When a couple struggles to conceive, the woman usually gets scans, blood tests and a lot of questions. The man often gets one thing: a semen sample in a pot. Almost nobody puts a hand on him and checks what is going on.
That is a problem, because one of the most common and most treatable reasons for poor sperm quality can only be found by examining him.
What a varicocele is
A varicocele is an enlarged vein in the scrotum, a bit like a varicose vein in the leg. It sits above the testicle and you usually can't see it. Most men with one have no pain and no idea it's there.
It matters because blood pooling in that vein can raise the temperature around the testicle. Sperm are made best at a temperature a little below normal body heat, which is why the testicles sit outside the body in the first place. Extra warmth can slow down production and affect how well the sperm develop.
How common it is
About 15% of men have a varicocele. Among men whose semen analysis comes back abnormal, the figure is around 40%. So if his numbers are low, this is one of the first things worth ruling out. It is also found in men whose results look fine on paper, which is part of why "normal" doesn't always close the case.
Not every varicocele affects fertility, and not every man needs treatment. But you can't make that decision if nobody has looked.
How it's found
A doctor can check by examining him standing up, sometimes asking him to bear down. If something is felt, or if the picture still doesn't make sense, a scrotal ultrasound can confirm it. It is quick and painless.
The current NICE fertility guideline says to consider treatment for a varicocele in some situations, so it is a recognised part of the conversation, and it is reasonable to ask for it.
What to do if you suspect one
You don't have to wait for a specialist to raise it. You can ask your GP directly: "Has he been examined for a varicocele?" If the answer is no, ask for that to happen.
If one is found, the next step is a conversation about whether it needs treatment or whether lifestyle changes and time are the better first move. That decision depends on his results, his age and how long you have been trying, and treatment is not a guarantee. A GP or urologist can talk you through it.
What else is worth asking about
A varicocele is only one item on the list. His hormones, past illnesses, medicines, injuries and childhood history can all matter too. Knowing which questions to ask, and what each answer means, is what changes a vague "everything looks fine" into a plan.
That is what my guide for men, Don't Accept "Fine", is built around. It includes a section on varicocele and the other physical causes, the exact wording to use with your GP, and a checklist to take to the appointment.
Get Don't Accept "Fine" for £6.99
This post is general education and does not replace medical advice.