24/02/2026
Is it necessary to check for fertility status before marriage?
A young man walks into the hospital requesting a fertility assessment. He is unmarried, not under pressure to have children, and has no reason to suspect any problem. He simply wants clarity about his reproductive health, and he wants it early. Routine evaluation reveals a left sided varicocele, one of the most common and most treatable causes of male infertility. His semen analysis shows a s***m count lower than expected for his age. In a society where male fertility is rarely discussed until there is a problem, that proactive decision alone was significant.
When couples struggle to achieve pregnancy, especially in Africa, the blame is often placed on the woman. This is both unfair and medically inaccurate. Research shows that 40 to 50 percent of infertility cases are due to male factors, either alone or combined with female factors. Despite this, men are seldom assessed early, and many only seek evaluation after years of unsuccessful attempts at conception.
More young men are beginning to take responsibility by assessing their fertility status even before marriage. Hospitals are now seeing men who want answers long before they settle down. One of the most frequent and readily treatable findings during these evaluations is varicoceles.
Varicoceles are enlarged veins surrounding the te**is. Many men have no symptoms and remain unaware of the condition without proper examination. In some cases, however, there may be a dull ache in the te**is, particularly on the left side, sometimes radiating to the groin. If untreated, impaired blood flow can gradually cause the te**is to shrink. Testicular size reflects function. A healthy, functional te**is is usually fuller in size, while a small, atrophic te**is is often poorly functional. Varicoceles damage the germinal epithelium, the tissue responsible for s***m production. Within the seminiferous tubules, cells divide rapidly to produce millions of s***m daily. Rapidly dividing cells, whether in the te**is, hair, or blood, are highly sensitive to changes in blood supply. Even minor impairment can significantly affect them. Over time, s***m production declines, leading to low s***m count and infertility. For this reason, varicoceles are considered one of the most important reversible causes of male infertility.
This raises a simple question: should individuals wait until marriage, or should men see a urologist and women see a gynaecologist earlier to assess their reproductive health? From a medical standpoint, marital status is irrelevant. When a varicocele is linked to abnormal or declining semen parameters, postponing treatment offers no advantage and may allow progressive testicular damage. Waiting until fertility is compromised reduces available options. Moreover, no one can predict exactly when marriage will happen.
Symptomatic varicoceles require attention and should not be ignored. A semen analysis establishes a baseline for s***m count and quality and should be monitored over time. Even asymptomatic varicoceles that are already affecting s***m parameters deserve treatment. Men with low or borderline s***m counts have limited room for delay and face a higher risk of further decline if follow up or intervention is postponed.
What makes this case noteworthy is not merely the diagnosis, but the timing. This was not a man seeking help because of infertility. It was a man who chose early evaluation, understanding that reproductive potential, once lost, is not always regained.
We offered him laparoscopic varicocelectomy, and his s***m count has already improved. Most patients who had been married for many years without children, and only later realised that urologists are the appropriate specialists to manage male reproductive problems, achieved pregnancy just three months after varicocelectomy. S***m production, from beginning to end of the cycle, takes 86 days.
In some cases, we have operated on university students who later graduated, got married, and returned to share the joyful news of the children they now have.
