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

@staystill thank you for updating. Can I ask if both of your husband's varicocele's were embolised? My DH has one and we think it's small. We have an appointment in Jan and another in Feb to hopefully get to the bottom of whether it could be causing issues or if it's maybe hormonal. Our issue isn't count as much as it is general vitality/motility being very poor.

@Anonbaby - we haven't been given any feedback, I think because we're not eligible for IVF on the NHS in our area, so they've pretty much leaving us to our own devices from this point on...

@thislittlebird - on the scan they'd only seen one varicocele (think they said it was 'significant' and the highest grade), but when my husband got there on the day of the embolisation they saw there was a smaller one on the other side, so they did both. From what I've read (I could be wrong), it seems like the longer the varicocele is there the more irreversible damage it can cause and my husband said he's had some dull pain since he was a teenager (38 now), which could be a reason his numbers haven't gone totally back to normal.

This is great feedback. Thanks.

My partner goes to get his NHS semen analysis results this afternoon, it will be just short of 3 months since his double varicocele embolisation. He has extremely low numbers across the board...

We did an Exseed at home test in December which showed some improvement but always nervous about the results until we have the NHS results this afternoon as Mr Ramsey said he doesn't trust the Exseed results, however, having looked at the videos, I do think/hope that there is an increase...

My partner has also been taking Impryl, anastrazole (prescribed by Mr Ramsey) omega 3 and vitamin d - I think I need to revisit it starts with the egg to see what else is in there for him. To be honest, although he as active/fit - our diet hasn't been the best lately for a number of reasons.

Your improvements have been fab - are you trying naturally still? What's your next step?

We didn't know whether to try IUI although know success is quite low.. I think I'm delaying the inevitable!

Will see how this afternoon goes and keep you updated! For reference/comparison, I have included a summary of my partners results (not exseed, but just NHS or Mr Ramsey) - I will update later too...

Thanks for posting, really reassuring/promising for the rest of us trawling these threads.

Best wishes x

Hey @hopefullyoneday22

Fingers crossed for your the results from today - can you let us know how it goes? Anecdotally, it does seem like the results continue to improve, so don't be too disheartened if there's not as much change as you hoped.

I'm not really sure what to think about the Exseed results, like I said, it's quite clear to see on the videos that there are way more sperm now than the start of December (and in December there were way more than the end of Sept), but I'm not sure their motility numbers are always correct etc... I like the fact that they manually verify each of the results though, which feels like it's more accurate.

Thanks for posting your partner's numbers - some of those morphology and motility numbers are really good!

Out of interest, how did the recent Exseed results compare?

Next steps for us... we're thinking ICSI in March/April as I'm gonna be 38 in a few months and even with the improvement in numbers our chances without IVF are still reasonably low, I guess (especially as I have "mild" PCOS). We'll keep trying for now though, just incase... Kind of just want to get on with the IVF as I just can't bear the idea of having to think about sperm counts and supplements for another 3 years!

In terms of the supplements, we started off with Impryl but didn't feel like it had enough of the crucial stuff in it (and read you're not meant to take anything else with it). If your partner is up for taking loads of extra pills I can PM you a list of the supplements we've got/been recommended?

Take care.

Thanks for responding!

I've attached the exseed results, but we've had issues with them before and upon messaging them; they did say some of the results seemed to have over calculated (even after being verified) due to a slight nudge in camera and the results have often varied quite significantly to the NHS ones (in terms of motility and count) but the TMSC has been in the same ish range! Will definitely keep you updated later today. I think todays results will help us think about next steps.

I am just drained with it all to be honest - hard to just keep waiting without being proactive. The wait for any update/referral etc on the NHS has been sadly painful - been going through it almost a year now and no further forward - constantly having to chase; lost blood tests, I could go on! I know how busy they are it's just every month feels like a lifetime doesn't it?!

Happy for you to PM although I'll need to look where to find them haha

Sounds like you've got a good plan and something to focus on which helps! x

@hopefullyoneday22 your partners results clearly show how much natural variation there is in terms of SA don’t they. Particularly with motility and morphology!

Absolutely - the first test was a really long absistence (probably too long for it to be reliable) so we think that might have impacted things and then the last test would have been impacted maybe by my partner taking anastrazole. The rest have been with a consistent 2-3 day absistence period.

My partner also has covid in December 2021 which might have impacted things - Mr Ramsey said he is seeing that more and more and can impact up to 6 months apparently.

It's so difficult to know what you did 3 months ago that worked and is impacting numbers now isn't it?!! I'm sure another rollercoaster when we get the results today.... fingers crossed xx

@hopefullyoneday22 yes definitely. So we have two children conceived without issue really. Second took 8 months so we did have some SA done and they were both fine. We’ve been trying for a third coming up to 2 years. We have been to two different clinics and one SA was fine, everything above the thresholds. Second clinic, everything was below and they’ve said that’s the reason we can’t conceive but I don’t feel convinced because previous results have been fine and as your results show, things can change dramatically from test to test so I’m not sure. If it’s not that then we have unexplained secondary infertility

@hopefullyoneday22 whah is anastrozole? We also spoke to dr ramsay over email and he told us about covid and also about how too many different supplements can over oxidise the sperm so we are just on proxeed now

Really hoping for you that the results from today match (or are even better than) the improvement from the last Exceed test!

Yeah, we said that if there wasn't a massive improvement in the December NHS test that we'd go for IVF... although that's a route I've really been putting off (not sure why really... money, loads of meds, pressure?!)

I feel your pain... I've been having tests since the start of covid and we're still no further along, 3 years later.

I've never sent a PM either, will see if I can figure it out! 😆

It's prescribed - I'm not actually too sure what it does but originally it was to help clear up any infection following covid - Mr R said it would help get a sperm 'back to where it was pre covid' but he has been on it since too.. I often see men on some of the fb groups taking anastrazole and clomid.

It's such a minefield isn't it?!

I'm not sure if I have PCOS or not - I've had day 21 tests which confirmed ovulation and an ultrasound and no cysts were picked up but I am overweight and get the odd few chin and upper lip hairs.. although I always just thought that was normal I have a short luteal phase too.. reading really contradictory stuff on this.

My previous hormone tests were ok but I had low SHBG which I think is linked to PCOS too.. hmm...?!

x

@staystill - thank you! Yes we keep saying "if things don't improve by x then we'll get a consultation re ivf" etc - it's good to have a plan as I'm worried the years will pass me by otherwise and I'll hold on to hope and then leave it too late!

It's so hard to know what to do isn't it? I've also struggled with all of those feelings re ivf + more. None of my friends have gone through this and it's difficult to talk about isn't it?

My partner has just left for his appt.. yikes x

PS - hmm that's difficult having 2 different sets of results - was there much difference between them both? Did your partner have covid or a fever that could have temporarily impacted the results do you think?

Presuming you've had all your tests done too? Fingers crossed for you! xx

@hopefullyoneday22 he potentially had covid end May (we didn’t test though) and this result was Oct so it was pushing it a bit being 5 months later. But I do just think tests change from month to month and from test to test. We have children and previous tests have been okay. I’ve had tests and everything is normal but my gut feeling is it’s more female than male. Maybe age, previous c section. I just don’t know x

@staystill

Absolutely gutted to say it's taken a nose dive and got much worse.. like halved from the previous professional test 😭 I'm just so confused....

The exseed test we did on 19/12 showed improvement and although it was Exseed - it was evidently better on the video. How can it have actually got worse overall?!!! Like halved?

In massive panic mode now and don't know what to do. It's so hard as I don't want my partner to feel even worse than he does by seeing me upset - I've had to come for a bath so he doesn't see how upset I am.

xx

Oh no :( really really sorry to hear this - fully understand how gutting it is when the results are not what you expected.

I don't get how it could be so different on Exseed 3 weeks ago.... like you said, it's quite clear to see on the videos whether there are more or less there...

Did you say it's hasn't quite been a full 3 months since the embolisation? I have read a few people say they don't see much change for 6 months (on reddit, I think)

(just sent you a PM by the way - not sure if it will work!)

@hopefullyoneday22 try not to panic, it can take 6 months for sperm to regenerate or whatever the process is they go through. 3 months probably isn't enough to gauge an improvement. If you look on reddit sub r/maleinfertility you might see some examples people have given of the eventual improvement. Afaik some men can have zero sperm after a varicocele removal and then it improves.

Thanks so much! I'll have a look on Reddit. Reacted really badly today and wasn't expecting to!

Thanks again x

And it really is up to 6 months, my DH had covid in April and a wisdom tooth removal infection in October and it screwed our November IVF round. We now have to wait 6 months probably (and get past another wisdom tooth removal) before it will have a chance to repair and we can try again. If he has his varicocele removed back to square one we'll go again. Do not pass go etc etc.

@hopefullyoneday22 I'm really sorry that the results aren't what you wanted, especially after all the effort you've made.
Perhaps it just needs a little more time?

@thislittlebird did your husband have an infection from his wisdom tooth?

My DH just finished 5 day course on antibiotics as a preventative measure with his wisdom tooth. He wasn't infected, but it was in case because it was hurting him as it was growing. I've been spiraling about the antibiotics feeling like they're gonna muck up our ICSI cycle in 6 weeks 😵‍💫😵‍💫😵‍💫

@JeanieJ he had one out, they gave him antibiotics but it wasn’t enough, he ended up in bed with a fever and then I had to go and collect more for him. Did your DH have his out? Mine has to have another out yet.

Tbh i would probably do a SA on your husband before going ahead with that cycle to check if it has done any damage. It’s really not worth mucking it up if it has impacted his sperm, which it did for us and I wish we’d thought about it and checked. We’ve basically flushed 7k down the drain.

To be clear: I don’t think the antibiotics harmed him, I think the infection and fever did.

@thislittlebird no, it's not come out & he hasn't had an infection or fever.
Basically it's coming through & was hurting his gums, so the dentist gave him some antibiotics as a preventative measure against infection.

He just did a pre IVF SA on Sat which was day 2.5 of Antibiotics & he finished the course yesterday. I'm hoping if there was an issue, we can see it on his sample 🙏🏻

I'm so paranoid about him picking up bugs & infections. He's a teacher and always come home with some sniffle from the kids. His sinuses have been blocked for months 🙄.

He thinks ICSI will override any potential issues, but I'm not confident. He had high dna frag from the varicocele which was embolised in Sept. all his other parameters are normal, so he's confident, but I'm just so wary.

Hi all, not sure if anyone is still on this thread but looking for some advice, please. We have MFI and my husbands numbers are v.poor (less than 1mil) so no chance of a natural conception as it stands (spent too many deluded years trying!).

I'm currently pregnant after ICSI which I'm so grateful for, but if we want to have more children in future, we have two options to try...

1. More embryo transfers (some in the freezer, thankfully) or

1. We attempt varicocele surgery. He has been diagnosed with one on both sides - double whammy - and on top of this, the consultant said his "abnormally small" testicles were probably a factor too.

In this case, is it even worth attempting surgery? Does anyone have experience with a double varicocele + such low numbers and a successful surgery outcome? By successful, I mean no need for IVF... Thank you!

Congratulations on your pregnancy first. I don’t have experience in what you are asking but we did embolisation for my partner, he had only on the left side. We are yet to see his semen test results after the procedure. I think it will be worth doing it as it is a very safe procedure. I remember the doctor said to him it can become worse with the years and something like the testicles can shrink or stop producing sperm… I am not sure fir the details but I think for his health it is good to do it. Not to mention that it will be great to have a natural pregnancy next time instead of going through the stressful ivf process etc which is also costly etc.