What Does a Varicocele on Ultrasound Mean for Health and Fertility?

A varicocele on ultrasound means the scan has shown widened veins in the scrotum, along the cord that leads to the testicle. Varicoceles are common, often cause no symptoms and often need no treatment.

This guide explains common report wording, the link with fertility and when treatment is usually discussed. It cannot interpret your own scan. Your clinician will combine the report with an examination, your symptoms and, if relevant, semen test results.

Some features mean a varicocele should be looked at more closely rather than simply watched. If any of these apply, ask the clinician who ordered the scan how soon it should be reviewed.

• A varicocele that appears suddenly in an older man. MedlinePlus notes this may be caused by a kidney tumour pressing on a vein, so a kidney ultrasound may also be done.
• A varicocele on the right side only. The European Association of Urology guideline advises that men with an isolated right-sided varicocele should be examined further for problems in the abdomen.
• A testicle that is getting smaller, or a new lump.
• Go to A&E or call an emergency number for sudden, severe testicle pain, testicle pain with feeling or being sick or tummy pain, or pain lasting more than an hour or continuing at rest, as advised by the NHS.

Cleveland Clinic estimates that varicoceles affect 15% to 20% of men. MedlinePlus says they are most common between ages 15 and 25 and usually develop slowly. They happen when valves inside the veins do not work well, so blood pools instead of flowing back towards the heart.

Most varicoceles are on the left. Cleveland Clinic notes that the right side, or both sides, can be affected less commonly, which is why a right-sided varicocele on its own is treated as less typical and checked further.

Symptoms, when present, include a dull ache or heaviness, enlarged, twisted veins or a painless lump above the testicle, or a testicle that is smaller than the other.

Clinicians often grade a varicocele by examination rather than by the scan. The European Association of Urology describes these grades:

• Subclinical: cannot be felt or seen, but shows on a Doppler ultrasound. Cleveland Clinic calls this grade 0.
• Grade 1: can be felt only when bearing down, as if straining.
• Grade 2: can be felt at rest.
• Grade 3: can be seen and felt at rest.

Before or alongside the scan, a clinician usually examines the groin, scrotum and testicles, sometimes while you are standing. Ultrasound is especially useful when the examination is unclear, and the European Association of Urology guideline also mentions it for checking a varicocele that returns after treatment.

A scrotal ultrasound uses sound waves, with no radiation, to show the testicles and nearby veins. Doppler ultrasound also shows blood flow. Reports may mention the width of the veins and whether blood flows backwards, called reflux, when you strain. The EAU guideline links veins wider than 3 mm with reflux lasting more than two seconds to a clinically significant varicocele, but measuring methods vary, so let the radiologist and your clinician interpret your numbers.

Reports often also describe the size of each testicle. A difference in size can matter, especially in teenagers. Ask whether anything else, such as a cyst or a hydrocele, was seen.

A varicocele can be linked with lower sperm count or quality, and MedlinePlus lists it as a possible cause of infertility. Cleveland Clinic estimates that it may contribute to about 40% of male infertility, but many men with a varicocele have children without any problem.

A scan finding alone does not show whether fertility is affected. If you are trying for a pregnancy, a semen analysis gives more useful information. If your semen results show low sperm movement, see the related guide on low sperm motility.

MedlinePlus says a varicocele often needs no treatment unless testicle size changes or there is a fertility problem. Cleveland Clinic adds that persistent pain is another reason. There are no medicines that remove a varicocele.

If a varicocele aches but needs no procedure, MedlinePlus says supportive or snug underwear may ease the discomfort. Further treatment may be discussed if pain continues or new symptoms develop.

For couples with fertility problems, the EAU guideline recommends treatment for men with a varicocele that can be felt, abnormal semen results and otherwise unexplained infertility, when the female partner has good ovarian reserve. It advises against treatment in men with normal semen results or a subclinical varicocele. In adolescents, surgery may be offered if one testicle stays smaller than the other.

Treatment options include surgery to tie off the affected veins, called varicocelectomy, and embolisation, where a fine tube is used to block the vein from the inside. Both are often done without an overnight stay. Your specialist can explain which suits you and what the risks are.

Take the full report and any semen results to the appointment.

• Which side is the varicocele on, and what grade is it on examination?
• Are both testicles a normal and similar size?
• Does anything about this varicocele, such as its side or how it started, need further checks like a kidney scan?
• Should I have a semen analysis if we are trying for a pregnancy?
• What would make treatment worth considering for me, and what are the options and risks?
• When, if at all, should this be reviewed again?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with a similar varicocele report weighed symptoms, semen results and treatment choices can help you plan questions for your own appointment.

Other cases cannot tell you whether you need treatment or how your fertility will be affected. Use them to prepare, then let your clinician guide the decision.