A varicocele is a nest of varicose veins around the testicle and may be unsightly, cause pain, or cause testicular atrophy or under development with associated fertility problems. When valves fail in the veins that drain this nest of veins, the blood pools and enlarges these 'varicose' veins around the testicle causing a varicocele which can have the appearance of a “bag of worms”

• Approximately 10 percent of all men have varicoceles
• 30 percent of infertile males have a varicocele
• Highest occurrence in men aged 15-35
• Usually left sided

Pain - aching pain when an individual has been standing or sitting for long periods of time and pressure builds up on the affected veins. Typically, painful varicoceles are prominent in size.

Fertility Problems - There is an association between varicoceles and infertility. The incidence of varicocele increases to 30 percent in infertile couples where the male is shown to have low or abnormal sperm count. Some experts believe varicoceles, cause infertility by raising the temperature in the scrotum and decreasing sperm production.

Testicular Atrophy - Shrinking of the testicle is another sign of varicoceles. Often, once the testicle is repaired it will return to normal size if treated when the patient is young.

Cosmetic - many males, and females, find the 'bag of worms' of a prominent varicocele quite unsightly irrespective of the presence of pain or atrophy

In men with reduced fertility and a varicocele, embolization is equally effective in improving fertility as surgical ligation without the associated recovery problems. Pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy.

In one study, sperm concentration improved in 83 percent of patients undergoing embolization compared to 63 percent of those surgically ligated.

The treatment options are surgery or embolization

Given the choice most patients express a strong preference for embolization.