In the UK 25% of fertility problems are due to male factor alone. There are many reasons for male infertility and not always are these causes clear. However we do know that the following can cause male infertility:

• Hormone imbalance, such as hypogonadism (reduced hormone production)
• Genetic problems
• Undescended testicles as a baby
• Structural problems – previous trauma or illness, or the tubes carrying sperm being absent from birth
• Infection such as chlamydia, gonorrhoea or prostatitis (infection of the prostate gland)
• Varicoceles (enlarged veins in the testicles)
• Previous surgery to the testicles or hernia repairs
• Overheating of the testicles – sometimes due to occupation or lifestyle
• Excessive alcohol consumption, smoking and using drugs such as marijuana or cocaine
• Certain medications, including testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some antibiotics and some antidepressants

Unfortunately in the UK we are not very good at investigating the reasons why a man may have a poor sperm count and even worse at treating the problem. We are very quick to recommend that the couple go straight for assisted conception without addressing why there may be a male fertility factor in the first place.

What is a varicocele?

A varicocele is present in approximately 15% of men suffering from infertility and is therefore a major cause of male infertility. A varicocele is a cluster of enlarged veins in the testes, similar to varicose veins in the legs. It is more common to have a varicocele in the left teste than the right. It may be apparent that one teste is larger than the other. Pain may or may not be experienced and the teste may feel like ‘a bag of worms’.

How is a varicocele diagnosed?

Often the man or his partner may identify a problem. This concern should be discussed with a doctor and the doctor will examine the testes and if necessary refer for an ultrasound scan of the testes. This is especially important if a previous semen analysis has been abnormal. You can read more about sperm tests here.

How is a varicocele treated?

Treatment for a varicocele is to have a surgical repair. In the UK this treatment is not currently recommended by NICE (2012), but is performed in some areas. Research has shown that semen analysis improved significantly 3-12 months after a varicocele repair (Esteves et al. 2012), however as yet this research has not be recognised by NICE. Unfortunately there is a long waiting list for this surgery, which may not be acceptable to the couple, and therefore seeking treatment privately may be the preferred option.

Male fertility - what is a varicocele?


NICE (2012) Available at:!scenario (Accessed: 7 February 2017).

Esteves, S.C., Zini, A., Aziz, N., Alvarez, J.G., Sabanegh, E.S. and Agarwal, A. (2012) ‘Critical appraisal of world health organization’s new reference values for human semen characteristics and effect on diagnosis and treatment of Subfertile men’, Urology, 79(1), pp. 16–22. doi: 10.1016/j.urology.2011.08.003.