Varicocele treatment or straight to IVF/ICSI?

[HayMay]

Hello,

Just wondered If any of you had partners who have seen a dramatic increase in SA results following treatment of a varicocele? My partner has had an ultrasound today and they measured one to be 3mm ish and I think he had a small one in the right side too. Mr Ramsay suggested IVF/ICSI and maybe a varicocele treatment but did imply it’s unlikely to get the numbers up to where they need to be for natural pregnancy but that it would help with ICSI nonetheless.

It came as a bit of a surprise: so trying to process it mentally and not sure where to go next.. I’ve not researched ICSI properly yet as we always hoped the anastrazole would help and whilst there has been a small increase, it’s nothing massive. He has been prescribed 3 months more and to take one every day from now. His total motile sperm count is c2m. Morphology and count really low, motility ok.

Just can’t decide whether a varicocele treatment could help us get pregnant naturally or if I’m just holding on to hope and it would be a waste of money so might as well head straight for ICSI?? Feel so flat. Any advice welcomed! Thank you xx

@Hithere22 It was £6k which I know is more expensive than others 🤢🤢.
He had one 5mm varicocele & they put 3 coils in there & some agent.
Today, he's got some lower back pain from it and is a little sore around the entry point from the catheter.
It was so simple, fast & straightforward that I'm finding it hard to believe it'll work right now. Honestly, the amount of times I've been prodded and opened up - everything seemed so complicated before.
If this works, I'm literally gonna tell anyone struggling to get their partners balls checked!

@Hithere22 they improved but not anywhere near enough for natural conception. So I think original count was around 1-2mil and it went up to 9mil and DNA frag went from >52% to 25%.

we did use the time to get in the best shape of our lives!!! We started making AA embryos after this and welcomed a little girl earlier in the summer.

Really helpful both in setting my expectations but also in terms of the positive impact/outcome on your journey! Congrats!!

Do you know how big your partners varicoceles were? My partners is 3.3mm on right and 2.2mm on the left - he will be having double embolisation xx

Hi all, we were also referred to dr Ramsey but unfortunately he is fully booked until mid November so we decided to see another specialist. It is very encouraging the success is possible to be achieved after the embolision. Our ICSI failed twice, 1st resulting in a miscarriage and 2nd no embryos developed to day 5. Really hoping for my partner’s SA to be fixed soon as I am 40 and have no time to wait and try various treatments. Will be good to get more info on quotes that you may have obtained from other clinics. Thanks for all your info as we are on the same boat.

@HayMay @Beyondshit @CocoPocoLoco @JeanieJ @TimetoChangeClinics @K8dferXdder @daisyrosebuttercup @PopcornPaz

having a hopeless evening this evening. Period on the way. DH did another SA today and they said they would post results on a portal within an hour.. no results posted but two missed calls from the clinic. By the time we saw the calls, the clinic was closed. Refusal to post results and wanting to call instead can only mean bad results. Do you agree? I was really hoping for at the very least a bad sample… zero sperm in his first and I was holding out hope that this was a dodgey test.

booked in with Ramsay in January. Really want to get to the root of the problem and treat the varicoceles. The thought of never being able to conceive is word shattering to me.

I also listened to a podcast where the guy went through a TESE and it didn’t work but he no longer produces testosterone and it breaks my heart thinking I’ll put my DH through something like that.

Hi @IslaO, I never dealt with a clinic that has a portal, mine are more primitive, so I can’t tell but please wait until tomorrow to find out what the call was all about. I am sure Ramsey will have a solution for you, he is a great professional so you will be in good hands. We are also waiting for our appointment with Tet Yap and taking vitamins in between. Has your hubby ever had hormones blood tests done? Prolactin, FSH, LH etc? Has he had the ultrasound and have they found why he produces little? I know sometimes they send them to MRI etc so hopefully the root cause will be found and with the appropriate treatment you will get success.
Our doctor said we can freeze multiple samples and use that towards an IMSI cycle which we never thought about. So doctors do have solutions. Fingers crossed for you and let us know the result tomorrow.
My hubby was previously on Clomiphene and it helped a bit so there is hope, there are treatments available!

Hi @IslaO , how are you doing?

@TimetoChangeClinics sorry, just seeing this. Away at the moment and taking a much needed mental break from things which has been nice! Going home tomorrow and starting to overthink again 😂 how are you doing??

@Hithere22 @JeanieJ any updates on your DPs varicocele treatment?

We were diagnosed with azoospermia officially (second SA) in September. DP has some epididymis cysts and a varicocele.

We have an appt with Ireland’s version of Dr Ramsay in December and Dr Ramsay himself in January.

The waiting is killing me- I have up and down days. Some days I am positive, some days I lose hope. DP has said he is completely closed off to the option of sperm donor if we can retrieve any sperm. Closing the door on options is unthinkable for me but trying not to jump 20 steps ahead.

after much reading up, I’m thinking we will push for varicocele treatment and then see where we are at. I’ve read that this can sometimes lead to sperm in the ejaculate which would be the ideal outcome, avoiding any SSR. I wonder how likely this is? I would love to know how you ladies are getting on as you are further down the line than I am.

sending lots of love- what a shit journey for all of us! Xx

@IslaO no update yet. Dr R said to not expect results for at least 3 months & it's only been a month for us. We did try this month, but I don't think I'll get a BFP.
We're gonna try ICSI in Feb if we don't get a BFP beforehand.

I'm sorry you're having such a tough time - it's crap isn't it?
I started feeling a bit better about everything after OH got his embolization because I feel liked we have a plan now.
You're making the right choices right now & I think not ruling anything out is good, perhaps your DP just needs time to process. I know my OH is kinda against donor sperm too, so I'm hoping we don't get to this point 🤞🏻

Hi all,

I just wanted to share our experience of varicocele / embolisation as I found it really hard to find any before/after results anywhere.

My husband's SA ranged from around 1mil/ml to 5mil/ml with approx. 15 - 20% motility and poor morphology (0% - 2%). We decided to go ahead with the varicocele embolisation as Mr Ramsey thought that it was worth a try due to the size of the varicocele (found out on the day of the embolisation that it was a bilateral varicocele so the consultant worked on both sides). The operation was in late May this year and we've had a lot of boozy events, so definitely haven't been working very hard on the lifestyle side of things. My husband has noticed that the volume of semen has been much higher (Sorry, TMI!) and we've also noticed that his legs have been getting hairier etc, which we think is probably an increase in testosterone, but indicated that something was happening.

We are booked in for a repeat SA in a few weeks, but in the meantime bought an at home sperm test which we tried out yesterday - we were really happy with the results - his sperm count is now 25 mil/ml (finally in the normal range!!!) which with the larger volume means approx. 90 million in total! His motility seems to have decreased, but we're not sure that's correct, so have asked the question on the app. But total motile sperm count is now also in the normal range...

The count / motility is still not ideal (and we don't know about morphology or DNA frag), but I think now with some lifestyle improvements etc we can probably increase that over the next few months.
We're still having consultations for ICSI, but it feels like there is at least a bit more hope now! I'll update when we have the proper SA results back form the clinic.

Hope this is helpful...

@staystill this is amazing and so great to hear the embolization can have such positive results! absolutely delighted for you both!

when you mention he has noticed an increase in volume, that’s really hit home. In the last year or so my DP has really noticed a decrease in overall volume and (again, TMI) at the point of climax, he feels he has reached it but says he isn’t sure if he felt much come out. This has been really frustrating for me when we were TTC and I didn’t know if it was all in his head/him putting pressure on himself but actually, it could be related to his varicocele and epididymis cysts!

how did your DP find the recovery from
the embolization??

please keep us posted on next results!

@IslaO Thank you! We weren't really sure what to expect in terms of results as have heard very varied things, but I was cautiously optimistic as I've been obsessively reading varicocele results stories on Reddit 😬.

I'm glad you're seeing Mr Ramsey in January, really hope that's helpful for you. That's interesting what you said about your DP's volume, I hadn't read it was a side effect of the varicocele but it was definitely one of the first things my husband reported as a noticeable change. Fingers crossed that's part of the problem for your DP and can be sorted with embolisation, if you go for it!

In terms of recovery, we were a bit worried for a while as my husband hadn't really had any major pain before the varicocele was diagnosed but a few months after the embolisation it became quite painful... he went back for an ultrasound and xray and they said it was all still looking good and that it could be something to do with exercise/the heat of the summer and should go away. It seems like it's been much better for around a month. The consultant said pain afterwards is very very rare though (1% or less) and I haven't read many other people saying it, so think he's just an anomaly!

I'll keep you updated on the proper SA results!

Hi everyone. Hope you don’t mind me joining the thread. Just wondered if anyone has any advice…. My husband and I have been TTC for around 1.5 years. We already have children, conceived without issue. We’ve had lots of test including a couple of SA. The first was perfectly fine but the most recent wasn’t, with concentration, motility and morphology all below the WHO reference levels. My husband had a couple of SA a few years ago too and the results of these were completely normal so not sure if this was just a bad test?!

I also just wondered if anyone had any advice in terms of lifestyle changes or anything else they’ve done to improve sperm count and quality and if anyone knows if epididymal cyst can negatively impact? I don’t think varicocele can be the issue as he had an ultrasound a few years back and the cysts were the only abnormalities noted and I know varicoceles seem to develop in puberty

@staystill - those are great results! 🙂🙂
My DH got the embolization in mid Sept & we've already noticed a difference in volume.
We're still early days & not expecting to get 🤰 soon, but I'm feeling really hopeful 🤞🏻

@Anonbaby - deffo worth seeing a urologist for more investigations.

When we spoke to J Ram about lifestyle changes, he said they were a bit pointless if we didn't get the varicocele sorted.
Now, since he's had the embolization, DH is on 'project good sperm' (😂). He's not drinking, doing more swimming, taken up yoga & is being a bit more careful about what he eats (we're pescatarian). He's also taking some supplements.
xx

@JeanieJ thanks for replying. As far as we are aware he doesn’t have a varicocele. He didn’t have it 4 years ago anyway and online it says they appear in puberty so I’m guessing the chance of him having one is pretty slim.

it feels like it’s either a one off bad test or something has changed drastically within the last 12 months since we have 2 children and a year ago the results were fine.

did mr Ramsay recommend proxeed or any specific supplements?

Would love to know if having the surgery helped sperm count? My partner has a varoceile and low sperm count (something like 1million per ml). When the consultant spoke to us about having the operation he said it wouldn't make much difference in terms of sperm count (or it may make a minimal difference. We only found out this was the reason when I was pregnant so maybe that's why they didn't encourage him to get the operation done.
We had ICSI to get pregnant, I got 17 eggs, only 7 fertilised and out of that 7 we got a good quality blastocyst which was implanted. He's now 10 months old! Just wanted to give a bit of hope but also following the thread as we would like to try again in a year or so for a second but unsure whether to consider the surgery or not. Not sure I could put myself through ivf again.

@JeanieJ interesting that you noticed the change in volume too! I Googled it, but couldn't see anyone else mention it. Hopefully it means that things are happening!

My DH is taking Impryl at the moment, but I'm going to do some more research into other things to take as well, is there anything you'd recommend? Apparently L Carnitine and Omega 3 are meant to be good... and a teaspoonful of organic tomato puree everyday 😅.

@lottie198 if you look at my first post you can see the change in my husband's count (5mil/ml at best pre-varicocele to 25mil/ml post varicocele embolisation and increased volume so overall count was much better, but we haven't had morphology or DNA fragmentation etc looked at since the embolisation) - we're hoping with lifestyle changes and a bit more time we might be able to improve it more.

I think it really depends on the size of the varicocele and how long it's been there... my husband's was very large on one side and he also had a smaller on on the other side. To some extent I think if it's been there quite a while then some damage is irreversible even with embolisation, but it definitely seems to have helped us a bit!

It would probably be worth getting an appointment with Jonathan Ramsey, if you haven't already seen him.

@Anonbaby - has your husband had covid recently (in the last 3 months)? I've read a lot about it reducing some men's sperm count to nearly 0 even if it was previously normal.

@staystill he was really ill early June but didn’t do a covid test. He was in bed for a week. That’s like almost 5 months between then and his most recent SA. I did actually speak to an embryologist online randomly and she said it can impact for 3-6 months but I don’t know. It seems a long time doesn’t it?!

@Anonbaby it does seem a really long time, but I guess it's possible if his sperm count has always been normal before? Hard to imagine what else it could be to change it so dramatically... Is your husband going to get another test done? I

@Anonbaby yes he will. Basically we were all ready to start IVF then based on this result they said it would have to be ICSI. We aren’t keen on ICSI so now just feeling like it’s not going to happen again for us.

I mean, regardless of the result this time, it wasn’t happening a year ago when the SA result was normal so I can’t help but feel like there may be an issue on my side which they haven’t identified.

i just don’t know what to do. What I want to do is think I already have two beautiful children and if it happens again great, if not never mind. But it doesn’t work like that does it! It never leaves my head xx

@Anonbaby can I ask why you guys are not keen on ICSI? No judgement but I think this may be our only option so wondering about the pitfalls? X

I personally would do ICSI even IMSI again as it has given us great fertilisation rates unfortunately with no positive outcome yet.
however I know it is the most invasive method and I feel bad that it doesn’t happen naturally and instead of nature controlling the selection process, a human does it.
as I said personally I have not much issue with it but would have been very happy if it happened the natural way as it should.
hope my comment is not offensive to anyone, we are all on the same boat :)

Just joining this to follow your various updates. After two rounds of failed ICSI and 5 embryos (3 good blasts, 2 non-blasts from a terrible second round) I think we will try the varicocele embolisation because we're running out of options. Will spend the next few months getting fit and healthy and taking all the supplements too, but I'm interested to hear if anyone's DNA frag and motility improved post-embolisation.

Hi! Just back with an update on numbers, as promised...

The at home (Exseed) sperm test 'team' reviewed our previous result and upped the motility slightly but reduced the count to 18.5million/ml (it meant the overall motile sperm count stayed the same, which was still in normal range).

Next we had the NHS semen analysis, which was done at the start of December. This came back as 14million/ml with 24% motility and 2% morphology - a bit disappointing at the time as we were hoping for more improvement. Still bearing in mind, as I said in my previous post, my husband had a boozy summer/autumn - so expect this is still having some effect.

Since the last semen analysis (2nd Dec) he's been taking all the supplements recommended in It Starts With the Egg and cut down on alcohol. We tried the at home sperm test again on Friday and the count has increased again to 36million/ml (verified by their medical team), over 100 million in total - I think it's reasonably accurate as you can see a video of the sperm and I'd estimate that they're approx. double their numbers at the end of November). Motility still around 20%, but I'm hoping that will improve 3 months on from making the lifestyle changes.

Not sure if vitamins can actually make any difference to the sperm within a month? Or I guess it could it be the effect of the embolisation still improving things slowly, or just a natural fluctuation... who knows! Key for me is that it seems to be continuing to improve, especially as his first test was around 1million/ml.

Sorry, very longwinded post, but hope it makes sense!

@staystill thats great that it’s moving in the right direction. What feedback were you given after the NHS test?