Q: I have mild varicocoele in the left scrotum. On seeing the results of my doppler test, my urologist advised that it is a minor problem. He said that if the problem was tolerable, then I need not undergo surgery. I have visited many websites and found that if it is left untreated, it can destroy the sperm and reduce the size of the scrotum. Many sites state that a smaller scrotum may result in lesser sperm and might create a problem to become a father. Sometimes, I feel some pain in the left abdomen. What should I do about the problem?

A:Varicocoele is dilatation and tortuosity with pooling of blood in veins within the pempeniform plexus (cord connecting the testis) while standing, occurring due to defective valves in long gonadal veins allowing the blood to flow in the reverse direction. Varicocoele can be documented in up to 15% of normal young males with normal fertility, and in 20 to 25% young males with poor semen quality. You must be clear in your mind that varicocoele and male infertility do not have a direct cause and effect relationship. American Society of Reproductive Medicine (2006) recommends that surgery for varicocoele should be offered only if: 1. Varicocoele is palpable on physical examination of the scrotum (not merely on a doppler examination) 2. The couple has known infertility (you have not disclosed your facts) 3. The female partner has normal fertility or a potentially treatable cause of infertility 4. The male partner has abnormal semen parameters or abnormal results from sperm function tests (you have not provided the results, or have not got these done). Varicocoele treatment for infertility is not indicated in patients with either normal semen quality or a subclinical varicocoele. It is recommended to follow such patients with yearly semen analysis and offer surgery only when a defect has been documented. You have rightly read about smaller sized testis being an indication for surgery if associated with varicocoele, a recommendation in adolescent males. Even the latter indication is when small testis is documented, and not done prophylactically.