Varicocele Embolization

❓ What is a varicocele?

A varicocele is an abnormal dilatation of the veins of the spermatic cord, most commonly on the left side. It results from impaired venous drainage and can cause scrotal pain or heaviness, and may affect male fertility by raising testicular temperature and impairing spermatogenesis.

Varicoceles are found in approximately 15% of all men and in 35–40% of men investigated for infertility.

💉 Why choose embolization?

Varicocele embolization is a minimally invasive, non-surgical technique that blocks the pathological veins responsible for the varicocele, stopping the abnormal retrograde venous flow.

• Relieves symptoms (scrotal pain, heaviness)
• May improve fertility parameters (sperm concentration, motility)
• Alternative to surgical ligation — no incision, no general anaesthesia
• Performed using cyanoacrylate glue or metallic coils

👨 Who is eligible?

• Men with a symptomatic varicocele (pain, discomfort, heaviness)
• Varicocele associated with impaired semen analysis
• Persistent or recurrent varicocele after previous surgery
• Patients who prefer a non-surgical approach

📊 Varicocele grades & broader indications

Varicoceles are graded 1 (palpable only on Valsalva), 2 (palpable at rest) and 3 (visible to the eye). Palpable grades 2–3 with an abnormal semen analysis are the best indications; subclinical forms (seen only on Doppler ultrasound) remain debated.

Beyond fertility, embolization is also considered for chronic scrotal pain, adolescent varicocele with impaired testicular growth, recurrence after surgery, and — as an emerging, case-by-case indication — symptomatic low testosterone.

🔬 How does the procedure work?

Embolisation remains effective even after failed or recurrent surgery: it is a reference salvage option, and recent literature positions it as a first-line treatment. When performed for infertility, sperm parameters improve in 60 to 80% of patients in published series. As noted above, the benefit for a couple's fertility should be discussed on a case-by-case basis — the indication is not automatic.

⚖️ Embolization vs Surgery

⚡ At a glance — key figures

A varicocele is an abnormal dilation of the pampiniform plexus in the scrotum, caused by reflux in the spermatic vein (also called the gonadal vein). Varicocele embolization occludes this dilated vein responsible for the reflux, through a catheter introduced via a vein in the groin or arm, under local anaesthesia as a day case — with no scrotal incision and no surgery.

Sources: EAU (European Association of Urology) guidelines. Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.

🛡️ Radiation & modern fertility markers

Radiation. The procedure is X-ray guided, but the dose is low and focused on the abdomen and pelvis; the testes lie at the edge of the field and the ALARA principle is applied (minimal screening time). No evidence shows an adverse effect of this brief exposure on later fertility.

Sperm DNA fragmentation (DFI). Beyond the standard semen analysis (concentration, motility), recent studies report a fall in the sperm DNA fragmentation index after embolization — a marker linked to sperm genetic quality and to success in assisted reproduction.

❓ Frequently asked questions