❓ 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?
Outpatient procedure — arrive in the morning, home the same day
Local anaesthesia — femoral or jugular vein access (small skin puncture only)
Venography — the internal spermatic vein is catheterised under fluoroscopic guidance
Embolization — coils or cyanoacrylate glue are deposited to occlude the vein permanently
Discharge 2 hours later — normal activity resumed next day
⚖️ Embolization vs Surgery
| 💉 Embolization (Cochin) | 🔪 Surgical ligation | |
|---|---|---|
| Anaesthesia | ✅ Local | General or spinal |
| Incision | ✅ None (skin puncture only) | Yes |
| Hospital stay | ✅ Day case | 1–2 nights |
| Return to work | ✅ Next day | 1–2 weeks |
| Bilateral treatment | ✅ Same session | Two procedures |
| Recurrence risk | ~10% | ~15% (Palomo approach) |
🛡️ 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
Does varicocele embolization improve fertility?
Several studies show improvement in sperm parameters (concentration, motility, morphology) after varicocele treatment. However, the decision to treat should be made jointly with your urologist or fertility specialist, considering the overall clinical picture.
Is the procedure painful?
The procedure is performed under local anaesthesia. You may feel mild discomfort at the access point. Some patients experience a dull scrotal ache for 24–48 hours afterwards, which is managed with paracetamol.
Is there radiation to the testicles?
The procedure is X-ray guided, but the dose is low and targeted on the abdomen and pelvis. The testes lie at the edge of the field and screening time is kept short (ALARA principle). No evidence shows an adverse effect of this brief exposure on later fertility.
Can embolization improve testosterone?
Recent data suggest a possible improvement in testosterone in some symptomatic men with a clinical varicocele. This remains under evaluation and is decided case by case with the andrologist; it is not a reason to treat an asymptomatic man.
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✅ Covered by French health insurance (Assurance Maladie). No extra fees at Cochin Hospital AP-HP.