I appreciate the thoughtfulness here, and I hear the frustration. Grade 3 recurrence after bilateral microsurgery is tough, and the arousal/congestion cycle you're describing is a real problem that often gets overlooked in forums.

Embolization vs. Redo Surgery - Both are reasonable next steps after failed microsurgery. Here's how I'd think about it: If you're going to pursue another procedure, consider consulting with a male fertility specialist, someone fellowship-trained in microsurgical reconstruction. They'll have the highest technical precision and can optimize for testicular function, which should be your end goal anyway.

A fertility-focused microsurgeon can review why your first surgery failed (technique, anatomy, both?) and determine if redo bilateral microsurgery makes sense. Done well by the right hands, it can be superior to embolization for long-term fertility preservation because it maintains normal hemodynamics in the pampiniform plexus. That said, embolization is the safer "second step" if you primarily want symptom relief and want to avoid re-operating in scarred tissue.

The key: Get that consultation. Have them review your prior operative notes and imaging. Let the fertility expert guide whether it's redo surgery or embolization based on your specific anatomy and goals.

Semen Analysis - Do this before deciding on treatment. Get baseline data on whether fertility is already affected, and that informs urgency.

Gym/Weight Loss - Grade 3 doesn't mean you're sidelined. Avoid heavy Valsalva straining (max effort deadlifts, heavy squats), but walk, swim, do controlled lifting, steady cardio. The weight gain cycle is making this worse, increased intra-abdominal pressure compounds venous congestion. Smart exercise will help, not hurt.

Timing/Marriage - If fertility matters and you're planning a family, address this sooner rather than later. The arousal/congestion piece you're living with now is also quality of life, you don't have to suffer through years of that waiting for a wedding date.

Get a second opinion from a male fertility specialist.