Varicocele Embolization NYC | Dr. Aaron Fischman

Overview

What Is Varicocele Embolization?

A varicocele is an enlarged network of veins within the scrotum — essentially a varicose vein of the testicle. It develops when one-way valves in the internal spermatic (gonadal) vein fail, allowing blood to flow backward and pool around the testicle. Varicoceles affect roughly 15 percent of all men and are found in about 40 percent of men evaluated for infertility, making them the most common correctable cause of male infertility.

Varicocele embolization is a minimally invasive, catheter-based procedure that treats a varicocele by closing the faulty vein from the inside. Dr. Aaron Fischman performs varicocele embolization at Mount Sinai in New York City through a single pinhole puncture in a vein — no scrotal incision, no general anesthesia, and no stitches.

Using real-time fluoroscopic imaging, a thin catheter is navigated into the refluxing gonadal vein. The vein is then permanently closed using coils, a sclerosant, or a liquid embolic agent. Blood immediately reroutes through healthy collateral veins, the pooling resolves, and testicular temperature normalizes. The testicle's own blood supply is unaffected.

Published studies show varicocele embolization achieves symptom relief and pregnancy rates comparable to surgical varicocelectomy^[1] — with no incision, fewer complications, a much lower rate of hydrocele formation^[2,3], and a faster recovery. Most men return to full activity within about a week, compared with two to four weeks after surgery.

For men in New York City seeking a non-surgical alternative to varicocelectomy — or facing a varicocele that has recurred after prior surgery — embolization offers a durable, well-tolerated option delivered by an academic specialist at Mount Sinai.

>90%

Technical Success

The great majority of varicoceles are successfully occluded in a single session.

No Incision

Pinhole Access

Unlike varicocelectomy, there is no scrotal or groin incision and no stitches.

Same Day

Discharge

An outpatient procedure — patients recover briefly on-site and go home the same day.

~1 Week

Full Recovery

Most men return to exercise within a week — versus two to four weeks after surgery.

~40%

Of Infertile Men

Varicoceles are the most common correctable cause of male infertility.

Expertise

Why Choose Dr. Fischman for Varicocele Embolization in New York City?

Minimal-Access Philosophy

Dr. Fischman built his practice on getting patients up and out the same day. For varicocele embolization he most often works through a single puncture in the neck vein — a direct route to the gonadal vein that lets patients sit up and walk immediately, with no incision, no stitches, and no scrotal wound to care for.

Academic Specialist, Not a Volume Clinic

Varicocele treatment in New York is often delivered by rotating or affiliated physicians at storefront clinics. Dr. Fischman is a Professor of Interventional Radiology and Program Director of Mount Sinai's nationally recognized IR residency — and he personally performs your procedure.

130+ Peer-Reviewed Publications

Dr. Fischman has authored over 130 peer-reviewed publications and textbook chapters in interventional radiology, including foundational work on embolization technique and embolic agents. He is an internationally recognized authority who trains other physicians in these procedures.

Expert in Recurrent Varicocele

Varicoceles that return after surgical varicocelectomy are notoriously difficult to re-operate on through scarred tissue. Embolization uses live venography to map the actual venous anatomy — finding collateral and duplicated veins that surgery missed. Dr. Fischman regularly treats post-surgical recurrence referred from urologists.

Castle Connolly Top Doctor

Recognized as a Castle Connolly Top Doctor for eight consecutive years — a peer-nominated distinction — with dual board certification in Diagnostic Radiology and Vascular & Interventional Radiology.

Patients Travel From Everywhere

Patients come from across the United States and internationally for Dr. Fischman's expertise. Telemedicine consultations make it straightforward to review your ultrasound and semen analysis before traveling to New York City for a same-day procedure.

Conditions Treated

What Varicocele Embolization Treats

🔴

Scrotal Pain & Aching

The most common symptomatic indication. A dull, dragging ache that worsens with prolonged standing, exercise, or through the day and improves when lying down. Embolization eliminates the venous congestion driving the pain.

🧬

Male Infertility

Varicoceles are the most common correctable cause of male infertility. Pooled blood raises testicular temperature and impairs sperm production. Embolization can improve sperm count, motility, and morphology — typically reassessed at about three months.

📉

Testicular Atrophy

When a varicocele causes measurable shrinkage of the affected testicle — particularly in adolescents and young men — treatment can halt progression and allow catch-up growth. Documented size discrepancy on ultrasound is an accepted indication for intervention.

🔁

Recurrent Varicocele After Surgery

A varicocele that returns after varicocelectomy is often driven by collateral or duplicated veins that surgery could not see. Venography maps them directly, making embolization the preferred approach for post-surgical recurrence.

The Procedure

What to Expect on the Day of Varicocele Embolization

Consultation & Ultrasound Review

Dr. Fischman reviews your symptoms, scrotal ultrasound with Doppler, and — when infertility is the indication — your semen analysis. Ultrasound confirms and grades the varicocele and documents any testicular size discrepancy. Telemedicine consultations are available for out-of-state patients.

Pinhole Venous Access & Venography

Under local anesthesia and light sedation, a catheter is introduced through a single small puncture in the neck vein (internal jugular) — occasionally the groin vein (femoral) instead, depending on your anatomy. Dr. Fischman navigates to the internal spermatic vein and performs venography to map the refluxing vessels and any collaterals.

Embolization of the Refluxing Vein

The faulty vein is permanently closed using coils, a sclerosant, or a liquid embolic agent — selected based on your anatomy. Collateral vessels are treated in the same session to reduce recurrence. Blood immediately reroutes through healthy veins; the testicle's arterial supply is untouched.

Same-Day Discharge

You recover briefly on-site and go home the same day with a small bandage at the access site — no stitches. There is no scrotal wound to care for. Mild soreness for a few days is normal and managed with over-the-counter medication.

Illustration of varicocele embolization through the right internal jugular vein: a 5 French sheath in the neck, with the catheter passing through the superior and inferior vena cava into the left renal vein and down the left gonadal vein to the varicocele. — **The route from the neck.** A small 5 French sheath is placed in the right internal jugular vein. The catheter travels down through the large veins that return blood to the heart (SVC and IVC), crosses into the left renal vein, and enters the left gonadal vein that drains the varicocele.

Close-up illustration of a catheter passing from the inferior vena cava into the left renal vein and down into the incompetent left gonadal vein through its ostium, with arrows showing reflux toward the scrotum. — **Where the problem starts.** The catheter passes from the IVC into the left renal vein, then enters the gonadal vein at its opening (ostium). Faulty valves let blood flow backward down this vein (red arrows), which enlarges the scrotal veins. Closing it off treats the varicocele.

Illustrations are schematic and not to scale.

Recovery Timeline

Day 1–2

Rest at home. Mild scrotal soreness or a pulling sensation is normal as the treated vein clots off. Managed with over-the-counter medication. Most men return to desk work within one to two days.

Days 3–7

The access site heals under a small bandage. Soreness resolves. Most patients return to full activity — including exercise and heavy lifting — within about one week.

Weeks 2–6

Scrotal aching and heaviness progressively improve as venous congestion resolves. Many men notice meaningful relief of pain within the first several weeks.

Month 3+

When performed for infertility, semen analysis is repeated at approximately three months — sperm production cycles take about 72 days, so improvement is not measurable before then.

Embolization vs. Surgery

Varicocele Embolization vs. Varicocelectomy: How Do They Compare?

Men with a symptomatic varicocele generally have two definitive options: embolization (closing the faulty vein from inside using a catheter) and varicocelectomy (surgically tying off the vein through an incision, most often microsurgically). Both are effective. Embolization is the only one that requires no incision, no general anesthesia, and no stitches — and it is generally the preferred approach when a varicocele recurs after prior surgery.

	Embolization Dr. Fischman · Mount Sinai	Microsurgical Varicocelectomy	Open / Laparoscopic Surgery
Surgical Incision	✓ None — pinhole access only	Required	Required
Anesthesia	✓ Local + light sedation	General or regional	General
Return to Full Activity	✓ ~1 week	2–3 weeks	2–4 weeks
Hydrocele Risk	✓ Very low — far lower than surgical ligation	Low	Higher — a known complication
Treats Both Sides in One Session	✓ Yes — same access	Requires bilateral incisions	Requires bilateral incisions
Maps Collateral Veins	✓ Yes — live venography	Limited to surgical field	Limited to surgical field
Well Suited to Post-Surgical Recurrence	✓ Yes — maps collateral veins directly	Difficult through scar tissue	Difficult through scar tissue
Semen Parameter Improvement	✓ Comparable to surgery	Comparable	Comparable
Insurance Coverage	✓ Medicare + most plans	Covered	Covered

Individual outcomes vary. This comparison is for informational purposes only and is not medical advice. Both embolization and microsurgical varicocelectomy are accepted, effective treatments; Dr. Fischman will discuss your specific venous anatomy, symptoms, and fertility goals during your consultation, and will tell you candidly if surgery is the better choice for you.

The Evidence

What the Research Shows About Varicocele Embolization

Varicocele embolization has been studied for decades, in randomized trials, meta-analyses, and large long-term series. Here is what the best available evidence shows for pain, fertility, safety, and technique.

Study	Patients	Key findings
Scrotal pain
Long-term pain outcomes^[6]	44 men · median 58-month follow-up	Average pain fell from 5.4 to 0.3 out of 10 at 12 months; 89% reported complete resolution of pain at 1 year, with better work, exercise, sleep, and sexual function.
Symptomatic varicocele series^[7]	62 procedures	95% success, with significant improvement in pain severity and quality of life.
Systematic review of embolic agents^[5]	21 studies · 2,236 men	Every study that measured pain reported improvement after embolization.
Fertility
Cochrane review^[1]	48 randomized trials · 5,384 men	Treating a varicocele (by surgery or embolization) may improve pregnancy rates versus no treatment (22–48% vs 21%). No clear difference in pregnancy rates between surgery and embolization.
Semen parameters after coil embolization^[8]	8 studies · 701 men	Sperm concentration improved in all five studies that measured it; motility improved in seven of eight.
Fifteen-year, two-center experience^[9]	225 men	96% technical and 94% clinical success; 51% of men treated for subfertility went on to conceive; complications 1.8%, none major.
After failed IVF-ICSI^[10]	42 couples	After varicocele embolization, 86% of couples who had previously failed IVF-ICSI achieved a live birth during follow-up.
Embolization vs. surgery
Meta-analysis, 30 studies^[2]	Embolization vs. surgical ligation	Embolization had fewer overall complications and about one-fifth the odds of hydrocele. Surgical high ligation had a modestly lower recurrence rate.
Meta-analysis, 20 studies^[3]	Children, adolescents, and adults	Hydrocele was significantly more common after surgery; no difference in pregnancy or recurrence rates.
Recurrent varicocele after prior treatment^[11]	18 studies · 1,073 men	Repeat treatment succeeded in 60–100% of cases, with pain resolution above 90%.
Technique
Embolic agents compared^[4]	30 studies · 3,505 men	Technical success above 90% with every embolic agent. Recurrence was lowest with glue (about 4%) versus coils (about 9%) or sclerosant alone (about 11%).
Neck (jugular) vs. groin access^[12]	144 men	Access through the neck vein cut radiation dose roughly in half compared with the groin, without any loss of technical success (93% vs 83%, not statistically different).
Complex venous anatomy^[13]	46 men · median 35-month follow-up	100% technical and 97.8% clinical success, with a 2.2% recurrence rate — including men with complex anatomy or prior surgery.

Much of the varicocele literature is observational, and results vary by patient and technique. Dr. Fischman will review how this evidence applies to you.

References (13)

Persad E, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev. 2021;4(4):CD000479. doi:10.1002/14651858.CD000479.pub6
Chen H, et al. Comparison of sclero-embolization and surgical ligation for varicocele treatment: a systematic review and meta-analysis. World J Urol. 2025;43(1):627. doi:10.1007/s00345-025-06014-4
Fabiani A, et al. Do sclero-embolization procedures have advantages over surgical ligature in treating varicocele in children, adolescents and adults? Andrologia. 2022;54(8):e14510. doi:10.1111/and.14510
Makris GC, et al. Safety and effectiveness of the different types of embolic materials for the treatment of testicular varicoceles: a systematic review. Br J Radiol. 2018;91(1088):20170445. doi:10.1259/bjr.20170445
Kasunic D, et al. Comparing the efficacy of different embolisation materials in improving pain and fertility outcomes in patients with varicoceles: a systematic review. J Med Imaging Radiat Oncol. 2025;69(1):112-125. doi:10.1111/1754-9485.13801
Sheehan M, et al. Pain relief after varicocele embolization: the patient's perspective. J Med Imaging Radiat Oncol. 2020;64(2):215-219. doi:10.1111/1754-9485.13001
Broe MP, et al. Spermatic vein embolization as a treatment for symptomatic varicocele. Can Urol Assoc J. 2021;15(11):E569-E573. doi:10.5489/cuaj.7077
Belczak SQ, et al. Improvement of semen parameters after coil embolization of varicoceles: a systematic review. J Vasc Bras. 2021;20:e20200137. doi:10.1590/1677-5449.200137
de Grae MNM, et al. A fifteen-year retrospective analysis of varicocele embolization: evaluating success, recurrence rates and embolic agents. CVIR Endovasc. 2025;8(1):59. doi:10.1186/s42155-025-00575-6
Verstandig A, et al. Live birth rates after varicocele embolization in patients after failed in vitro fertilization with intracytoplasmic sperm injection. Andrology. 2026;14(7):2081-2086. doi:10.1111/andr.70328
Fallara G, et al. Treatment of persistent or recurrent varicoceles: a systematic review. Eur Urol Focus. 2023;9(3):531-540. doi:10.1016/j.euf.2022.11.008
Nigri B, et al. Transfemoral versus transjugular varicocele embolization: does it affect the technical success rate and radiation exposure? J Vasc Interv Radiol. 2026;37(7):108761. doi:10.1016/j.jvir.2026.108761
Küçükay F, et al. Endovascular embolization of left-sided varicocele: outcomes by venographic anatomy and coil-adjunct strategy. J Vasc Interv Radiol. 2026;37(10):108949. doi:10.1016/j.jvir.2026.108949

Fertility

Varicocele Embolization and Male Fertility

Varicoceles are found in roughly 40 percent of men evaluated for infertility, and they are the most common correctable cause of male-factor infertility. The mechanism is temperature: pooled venous blood warms the testicle above its optimal range, impairing sperm production and damaging sperm DNA.

By eliminating the reversed flow, embolization allows testicular temperature to normalize. Published series report improvements in sperm concentration, motility, and morphology after embolization that are comparable to those achieved with surgical varicocelectomy, with similar subsequent pregnancy rates.

Timing matters for expectations. Spermatogenesis takes approximately 72 days, so semen parameters are not meaningfully reassessed until about three months after the procedure, with continued improvement often seen at six months.

The honest framing: not every man improves, and a varicocele is rarely the only variable in a couple's fertility picture. Dr. Fischman works alongside reproductive urologists and will give you a candid, evidence-based assessment based on your ultrasound and semen analysis — including telling you when embolization is unlikely to help.

The bottom line: If a varicocele is contributing to your infertility, correcting it is a one-time, non-surgical intervention that treats an underlying cause rather than working around it — and it does not preclude IVF or other treatments later if needed.

Patient Selection

Am I a Candidate for Varicocele Embolization?

Varicocele embolization is appropriate for most men with a symptomatic varicocele confirmed on ultrasound. Dr. Fischman evaluates each patient individually at Mount Sinai, reviewing imaging and clinical history — and semen analysis when fertility is the concern — before recommending any procedure.

✓

A varicocele confirmed on scrotal ultrasound with Doppler

✓

Dull scrotal aching or heaviness, worse with standing or exercise

✓

Male-factor infertility with abnormal semen parameters

✓

Documented testicular atrophy or size discrepancy on ultrasound

✓

A varicocele that has recurred after prior surgical varicocelectomy

✓

Bilateral varicoceles — both sides treated in a single session

✓

A preference to avoid surgery, general anesthesia, or a lengthy recovery

✓

Adolescents and young men with progressive testicular size discrepancy

Asymptomatic varicocele? A varicocele found incidentally that causes no pain, no testicular atrophy, and no fertility concern generally does not require treatment. Dr. Fischman will tell you when observation is the right answer.

Schedule a Consultation

Dr. Fischman's team will review your symptoms, ultrasound, and any prior treatment to determine whether varicocele embolization is right for you. Telemedicine consultations are available for patients outside New York and international patients.

Office: Mount Sinai Health System
5 East 98th Street, 12th Floor
New York, NY 10029

Phone: (212) 241-4046

Request a Consultation

Insurance: Varicocele embolization is covered by Medicare and most major insurance plans when performed for accepted indications such as scrotal pain, testicular atrophy, or male infertility. Dr. Fischman's team will handle insurance verification and prior authorization before your procedure.

Frequently Asked Questions

Common Questions About Varicocele Embolization

What is varicocele embolization?

Varicocele embolization is a minimally invasive, non-surgical treatment for varicoceles — enlarged veins in the scrotum caused by faulty valves that allow blood to flow backward and pool around the testicle. An interventional radiologist advances a thin catheter into the internal spermatic (gonadal) vein through a small puncture in the neck — or, less commonly, the groin — then closes the refluxing vein using coils, a sclerosant, or a liquid embolic agent. Blood reroutes through healthy veins immediately. There is no scrotal incision and no general anesthesia.

Is varicocele embolization as effective as surgery?

For most men, yes. In randomized trials, pregnancy rates after embolization and after surgery are similar, and meta-analyses show embolization has fewer complications and a much lower rate of hydrocele (fluid around the testicle). Microsurgical varicocelectomy has a modestly lower recurrence rate in some analyses, and the embolic agent matters: glue has shown the lowest recurrence among embolization techniques. Embolization avoids an incision and general anesthesia, and most men return to full activity within about a week. Dr. Fischman will tell you candidly if surgery is the better choice for your anatomy.

Does varicocele embolization relieve scrotal pain?

In most men, yes. In a study that followed men for a median of nearly five years, average pain fell from 5.4 to 0.3 out of 10 and 89% reported complete pain relief at one year, along with improvements in work, exercise, sleep, and sexual function. A systematic review found that every study measuring pain reported improvement after embolization. Pain usually eases over several weeks as the congested veins decompress. Dr. Fischman first confirms that the varicocele, and not another cause, is driving your pain.

Can varicocele embolization improve fertility?

Varicoceles are found in roughly 40 percent of men evaluated for infertility and are the most common correctable cause of male infertility. By eliminating the reversed venous flow that raises testicular temperature, embolization can improve sperm count, motility, and morphology. Improvement in semen parameters is typically assessed at about three months, since sperm production cycles take approximately 72 days. Not every man improves, and Dr. Fischman will review your semen analysis and ultrasound to give you a realistic assessment.

Can varicocele embolization help if IVF has not worked?

It may. In a 2026 study of 42 couples who had failed IVF with ICSI, 86% achieved a live birth after the male partner's varicocele was embolized — some naturally and some through further IVF. A varicocele can harm sperm quality in ways ICSI does not bypass. Dr. Fischman works with reproductive urologists and fertility specialists to decide whether treating the varicocele is worthwhile in your situation.

Does varicocele embolization hurt, and what is recovery like?

The procedure is performed under local anesthesia with light sedation. Patients feel pressure but not pain, and there is no scrotal incision. Most men go home the same day with a small bandage at the access site. Mild soreness or a pulling sensation for a few days is normal. Most patients return to desk work in one to two days and to full activity including exercise within about one week.

Where is the catheter inserted for varicocele embolization?

A varicocele is a venous problem, so access is through a vein rather than an artery. Dr. Fischman most often uses the internal jugular vein in the neck, which offers a direct route down into the internal spermatic (gonadal) vein and lets patients sit up and walk immediately afterward. Occasionally the femoral vein in the groin is used instead, depending on individual venous anatomy. Either way it is a single small puncture — no incision and no stitches.

Can varicocele embolization treat a varicocele that came back after surgery?

Yes. Recurrent varicocele after surgical varicocelectomy is a common indication for embolization. Because embolization uses venography to map the actual venous anatomy in real time, it can identify collateral and duplicated veins that were missed or that developed after surgery — vessels that are difficult to find through a repeat operation in scarred tissue. Embolization is often the preferred approach for post-surgical recurrence.

Is varicocele embolization covered by insurance?

Varicocele embolization is covered by Medicare and most major insurance plans when performed for accepted indications such as scrotal pain, testicular atrophy, or male infertility. Dr. Fischman's team at Mount Sinai handles insurance verification and prior authorization before your procedure.

Does Dr. Fischman see out-of-state and international patients for varicocele embolization?

Yes. Patients travel from across the United States and internationally for Dr. Fischman's expertise. Initial consultations can be conducted via telemedicine with review of your ultrasound and semen analysis, with travel to New York City for the same-day procedure. Contact (212) 241-4046 to begin.

Varicocele Embolization in NYC with Dr. Aaron Fischman