My husband has been told he has a varicocele. Does it need surgery before we try?

A varicocele is a swelling of the veins in the scrotum, a bit like a varicose vein. It is very common, found in roughly 15 in 100 men overall and more often in men with fertility problems. Many men with a varicocele father children without any treatment, so finding one does not automatically mean it is the cause. Repair (surgery or a radiology procedure called embolisation) is usually considered when three things line up: the varicocele can be felt on examination (not just seen on a scan), the semen analysis is abnormal, and the female partner's tests are normal or her fertility is not time-limited. In that situation repair can improve sperm count and movement in some men, though improvement takes around three to six months to show, because that is how long new sperm take to develop. If the female partner is in her mid-30s or older, or IVF is already being advised for other reasons, many specialists suggest not delaying treatment for the repair. Small varicoceles seen only on ultrasound with a normal semen report generally don't need surgery. The decision depends on the grade of the varicocele, the full semen picture and the female partner's age and tests, so it is best made together with a urologist or andrologist and your fertility doctor. See a doctor promptly if there is pain, a sudden new swelling, or a varicocele only on the right side.