Microsurgical varicocelectomy usually ranges from ₹50,000 to ₹1,00,000. If fertility is a concern, we might also do a semen analysis to check sperm count and quality . But if you have pain, testicle shrinkage, or fertility concerns, it is time to consider treatment regardless of the grade . In fact, most men with varicocele have normal spermatogenesis. Talk to a healthcare provider about your treatment options, including how surgery may affect your fertility. Some people who have varicoceles have fertility issues.
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.
About the role of other hormones in patients with varicocele, a significantly lower concentrations of AMH was found in subfertile men, as a result of Sertoli cells damage, without differences related to the grades of subfertility. In fact, although in published literature the correlation between varicocele and infertility is no longer so close, gonadotropins impairment could at least in part explain the alteration of spermatogenesis. Evaluation of FSH and LH levels may be necessary at the first diagnosis of varicocele especially if the patient is seeking medical attention for infertility. A meta-analysis by Tian et al. showed higher FSH and LH levels in varicocele-bearing patients that significantly lowered after surgery (34).
Many studies demonstrated changes of serum FSH and LH in men with varicocele, but the reasons are not clear. Although the consequences of varicocele and its resolution have been described for decades, only few studies have been conducted in this field, often retrospective, and therefore with limited value even because with contradictory results (26–28). Sertoli cells are also the principal site of production of Inhibin-B (Inh-B) that acts as a circulating feedback modulator of FSH secretion by the pituitary gland. Varicocele increase internal scrotal temperature and can cause decrease of testosterone synthesis by Leydig cells, reduction of Sertoli cells function and germinal cells damage. In Leydig cells, Luteinizing Hormone (LH) stimulates steroidogenesis by triggering the cascade of events at mitochondrial level leading from cholesterol to testosterone.
Treatment often improves sperm count, motility, and quality. After that, you can gradually return to normal activities . Afterward, there may be mild discomfort for a day or two, easily managed with pain medication .
Different studies demonstrated the relationship between varicocele repair and testosterone levels, suggesting that varicocelectomy leads to an enhancement of testosterone production up to eugonadal levels, significant for men of all age groups (31, 32). A varicocelectomy is a surgical procedure that treats severe varicoceles that are painful or affect your fertility. The indications for surgery have been primarily testicular hypotrophy/atrophy but also include varicocele size, pain and abnormal semen analyses (if old enough).
These baseline values are all what would be considered the lower range of normal for adults and as a baseline, these normal values for adolescents give pause to the concept of measuring the androgen axis in teens with varicocele. In a smaller study on discarded blood samples in children undergoing elective non-endocrine related surgery, Kulle derived similar hormone levels in Tanner 4 and 5 adolescents and ages 13 to 18 (Table 3) (19). The intent was to stratify normal reference ranges of all fertility hormones (T, E2, FSH, LH, SHBG, Prolactin), by age and Tanner groups for both males and females. Male fertility is dependent on spermatogenesis and T is crucial in maintenance of spermatogenesis.
In a case-control study, Garolla et al. evaluated 40 patients with left varicocele, 20 obese men and 20 healthy control subjects for a series of parameters such as testicular volume, hormones, sperm parameter and 24-h scrotal temperature monitoring by a cutaneous thermochip. Nine clinical trials evaluated alteration of serum FSH and LH levels in a cohort of 312 patients before and after varicocelectomy. A recent study including 100 patients (50 hypogonadal and 50 eugonadal) with varicocele of all grades, showed a significant difference in pre- and post-varicocelectomy testosterone concentrations in hypogonadal patients but not in eugonadal ones (33). On the other hand, some studies have demonstrated an inhibition of testicular C-17,20-lyase activity, enzyme involved in testosterone production (21) (Figure 1).
Embolization is less invasive with faster recovery, while microsurgery has very low recurrence rates. Both embolization and microsurgery are highly effective. Dr Pradeep Muley specializes in non-surgical embolization with over 30 years experience . Maybe some dull ache for a day or two, easily managed with over-the-counter pain medication.

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