Does correction of varicocele reduce Follicle-Stimulating Hormone (FSH) levels?

Does Correction of Varicocele Reduce FSH Levels?

Yes, correction of varicocele significantly reduces FSH levels, particularly in patients with high-grade varicoceles and testicular hypotrophy. 1, 2

Mechanism and Evidence

• Varicocele is present in approximately 15% of the normal male population, but this percentage increases to 25% in men with abnormal semen analysis and 35-40% in men presenting with infertility, demonstrating a clear correlation between varicocele and fertility issues 3

• Patients who undergo varicocelectomy show a significant decrease in FSH levels after surgery, with the most recent and comprehensive meta-analysis (2024) showing a mean difference of -1.43 IU/L (95% CI: -1.82 to -1.04; p<0.00001) compared to pre-treatment values 2

• FSH levels in patients after varicocele repair are also significantly lower than those of patients with untreated varicocele (mean difference -2.35 IU/L, 95% CI: -4.06 to -0.65; p=0.007) 2

• Higher grades of varicocele (grade 3) and spermatic vein reflux (grade 4) are associated with higher FSH levels before treatment, and these patients show the most significant reduction in FSH levels after correction 1

Clinical Implications

• The reduction in FSH levels after varicocele repair indicates improved testicular function, as elevated FSH typically reflects impaired spermatogenesis 2

• The decrease in FSH levels correlates with improvements in semen parameters, including:

  • Increased sperm concentration 4, 5
  • Improved sperm motility 4, 5
  • Better sperm morphology 5

• These hormonal improvements typically occur within 3-6 months after varicocele correction, coinciding with the timeframe for semen parameter improvements 6, 5

Treatment Considerations

• The method of varicocele correction (surgical varicocelectomy vs. sclerotherapy/embolization) does not significantly affect the hormonal outcomes, though some studies suggest sclerotherapy may have slightly better outcomes for fertility 4, 2

• Patients with initially abnormal hormonal profiles (particularly those with higher FSH levels) show the most significant improvements after varicocele repair 6, 1

• Varicocele repair has been shown to improve semen parameters and fertility outcomes in men with clinical varicoceles and abnormal semen analysis 7, 3

• After varicocele repair, improvements in semen parameters typically take up to two spermatogenic cycles (approximately 3 months), with spontaneous pregnancy occurring between 6 and 12 months after varicocelectomy 7

Important Caveats

• While FSH levels decrease after varicocele repair, they often remain higher than those of healthy controls without varicocele (mean difference 2.71 IU/L, 95% CI: 1.12-4.31; p=0.0009) 2

• Treatment of subclinical (non-palpable) varicoceles is not effective at increasing chances of spontaneous pregnancy or significantly improving hormonal profiles 7, 3

• The most significant hormonal improvements are seen in patients with clinical grade 3 varicocele, testicular hypotrophy, and grade 4 spermatic vein reflux 1

• Routine use of ultrasonography to identify non-palpable varicoceles is discouraged, as treatment of these subclinical varicoceles is not associated with improvement in either semen parameters or fertility rates 3