Varicocelectomy: Improving Fertility and Reducing Testicular Pain
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Editorial note: This article is provided for educational purposes only. It is not medical advice. Always consult a qualified healthcare professional for diagnosis and treatment of any condition.
Quick Answer
A varicocelectomy is surgery to repair swollen veins in the scrotum, called varicoceles, by cutting and sealing the affected veins so blood flows through healthy ones. It is the most common procedure for treating male infertility and is also used for testicular pain or low testosterone. Most people go home the same day and fully recover within about six weeks. [1]
What the research says
Surgery may improve pregnancy rates, but live birth is uncertain. A Cochrane review of 48 studies (5,384 participants) found that surgical or radiological treatment may improve pregnancy rates compared with delayed or no treatment (risk ratio 1.55; 95% CI 1.06-2.26; low-certainty evidence). It could not tell whether live birth rates improve. Microscopic subinguinal surgery probably gives slightly higher pregnancy rates and fewer recurrences than other surgical methods (Persad et al., Cochrane Database of Systematic Reviews, 2021 [2]).
A randomized trial found more pregnancies after surgery. In 145 infertile men with palpable varicoceles and impaired semen quality, spontaneous pregnancy within 12 months occurred in 32.9% after microsurgical varicocelectomy versus 13.9% with observation (odds ratio 3.04; 95% CI 1.33-6.95), and semen parameters improved (Abdel-Meguid et al., European Urology, 2011 [3]).
Most men with painful varicoceles are pain-free after microscopic repair. In 59 patients, 85% reported complete pain resolution, 6% partial resolution and 9% persistent pain after a median follow-up of 24 months. Repeat surgery raised the risk of persistent pain (Bercovich et al., Basic and Clinical Andrology, 2025 [4]).
Key takeaways
A varicocelectomy repairs enlarged scrotal veins and is mainly done to improve male fertility or relieve persistent testicular pain [1].
It is a relatively safe procedure with a low risk of complications, and the results are usually permanent [1].
Most people return to work or school within a few days and fully recover in about six weeks, though results for fertility vary [1] [2].
What are varicoceles and why might surgery be needed?
Varicoceles are swollen veins in the scrotum, often described as feeling like a "bag of worms". They affect 15 to 20 out of every 100 males in the U.S. Medicine cannot treat or remove the swelling, so a varicocelectomy may be recommended if varicoceles cause problems [1].
The main reasons for surgery are male infertility, a lot of testicular pain and low testosterone. Many people choose the procedure to improve their chances of having a biological baby [1]. Varicoceles can also be associated with a shrinking testicle (atrophy), another reason to have them checked.
How are varicoceles diagnosed and graded?
Before recommending surgery, a provider examines you and may use imaging. During the exam you may be asked to bear down (the Valsalva maneuver) so that smaller varicoceles can be felt. A scrotal ultrasound, semen analysis and blood tests can confirm the diagnosis and show how it affects fertility.
Varicoceles are graded by size and how easily they are detected, which helps guide the treatment approach.
Grade | Description | How it is detected |
Grade 0 | Subclinical varicocele | Only on ultrasound imaging. |
Grade I | Small varicocele | Felt only when bearing down (Valsalva maneuver). |
Grade II | Moderate varicocele | Felt during a physical exam but not visible. |
Grade III | Large varicocele | Clearly visible through the skin of the scrotum. |
What surgical techniques are used?
There are several approaches, from traditional open surgery to minimally invasive techniques. Your provider will recommend the best type for you [1].
Open surgery: the surgeon cuts the skin and tissues for a clear view. Approaches include inguinal ligation (through the groin) and retroperitoneal high ligation (from behind the lining of the abdomen) [1].
Microsurgical varicocelectomy: a few tiny incisions in the groin and a powerful operating microscope. It is the gold standard and the most common approach [1].
Laparoscopic varicocelectomy: a few tiny incisions in the lower abdomen and a thin camera rod. It is not common because varicoceles have a high chance of coming back and there is a higher risk of injury [1].
Feature | Microsurgical approach | Laparoscopic approach |
Tools used | High-power operating microscope | Laparoscope (camera rod) |
Incisions | A few tiny incisions in the groin | A few tiny incisions in the lower abdomen |
Duration | 1 to 3 hours | 30 to 40 minutes |
Notes | The gold standard and the most common approach | Less common because of higher recurrence and injury risk |
Source: Cleveland Clinic [1].
What happens before, during and after the procedure?
Before: you meet your care team to choose the technique and check your general health, vital signs, medicines that raise bleeding risk and allergies. You should not eat or drink after midnight the night before, and if you must take medicine, take it with a small sip of water [1].
During: a team that usually includes a urologist and an anesthesiologist gives you general anesthesia. The surgeon makes incisions in the abdomen or groin, cuts the veins and seals the ends so blood flows into healthy veins, and then stitches the incisions closed. Open surgery usually takes at least an hour, and treating both sides takes about twice as long [1].
After: you move to a recovery room where staff monitor you and treat pain or nausea. You may be prescribed pain medicine, stool softeners, antibiotics or blood thinners. Most people go home a few hours later, and someone must drive you. Plan to have help for the first day or two [1].
What are the risks and how successful is it?
A varicocelectomy is relatively safe with a low risk of complications. Risks include anesthesia risks, healing problems, infection, hematoma, swelling, bruising, scarring, tenderness in the testicles, hydrocele and injury to a testicular artery. In rare cases the testicle may no longer work or the varicocele may come back [1].
About 8 out of 10 people have less pain afterward, and many have a higher sperm count at follow-up. About 3 out of 10 can get their partner pregnant [1]. The results are usually permanent [1].
What is recovery like?
Recovery varies from person to person. Bruising in the groin and scrotum usually goes away in three to four weeks, swelling can last six to eight weeks and tenderness in the groin can last up to six weeks. Most people can go back to work or school within a few days [1].
Take NSAIDs for pain only if your provider says they are safe for you, and take any prescribed antibiotics or other medicines as directed.
Apply an ice pack wrapped in a towel for up to 10 minutes at a time, repeatedly through the day.
Keep the area clean, avoid baths and swimming, and clean gently in the shower.
Avoid strenuous activity and do not lift anything over 10 pounds for at least two weeks.
Drink extra water and eat more fiber to prevent constipation and straining.
Avoid sexual intercourse and masturbation for at least one week.
Source: Cleveland Clinic [1].
Bottom line: what every reader should remember
A varicocelectomy is a safe and common way to treat the pain and fertility effects of varicoceles. It can reduce pain, may improve the chances of pregnancy and has a fairly quick recovery, though a better pregnancy chance is not guaranteed [1] [2].
Take action today: If you have scrotal pain or are having trouble conceiving, talk to a urologist about whether a varicocelectomy is right for you. Bring a list of your medicines and symptoms to the visit [1].
Frequently Asked Questions
1. What is the primary goal of a varicocelectomy?
The main goal is to repair swollen scrotal veins to reduce testicular pain and improve male fertility [1].
2. How long does the surgery take?
It depends on the technique. Open surgery usually takes at least an hour, microsurgical surgery one to three hours and laparoscopic surgery 30 to 40 minutes. If both sides are treated, it takes about twice as long [1].
3. Is the procedure done under general anesthesia?
Yes. You are given general anesthesia, so you are not awake and do not feel pain during the procedure [1].
4. When can I return to work or school?
Most people can go back within a few days. Your provider will give you a better idea for your situation [1].
5. How soon can I have sex or masturbate?
Avoid sexual intercourse and masturbation for at least one week, because they put pressure on your stitches [1].
6. Will the surgery definitely improve my fertility?
Not for everyone. In a randomized trial of infertile men with palpable varicoceles, 32.9% of those who had surgery achieved a spontaneous pregnancy within a year, compared with 13.9% of those who were observed [3]. A Cochrane review concluded that treatment may improve pregnancy rates, but the effect on live birth is uncertain [2]. Cleveland Clinic estimates that about 3 in 10 can get their partner pregnant [1].
7. What are the most common risks?
Risks include anesthesia risks, healing problems, infection, a collection of clotted blood (hematoma), swelling, bruising, scarring, tenderness in the testicles, hydrocele and injury to a testicular artery [1].
8. Are the results permanent?
The results are usually permanent. In rare cases, the varicocele can come back [1].
9. How do I manage pain during recovery?
Your provider may suggest NSAID pain relievers if they are safe for you. An ice pack wrapped in a towel can be applied for up to 10 minutes at a time, repeatedly through the day [1].
10. Do I need to fast before the surgery?
Yes. You should not eat or drink anything after midnight the night before surgery. If you must take medicine, take it with a small sip of water [1].
11. Can varicoceles cause the testicles to shrink?
Varicoceles can be associated with testicular shrinkage (atrophy). If you are worried about testicle size, talk to a urologist about whether surgery is appropriate.
12. Is a varicocelectomy a safe procedure?
A varicocelectomy is considered relatively safe, with a low risk of complications. In rare cases the testicle may no longer work or the varicocele may come back [1].
13. Will I have visible scars?
Scarring is a possible risk. Microsurgical surgery uses a few tiny incisions, and minimally invasive techniques cause less damage than open surgery [1].
14. When should I call my doctor after surgery?
Call your provider for heavy bleeding at the incisions, discolored drainage, signs of infection (a fever of 100°F or 38°C or higher, chills or a headache), a bad odor, skin separating at the stitches or increased pain [1].
15. What is the difference between Grade I and Grade III varicoceles?
A Grade I varicocele can be felt only when you bear down (the Valsalva maneuver), while a Grade III varicocele is large and clearly visible through the scrotal skin.
Related Reading
Learn more in our guide to Semen Analysis: Purpose, How to Prepare and What Results Mean.
References
Cleveland Clinic. Varicocelectomy: Purpose, Procedure, Risks & Recovery. Cleveland Clinic. Last updated September 10, 2026. https://my.clevelandclinic.org/health/treatments/24234-varicocelectomy
Persad E, O'Loughlin CA, Kaur S, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database of Systematic Reviews. 2021;(4):CD000479. PMID: 33890288. https://doi.org/10.1002/14651858.CD000479.pub6
Abdel-Meguid TA, Al-Sayyad A, Tayib A, et al. Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. European Urology. 2011;59(3):455-461. PMID: 21196073. https://doi.org/10.1016/j.eururo.2010.12.008
Bercovich S, Hendel H, Ventura Y, et al. Microscopic surgery for the repair of painful varicocele: efficacy and predictors of successful outcomes. Basic and Clinical Andrology. 2025;35(1):31. PMID: 40817229. https://doi.org/10.1186/s12610-025-00277-y
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