm: deterioration in the sperm values, shrinkage of the testicle, or pain that does not settle.
On examination a varicocele is graded in three degrees: felt only on straining (grade 1), felt by hand (grade 2) and visible from outside (grade 3). The examination is carried out standing; an examination done lying down can be misleading. Ultrasound confirms the finding and measures the testicular volumes.
AN IMPORTANT WARNING: if a varicocele appears suddenly later in life, is on the right side only, or does not disappear on lying down, it must be investigated for a mass in the kidney region. This is a rare situation but one that should not be missed.
Who is it suitable for?
May be suitable
- Couples wishing to conceive where the man has a varicocele detectable by hand and deterioration in the sperm values
- Adolescents and young men in whom the testicle on the side of the varicocele has become smaller
- Men with pain due to the varicocele that does not settle despite painkillers and supportive measures
- Couples planning assisted reproduction where improving sperm quality is the aim
- Selected men in whom low testosterone is being assessed alongside the varicocele
May not be suitable
- Men with no symptoms and normal sperm values — having a varicocele is not in itself a reason to operate
- Men whose varicocele is seen only on ultrasound and cannot be felt on examination — no benefit from surgery has been shown in this situation
- Couples where there is an untreated problem on the woman’s side preventing pregnancy — the assessment must be made as a couple
- Situations where sperm production has stopped altogether and cannot be explained by the varicocele — genetic and hormonal assessment is needed first
- Men who believe surgery will guarantee a pregnancy — no such guarantee can be given
Technology used
- Physical examination standing and with straining (Valsalva)
- Scrotal colour Doppler ultrasound — measuring reflux and testicular volumes
- Semen analysis (at least two separate samples) and sperm DNA assessment where needed
- Hormone profile (FSH, LH, testosterone)
- Microsurgical subinguinal approach with the operating microscope — distinguishing veins, artery and lymphatics
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Step 1
Assessment
The examination is carried out standing and with straining. Reflux and testicular volumes are measured by ultrasound. At least two semen analyses are requested — a single analysis is not enough to decide on.
- Step 2
Assessing the couple together
If there is a wish for children, the woman must have been assessed too. Varicocele surgery does not resolve a problem on the woman’s side.
- Step 3
The decision to operate
The decision rests on a varicocele that can be felt on examination occurring together with deteriorated sperm values, a smaller testicle, or pain that does not settle.
- Day of surgery
Microsurgical varicocelectomy
Access is through a small incision below the groin. Under the operating microscope the enlarged veins are tied off while the testicular artery and the lymphatic channels are preserved. The procedure takes 45–90 minutes and the patient is discharged the same day.
- Week 1
Early recovery
Swelling and tenderness in the groin are expected. Ice and supportive underwear bring relief. Gentle walking is allowed.
- Months 3–6
Assessing the outcome
Because sperm production works on a cycle of about three months, semen analysis is repeated no earlier than three months after surgery. Assessment is made at 3 and 6 months.
Method comparison
| Criterion | Microsurgery | Embolisation | Surveillance |
|---|---|---|---|
| Intervention | Small incision below the groin | From inside the vein, no incision | None |
| Anaesthesia | General or spinal | Local | None |
| Hydrocele risk | Low (lymphatics preserved) | None | None |
| Recurrence | Lower | Can be higher | Not applicable |
| Return to work | 3–7 days | 1–2 days | None |
| Who it suits | Where there is impaired sperm, shrinkage or pain | Men unsuited to surgery or with recurrence | Men with no symptoms |
The microsurgical approach is preferred because the artery and the lymphatic channels can be distinguished under the microscope. Even so, not every man needs surgery; surveillance is a legitimate option too.
Risks
- THERE IS NO GUARANTEE OF PREGNANCY: surgery can bring improvement in the sperm values, but this does not happen in every man, and even where it does a pregnancy cannot be guaranteed. This is not a failure of the method but a consequence of how many factors male infertility involves
- Hydrocele (a collection of fluid around the testicle) — caused by damage to the lymphatic channels; reducing this risk is one of the reasons the microsurgical approach is preferred
- The varicocele recurring or not disappearing completely
- Damage to the testicular artery — very uncommon but serious; the microscope is used to reduce this risk
- Wound infection and bleeding
- Temporary numbness or tenderness in the groin
- In men operated on for pain, the pain not going away completely
Alternatives
- Surveillance — the right approach in men with no symptoms and normal sperm values
- Supportive measures for pain — supportive underwear, painkillers, avoiding long periods standing
- Percutaneous embolisation — closing the vein from the inside under radiological guidance; for men unsuited to surgery or with recurrence
- Laparoscopic varicocelectomy — an option in bilateral cases
- Going straight to assisted reproduction — where the woman’s age is advanced or time is short
- Sperm freezing — as a safeguard before treatment
Recovery
First 48 hours
Swelling and tenderness in the groin are expected. Ice and supportive underwear are advised. Painkillers provide comfort.
Days 3–7
A return to desk work is possible. Gentle walking is allowed; heavy lifting and sport are not.
Weeks 2–4
A gradual return to normal physical activity is made. A return to sexual activity is planned during this period.
Month 3
The first follow-up semen analysis is carried out. Because sperm production works on a cycle of about three months, testing earlier is not meaningful.
Month 6
A second semen analysis clarifies the outcome. Where needed, assisted reproduction options are discussed again.
Frequently asked questions
I have a varicocele — must I have surgery?
No. Varicoceles are very common and the great majority of men who have one father children without difficulty. The decision to operate rests not on the presence of a varicocele but on evidence that it is doing you harm: deterioration in the sperm values, a smaller testicle, or pain that does not settle. Where these are absent, surveillance is the right approach.
Does a varicocele cause infertility?
A varicocele can affect sperm production adversely, but not every man with one is infertile. The diagnosis alone is therefore not enough; at least two semen analyses and an assessment of the couple together are needed. If there is a problem on the woman’s side, varicocele surgery will not resolve it.
If I have the operation, will I father a child?
No guarantee can be given on this. Surgery can bring improvement in the sperm values, but this does not happen in every man, and even where it does a pregnancy is not certain. Male infertility involves many factors; the woman’s age and other factors also shape the outcome. Be wary of any approach that promises you a certain pregnancy.
Why is it always on the left?
The reason is anatomical. The left testicular vein joins the left kidney vein at a right angle, which makes backward flow easier. On the right the connection is at a shallower angle. That is why a one-sided varicocele is usually on the left.
My varicocele is on the right side only — does that matter?
This is less common and does call for attention. In a varicocele that begins suddenly later in life, is on the right side only, or does not disappear on lying down, it must be investigated whether a mass in the kidney region is pressing on the vein. It is a rare situation but should not be missed.
When should I have a semen analysis after the operation?
No earlier than three months. Sperm production works on a cycle of about three months, so an analysis done sooner does not reflect the true result. Assessment is usually made at 3 and 6 months.
What is the difference between microsurgery and a standard operation?
Microsurgery uses the operating microscope. This allows the veins that need tying off to be distinguished from the testicular artery and the lymphatic channels that need preserving. That helps both to protect the blood supply to the testicle and to reduce the risk of a hydrocele (a collection of fluid).
Can I have surgery for my pain?
If the pain is due to the varicocele and does not settle with supportive measures, surgery is an option. But because pain can have other causes, these must be ruled out first. It also cannot be guaranteed that the pain will disappear completely after surgery; this is discussed from the outset.
A varicocele has been found in my teenage son — what should we do?
In adolescents the criterion for a decision is whether the testicle on the affected side has become smaller. If it has, surgery comes into consideration; if not, surveillance with regular measurement of testicular volume is carried out. Rushing into surgery is not right in this age group.
When can I fly and return to work?
Flying is usually permitted after 3–5 days; a stay of 4–6 days is planned for patients travelling from abroad. A return to desk work is possible within 3–7 days. For heavy lifting and sport, waiting 2–4 weeks is advised.
Articles on this topic
Scientific sources
This page is for general information only and is not a substitute for medical advice.
Let's talk about this treatment
Message us on WhatsApp with your questions or fill in the pre-assessment form.
Pre-assessment form
Leave your details and our team will get back to you shortly.
Other treatments
Overactive Bladder and Urgency Incontinence
A sudden, hard-to-defer need to pass urine, going frequently, and sometimes not getting there in time. Treatment is stepwise, and most women improve markedly without needing medication or surgery.
Learn moreTesticular Cancer: Why Acting Early Changes Everything
The commonest solid cancer in young men, and one that responds very well to treatment. If you have noticed a painless lump, do not wait — delay turns a readily treatable disease into a harder one.
Learn moreStress Urinary Incontinence: the Treatment Options
Leaking urine when you cough, sneeze or exercise. The type has to be established first, and treatment should begin with the least invasive step — surgery is not the first option.
Learn more