Recently the scrotal ultrasound has been found to be an accurate way of confirming the presence of a varicocele. The size of the veins and abnormal blood flow can be seen and measured using the ultrasound. Repair of the varicocele is indicated when the couple has documented infertility with normal or potentially normal female partner but a male with one or more abnormal semen parameters and the presence of a varicocele on physical exam. Repair should be done when a varicocele causes testicular pain or discomfort or there is a significant discrepancy between the size of the two testicles. Treatment options to aid with fertility include surgical varicocele repair, angiographic embolization, intrauterine insemination, in-vitro fertilization and medical therapy with clomid.
Surgical repair offers the best results.
In men with preoperative sperm counts under 10 million the surgery is less likely to succeed than when the counts are over 10 million. Surgery is performed through a one and one half inch incision made below the belt line with a technique called microsurgical inguinal varicocele repair. The abnormal veins are identified using an operating microscope and are interrupted so blood can no longer pool around the testicle. Surgery is on an outpatient basis and generally takes 30-45 minutes to complete. Depending on the individual circumstances and the severity of the sperm abnormalities, multiple approaches to this problem can be taken.