In other cases both testes will be smaller than normal. The severity of atrophy can range from a very small amount up to a loss of all spermatogenic elements. The difficulty is determining which patients will improve and how much and how quickly they will improve. If a patient with a varicocele has a normal, or only slightly impaired semen analysis, the varicocele may not need to be repaired, even if some atrophy has occurred. Sometimes, if the semen analysis is very poor, there likely would not be enough improvement to make the repair worthwhile.
All factors have to be considered to be able to make an informed and appropriate decision.
Sometimes it is elevated because it is pushing the testicle to work hard and keep sperm production up despite the effects of the varicocele. Unfortunately, this finding is not consistent. Therefore, the cord can easily be found through a small incision and brought to the surface. Care must be taken to dissect off only the abnormal veins, leaving the testicular artery intact. If the procedure is performed using a microscope, the chance for complications is very low.