Varicocele
What it is, how it affects male fertility, and what to do about it.
What is a Varicocele?
A varicocele is an enlargement of the veins within the scrotum (specifically, the pampiniform plexus), kind of like a varicose vein—but in the testicles. These veins help cool the blood before it reaches the testes, which is essential for healthy sperm production. When they become enlarged or twisted, they can raise the temperature in the testes and impair fertility.
Varicoceles are one of the most common causes of male factor infertility—affecting up to 15% of all men, and around 40% of men dealing with infertility.
In many cases, a varicocele is silent, meaning it causes no pain or symptoms. But for some men, it can impact testosterone production, sperm quality, and even testicular function.
Symptoms of a Varicocele
Most men don’t know they have a varicocele until they start trying to conceive—or until a routine physical exam reveals it. But if symptoms are present, they may include:
🌡️ A heavy, achy, or dragging feeling in the scrotum
🧊 Visible or palpable enlarged veins (like a “bag of worms”)
🪫 Testicular shrinkage or asymmetry
🥵 Worsening pain with exercise, standing, or heat exposure
🧬 Low sperm count, poor motility, or high DNA fragmentation on semen analysis
Because sperm are very sensitive to temperature and oxidative stress, even a mild varicocele can impact sperm production, quality, and overall fertility.
Who Does Varicocele Affect?
Varicoceles most commonly develop during puberty and are more likely to occur on the left side, due to differences in venous drainage. But they can occur at any age.
🧍♂️ 15% of all men have a varicocele
🤰 ~40% of men with primary infertility have one
👨👦👦 Up to 80% of men with secondary infertility may have developed one later in life
And yet—many men with fertility issues are never properly screened for varicocele. That’s a huge missed opportunity.
How is a Varicocele Diagnosed?
A varicocele can often be detected during a physical exam by a urologist, particularly when standing and performing a Valsalva maneuver (bearing down). But to fully assess its impact on fertility, further evaluation is usually needed.
🔍 Scrotal Ultrasound: Confirms the presence and size of the varicocele, and measures vein diameter and reflux
🧫 Semen Analysis: Assesses sperm count, motility, morphology, and DNA fragmentation
🧪 Hormone Testing: Checks testosterone, FSH, LH, and estradiol levels for signs of impaired testicular function
🧬 Sperm DNA Fragmentation Test: Identifies oxidative stress and breaks in sperm DNA, which are often elevated with varicocele
Many men are told their semen analysis is “normal” even when it’s suboptimal. A functional approach looks deeper than just sperm count.
How Does a Varicocele Affect Fertility?
Varicoceles can impair fertility in several key ways:
🔥 Increased Scrotal Temperature: Elevated heat can impair spermatogenesis and lower testosterone
💥 Oxidative Stress: Varicoceles can cause a buildup of reactive oxygen species (ROS), damaging sperm membranes and DNA
📉 Lower Sperm Quality: Men with varicocele often have low motility, poor morphology, or high DNA fragmentation
🪫 Hormonal Disruption: Long-standing varicoceles may affect Leydig cells, reducing testosterone production
🔁 Inflammation & Vascular Congestion: Leads to impaired testicular function and potentially pain or discomfort
And it’s not just about sperm count. Even with “normal” numbers, quality and function may still be compromised—which is why addressing varicocele is often critical in male fertility workups.
We Can Help!
Whether or not a varicocele requires surgery (varicocelectomy) depends on the severity and fertility goals—but there is so much you can do to support sperm quality naturally, too.
At The Greenhouse, we specialize in male fertility, too. Whether you're trying naturally or preparing for IVF, we help you optimize sperm health, reduce inflammation, and create a plan that works for you.
👉 Apply for our Male Fertility Tune-Up session
Learn More
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References
- Agarwal, A., Sharma, R., & Harlev, A. (2017). Effect of varicocele on semen characteristics according to the new 2010 World Health Organization criteria: A systematic review and meta-analysis. Asian Journal of Andrology, 18(2), 163–170. https://doi.org/10.4103/1008-682X.168734
- Schauer, I., Madersbacher, S., & Jost, R. (2012). The impact of varicocele on sperm parameters and fertility: A review. Andrologia, 44(3), 171–176. https://doi.org/10.1111/j.1439-0272.2010.01113.x
- Esteves, S. C., Miyaoka, R., & Agarwal, A. (2011). An update on the clinical assessment of the infertile male. Clinics, 66(4), 691–700. https://doi.org/10.1590/S1807-59322011000400026
**Not medical advice. Always consult your doctor before making changes to your health or fertility plan.
