Dear Dr G,

My name is Adrian and I am 32-years-old.

My wife, aged 30, and I have been married for two years and we have been trying for a baby for the last 12 months without success.

Needless to say, going back to the hometown for Chinese New Year was a bit of a torture, as all our relatives have been asking about the baby.

The reality is that we saw a fertility specialist at the end of last year.

The specialist examined my wife and told us that she was fine.

On the other hand, my sperm counts on two occasions, have not been great.

I was told I have something called OAT syndrome. This is apparently very common among men facing the problems of fertility.

I don’t understand this, as I am a healthy guy.

OK, I might be a bit on the heavy side (height 172cm and weight 96kg). I only have alcohol occasionally and smoke only half a packet of cigarettes per day.

I did an ultrasound of my testicles and the specialist told me I have something called varicocele.

This is apparently something like “a bag of worms in my pants”, “heating up my balls”, and making the sperm ill.

The specialist advised me to have an operation to get rid of the varicocele to generate a cooling effect in the pants and rejuvenate the sperm in my sac.

I hope to put Dr. G on the spot about varicocele this week. What exactly is varicocele and how did I get it?

Apart from harming my sperm, is varicocele harmful to my health?

Lastly, how will the specialist operate on my balls, and is it completely necessary?

Cannot wait to hear from you.


Infertility is defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year.

According to the World Health Organisation, about 15% of couples encounter such problem.

One in eight couples has problem attempting to conceive the first child and one in six has difficulty in having a second child.

With such prevalent statistics, one would hope the nosy uncles and aunties would mind their own business, especially during the festivity.

Of course, infertility can happen in both men and women. However, it is not common knowledge that male-associated fertility issues affect half of involuntary childless couples.

The true scale of male-factor impairment may never be known as fertile younger female partners often compensate for the fertility problems of men.

Sadly, in a third of the cases, no real etiology for male infertility is discovered. However, there is a strong association with sedentary lifestyle!

One of the identifiable causes of male infertility is varicocele. This is an abnormal enlargement of the veins in the scrotum, suppose to drain blood from the testicles back to the core body.

Varicocele is detected in 12% of the adult male population, and 25% of men with abnormal semen analysis.

In addiction, varicocele is also more common in obese individuals. The exact association between male fertility and varicocele is unknown, as men with varicocele are not necessary infertile.

The discussion of the benefits of corrective surgery of varicocele is ongoing. The 2009 Cochrane review concluded that there is no evidence of surgery improving chances of conception.

However, another meta-analysis showed semen improvement observed after surgical correction.

The rational behind the intervention indicates the cooling effect may reverse the DNA damage of sperm caused by the excess heat of varicocele in the pants.

Varicocele can be repaired by various surgical methods. This can range from minimally invasive embolisation (pieces of clots being dislodged into the veins of the testicle), sclerotherapy (injection of scarring agents into the scrotum), intra-abdominal laparoscopic ligation (keyhole operation to tie to vessels) and microsurgery varicocelectomy (using microscope to manipulate the contents of the manhood, OUCH!!!).

Although all these may reflect technological advancement to minimise complications, these are still surgical interventions on a man’s “crown jewels”, tolerating no rooms for error!

To cut or not to cut varicocele for the improvement of male fertility remains a hotly debated subject.

Sir Arthur Conan Doyle, famously known for his detective fiction featuring Sherlock Holmes, once said: “There is nothing more deceptive than an obvious fact!”

The obvious fact of many men presented with male-factor infertility is associated with smoking, alcohol, lack of exercise and obesity.

When Dr G is put on the spot for the detective work of unearthing the mystery of the dying sperm, his response is generally: “There is nothing more deceptive than a self-perceived healthy man!”

The obvious fact is that improving lifestyle should naturally ease the sperm back to its former glory, and this can also spare the poor balls the blade, for the purpose of further cooling in the pants!


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