Q: I am 34-year-old married male. I have slight pain in my scrotum and discomfort in my testicles. I consulted a urologist and underwent an ultrasound. The Doppler report of scrotum says: size of both testes is normal, no hydrocoele found, and mild left varicocoele. The doctor suggested a surgery. My wife is 27 years old. She stays in another city. We eagerly wish to have a child. I stayed with her for 5 days last month, which was her fertile period, but she didn't conceive. We used KY jelly as a lubricant during intercourse. I did a semen analysis, the report says: Volume: 2.1 cc; Colour: creamy white; Consistency: viscous; Reaction Ph: Alkaline; Liquefaction: After 20 minutes; Sperm count: 16,000,000 / ml; Motility: Sluggish; Viability immediately after emission: 20%; After 1 hour at 37°C: 15%; After 2 hour at 37°C: 10%; After 3 hour at 37°C: 05%; Abnormal forms: 28%; Spermatogenic cell: 3 – 4 /hpf; PN Leucocytes: 6 – 8 /hpf; Redblood cell: 1 – 2 /hpf; Remarks – Oligo – Athenospermia. What is the most recommended surgery for Varicocoele? What does my semen analysis indicate? Will my wife become pregnant with the current status of my semen? Will the surgery for varicocoele improve the quality of semen? How much time will it take? I took Gentaplex for 7 days, and tried Levitra for better erection on doctor's advice.

A:On reading your mail it gives me an impression, in your temerity to have a child you are mixing up the issues of poor erections and varicocoele leading to deficient quality of semen. These are two separate issues and we will deal with them separately. Do you have poor erections and since when? At your age this would need to be investigated and treated. In the majority of the patients the poor erections are psychological in nature but still need a thorough investigation and proper treatment. As regards to the larger issue of your fathering a child. If you have a confirmed Varicocoele it has to be operated and after the surgery it is bound to improve your semen analysis report. It may not improve your erections. As regards to what is the ideal surgery for Varicocoele, you should choose a surgeon and leave it to him. No surgeon is going to take any one's dictation, as he will do some thing, which has given him good and consistent results. About the surgery waiting for your return to India you will have to take a decision. No one knows for how long you have varicocoele? All I can say, earlier you get it done better it is. As regards to social separation with your wife on account of your job commitments again very little can be said. I do not think there is any minimum number of days one needs to have intercourse in a month to produce a child. It is a matter of chance and usually one intercourse - but the question is, which one.