Dr. Aaron Fischman / Varicocele Embolization
A minimally invasive, same-day treatment for varicoceles causing scrotal pain, testicular atrophy, or male infertility. No scrotal incision, no general anesthesia, no stitches. Performed through a single pinhole puncture in a vein by a board-certified interventional radiologist at Mount Sinai.
Embolization Authority
130+ peer-reviewed publications; trains physicians worldwide
Mount Sinai, NYC
Leading academic IR center in New York
No Incision
A non-surgical alternative to varicocelectomy
Castle Connolly
Top Doctor — 8 Consecutive Years
Overview
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 improvements in semen parameters comparable to surgical varicocelectomy — with no incision, a lower rate of hydrocele formation, and a substantially 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
1
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.
2
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.
3
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.
4
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.
5
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.
6
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
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.
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.
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.
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
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.
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.
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.
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.
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
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.
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.
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
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.
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 ConsultationInsurance: 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
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.
Yes. Published studies show varicocele embolization achieves technical success and symptom relief comparable to surgical varicocelectomy, with similar improvements in semen parameters and pregnancy rates when performed for infertility. Embolization avoids a scrotal or inguinal incision, avoids general anesthesia, and carries a lower rate of hydrocele formation than surgery. Recovery is faster — most patients return to full activity within about a week compared with two to four weeks after surgery.
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.
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.
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.
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.
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.
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.
Schedule a consultation with Dr. Fischman at Mount Sinai, New York City — in person or via telemedicine. No incision. No general anesthesia. Home the same day.
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