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Talk to a healthcare provider if you suspect you have infertility. The higher temperature affecting both testicles may affect sperm count or production. However, many people with varicoceles have no problems achieving pregnancy. Varicoceles can contribute to about 40% of all cases of male infertility. If a varicocele doesn’t bother you, you may not need treatment. Varicoceles are usually painless but can sometimes cause testicular pain, which may come and go.
In a non-randomized surgical series of 40 pubertal boys, mean age 14.5, with grade 2 and 3 varicoceles, 24 underwent surgery and 16 were observed (by the choice of the parents). The repair of varicoceles considered "subclinical" or in men with normal seminal parameters was not recommended. Infertile men with varicoceles were found to have decreased testicular volume, impaired sperm quality, and decline of Leydig cell secretion. In the adult the main indications for intervention are infertility and abnormal semen analysis, both unavailable in most teens.
And the old days of only having big surgery with weeks of recovery are long gone. If you have a Grade 1 varicocele with no symptoms, your doctor might simply suggest watching it. Supportive care or minimally invasive treatment Usually no pain or very mild discomfort This matters because treatment often depends on how advanced your condition is . Others feel pain, heaviness, or notice a lump. The veins stretch and enlarge, like varicose veins in your legs .
In contrast to adults with varicocele, fertility status is not yet known and it is not generally feasible to obtain a semen analysis in adolescents in order to guide treatment. Castro-Magana et al. observed an increased androstenedione/testosterone (A/T) ratio after hCG administration before, and its normalization 3 months after varicocelectomy, suggesting an impaired 17β-HSD activity in males with varicocele (46). Maintaining normal estrogen concentrations is very important since they play a negative role in the testis by inhibiting Leydig cells 17β-hydroxysteroid dehydrogenase (17β-HSD), and thus inhibiting the conversion of androstenedione to testosterone, lowering testosterone production. The higher than normal temperature impairs Leydig cells function causing reduced testosterone production.
If you receive treatment for a varicocele, schedule follow-up appointments with your provider. They can diagnose a varicocele and recommend the best treatment for you. Medical experts aren’t sure what causes varicoceles to develop. Some people may experience mild discomfort during certain activities, but the varicoceles won’t cause serious or long-term health problems.
Deciding whether to treat a varicocele is up to you. A varicocele is a common condition that can affect males at different ages and stages of life. A varicocele is an enlarged vein in your scrotum. They’ll monitor your health and may order additional tests to make sure your treatment is effective. Talk to a healthcare provider if you have varicocele symptoms, including an inability to get your partner pregnant. This redirects blood flow to other healthy veins in your scrotum.
In those tested, all seminal parameters (concentration, motility and morphology) showed statistically significant improvement in the surgical vs. the observed group. In one series of 30 symptomatic boys average age 14.4, 77% demonstrated ipsilateral hypotrophy and the author recommended surgical correction (16). Varicoceles appear during adolescence as the testes enlarge and usually present as scrotal swelling and rarely pain (12-14). As controversial as treatment in adults has turned out to be, historically, this has been even more of a problem in teens. Fertility potential is not easily measured in the adult let alone the adolescent; as a result ipsilateral testicular hypotrophy/atrophy is commonly used as a surrogate indication.
In fact, they increase only when the azoospermia is related to impaired spermatogonia number and function, whereas they persist in the normal range when the azoospermia is related to maturation arrest at spermatocyte or spermatide stage (8, 51). FSH levels seem to depend on the different steps of spermatogenesis at which the impairment occurs. In some cases the adrenal androgen secretion might compensate in the first weeks for the impaired Leydig cells function due to varicocele (50). We know that varicocele can cause Leydig cells dysfunction in various ways, and it becomes gradually more impaired with the duration of the varicocele. On the contrary, the relationship between clinically detectable varicocele and hormonal pattern alterations is still unclear. A meta-analysis of Agarwal et al. showed that varicocele was the primary reason for alteration of spermiogram in adult infertile men (47). In men with higher rise in FSH and LH after GnRH infusion, free testosterone levels were lower, and free estradiol and SHBG levels were higher.
A meta-analysis by Li et al. which included most of these studies, evaluated the effect of surgical varicocele repair on improving Leydig cells function. In particular treating infertile men with clinical varicocele, abnormal semen parameters, or otherwise unexplained infertility in a couple in which the female partner has a good ovarian reserve, to improve the fertility rate, is considered a strong recommendation. The impact of varicocele on semen production and fertility is known, but the relationship between clinical varicocele and impaired hormonal production is not clear. If left untreated over many years, varicoceles can sometimes cause the testicle to shrink or affect testosterone levels . While varicocele is the most common surgically correctable risk factor for male infertility, not all males with varicocele experience infertility. A varicocelectomy can repair a varicocele and sometimes improve your fertility. Medical experts don’t understand what role varicoceles play in infertility.

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