Eighteen months of trying. Four semen analyses, every one of them "within normal range."
Then an IVF referral. And then, almost as an afterthought, a scrotal ultrasound that found the thing that had been there the whole time.
It could have been found in 30 seconds with a gloved hand and a cough. That exam was never offered.
Count. Motility. Morphology. Volume. The standard semen analysis is a photograph of what came out. It says nothing about the place it was made.
A varicocele is a cluster of enlarged veins in the scrotum. It is a plumbing fault in the factory, not a defect in the product. It does not appear in a sample pot.
So a man can pass every row on the report, four times over, and still have a grade 3 varicocele quietly warming the environment his sperm are built in. Many do.
This is the single most common story on UK fertility forums. He felt something. He mentioned it. He was told not to worry. He stopped thinking about it.
A decade later, trying for a baby, the ultrasound finds a grade 3 varicocele. The same one. Bigger.
Very often his wife noticed first. Very often he has never said the word out loud to anyone.
"My husband had actually gone to the GP about ten years ago. The GP said he definitely doesn't have them so we didn't give it another moments thought. Cut to ten years later, it turns out he does have a varicocele. A big one, grade 3."IMISSCOFFEE2021 · MUMSNET
"he admitted the lump or varicocele in his groin he has felt it since he was a teen! He thought it was normal! He's now 37 so I kinda worry about damage over time!"CATSNKIDSISTHEPLAN · MUMSNET
Bloods, scans, tracking, maybe a laparoscopy on her side. One sample on yours. If that sample said "normal" and nobody examined you, the exam on this page is the second test. The 90 days that follow are the part you can do.
The exam is palpation of the scrotum while you bear down. The Valsalva manoeuvre. Bearing down fills the veins, and a varicocele becomes easy to feel. Thirty seconds. Gloved hand. Done.
It is not part of a standard fertility consultation. Most men have never had it. If you want it, you will almost certainly have to ask.
A scrotal ultrasound then confirms what the hand suspects and grades it. It is not on the standard NHS fertility pathway. Privately it is around £300.
On the NHS pathway ✓
Covered ✓
Finds a varicocele ✕
On the NHS fertility pathway ✕
Offered without asking ✕
Finds a varicocele ✓
£300"I was told they wouldn't scan me for this as they're not dangerous so I told them I found a lump on my testicle and I was then sent for the scan."CHRISM1989 · MUMSNET
"I have been trying to conceive for over a year, I have a semen analysis on file, and I would like a scrotal examination with Valsalva and a referral for a scrotal ultrasound to rule out varicocele." Write it down. Bring it.
Varicocele is found in 15 to 20% of men in the general population and as much as 40% of infertile men. It is one of the most common identifiable findings in male infertility.
And yet, as one forum member was told: "the NHS won't treat varicoceles unless they're causing the man pain or discomfort. Infertility isn't considered a valid reason for treatment."
That is a gap in the pathway. Not in your biology.
of infertile men have a varicocele. 15 to 20% of all men do.
Source: Well-Life Hospital, Lagos; published prevalence reviewsFour semen analyses in eighteen months, all normal. Asked for the exam after reading about it. Grade 2 on the left. Ran the 90 days alongside the urologist's plan. Finally felt like I was doing something.
The veins that drain the testicle are supposed to carry warm blood away. When their valves fail, blood pools. The scrotum runs around 2 to 3°C warmer than sperm production needs.
Warm, stagnant blood generates reactive oxygen species. Sperm cells carry almost no antioxidant defence of their own, and they have no way to undo DNA damage once it happens.
So the damage accumulates across the full 74-day cycle it takes to build each sperm. The upstream cause is anatomical. The downstream damage is oxidative.
"His DNA frag was 52% and in our first round we got no embryos. After the op (3 months after) his DNA frag dropped to 23%."ANYONEELSEWILLDO · MUMSNET
Grade 1 is felt only during Valsalva. Grade 2 is felt without it. Grade 3 is visible through the skin. A grade 1 is often met with "not big enough to operate on, come back in six months." Only the ultrasound tells you which you have.
The two clinical routes in the UK are embolisation, a day procedure that often costs £3,000 to £5,000 privately, and microsurgical varicocelectomy. Both address the vein. Neither changes the sperm already made.
That is why the consultant says "wait 12 weeks and retest." A fresh cohort takes that long. The wait is not dead time. It is the window.
"He had the varicocele embolisation and we were told to wait 6-9 months for results. I ended up falling pregnant 3 months later (after trying for 2.5 years in total)."STBERNIE · MUMSNET
Run one full protocol through the wait your consultant has asked you to sit through. If your numbers don't move after it, you get a refund. Pause or cancel any time.
Let us be plain about what Nerelle is not. It does not shrink a varicocele. It does not replace an ultrasound, a urologist, an embolisation or an IVF cycle. If you suspect a varicocele, the first step is a clinician.
What it is: five compounds at clinical doses, built around the oxidative side of the story above, taken once a day across the same 74-day window your consultant is asking you to wait through. Alongside clinical care. Never instead of it.
Fuels the mitochondria in every sperm tail.
Carries fuel into the cell.
Protects sperm DNA from oxidative stress.
Helps build new mitochondria.
Gets the CoQ10 past your gut.
Nothing else in the capsule. That's the point.
| Waiting and hoping | Boxers, cold showers, cooling briefs | Standard NHS semen analysis | Nerelle | |
|---|---|---|---|---|
| Finds the varicocele | ✕ | ✕ | ✕cannot see a vein | ✕ask for the exam |
| Addresses the oxidative side | ✕ | Reduces heat input only | ✕ | ✓ |
| Clinical CoQ10 dose (300mg) | ✕ | ✕ | n/a | ✓ |
| Built around the 74-day cycle | ✕ | ✕ | ✕ | ✓ |
| Works alongside embolisation or surgery | ✕ | ✕ | ✕ | ✓ |
| 90-day money-back guarantee | ✕ | ✕ | ✕ | ✓ |
Two years trying. Clinic said IVF was next. Asked for the ultrasound first and it found a grade 3. Had it embolised, ran the protocol through the 12-week wait, retested. We pushed IVF back.
Not big enough to operate on, apparently. So I had six months of nothing to do. The protocol was the something. Took it every morning before work.
She told me to get it checked. I put it off six months. Bilateral grade 2. The urologist did his part. This was my part, every day, in the kitchen.
GP said don't worry. Twelve years later the scan found it. I wish someone had handed me this page back then. Ordered the three-pack the same night.
Three bottles is one full 90-day protocol, one complete sperm cycle plus the retest window. Pause or cancel any time.
STARTER
THE FULL PROTOCOL
THE COMPLETE CYCLEEvery option comes with the 90-Day Sperm-Cycle Guarantee. If your numbers don't move after a full protocol, refund. Pause or cancel any time from your account.
A scrotal ultrasound is around £300. An IVF cycle is around £5,000. Ask for the scan first, then give the protocol the full cycle. If your semen analysis numbers don't improve after 90 days, you get your money back. Full terms at trynerelle.com.
Ask for the exam. Then own the next 74 days.