What are the implications of having a subclinical varicocele on my fertility and testicular health, given that my sperm count is currently within normal limits?

Subclinical Varicocele with Normal Sperm Count: No Treatment Indicated

You do not need treatment for a subclinical (non-palpable) varicocele when your sperm count is normal, as intervention in this scenario does not improve fertility outcomes or pregnancy rates. 1, 2

Treatment Criteria for Varicoceles

The decision to treat varicoceles follows a clear algorithm based on two essential factors:

Clinical Palpability

• Subclinical varicoceles (detected only by ultrasound, not palpable on physical exam) should not be treated regardless of other factors 1, 3, 2
• Only clinical (palpable) varicoceles are candidates for treatment 1, 2
• Routine ultrasonography to identify non-palpable varicoceles is actively discouraged, as treating these does not improve semen parameters or fertility rates 1, 3, 2

Semen Parameters

• Treatment is only recommended for men with both a palpable varicocele and abnormal semen analysis 1, 3, 2
• Men with normal semen parameters should not undergo varicocele repair, even if the varicocele is palpable 1, 3, 2

Why Your Situation Doesn't Warrant Treatment

Since you have:

1. A subclinical varicocele (non-palpable)
2. Normal sperm count

You meet neither criterion for intervention. The European Association of Urology and American Urological Association guidelines are explicit that treatment of subclinical varicoceles in men with normal semen analysis is not effective at increasing chances of spontaneous pregnancy 1, 2

Long-Term Monitoring Considerations

While immediate treatment is not indicated, be aware that:

• Varicoceles can be progressive lesions that may affect testicular function over time 4
• Approximately 15% of the general male population has varicoceles, but only 35-40% of infertile men have them, meaning most men with varicoceles maintain normal fertility 1, 2, 5
• If you develop abnormal semen parameters in the future (particularly decreased motility or "stress pattern"), reassessment would be warranted 6

Important Caveats

Testicular size monitoring: The one exception where treatment might be considered even with normal sperm count is if you develop persistent testicular atrophy (size difference >2 mL or 20% between testicles, confirmed on two visits 6 months apart), though this applies to clinical varicoceles, not subclinical ones 1

Avoid unnecessary imaging: Do not pursue repeated ultrasounds to "monitor" a subclinical varicocele, as this leads to overtreatment without benefit 1, 3, 2