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

@K8dferXdder thanks for the congrats and taking the time to message. I hope your partners next analysis shows that the surgery was successful!

@Summerdays90 @JeanieJ @K8dferXdder Hi everyone, had a question about consultations with Dr Ramsay - I've seen some people say you get test results same day and others say it takes 4-6 weeks to get test results. I was just wondering what your experiences have been, as I'm a bit confused! Many thanks x

@Ecdysiast
We had an initial consultation in August, then a follow up around a month later where we got the results.
Hope that offers some clarity.
xx

My partner was under Tet Yap at the end but he had most tests from NHS so don’t really know to be honest. Makes sense to comment results on the follow up appointment to make a holistic plan further.

Thanks @JeanieJ and @K8dferXdder ! @K8dferXdder , what did you think of Tet Yap?

We tried for 2 years, no joy at all. We went straight to icsi as advised by our fertility team and it worked on the second transfer.

We then conceived two natural pregnancies extremely quickly 8 months after DS was born but we lost the pregnancy and then another 5 months later we conceived our second DS naturally

DH didn't do anything different, a sample came back "normal" despite initially having low count, poor motility and "sticky sperm"

Tet Yap was great, he did refer him for embolisation and we proceeded. He was very accomodative with letters etc to the Private Medical insurance etc so all went well. We went to him as we didn’t want to wait for dr. Ramsey for an appointment 3 months and it was a good decision. He also works with most well known fertility doctors/clinics so all good with him.

This flashed up on Active threads and caught my eye as this was our experience for four years.

3 failed IVF cycles blamed on my age until DH had a varicocele and DNA fragmentation diagnosed. DH had the treatment and we had IMSI at the Lister.

My Mr Ramsey baby is now seven and currently upstairs refusing to go to bed. I was 42 when she was born and she’s been a delight every single day since. Good luck to all of you and please don’t give up.

Little update on our situation: My husband had an MRI to see why his earlier embolization couldn't be performed (they previously sedated him and then realised it couldn't be done due to access). 6 months after the MRI, we've just got the "results".... turns out the MRI was pointless as there were visibility issues so couldn't see what they needed to. The consultant has advised that they can attempt surgery again, but no real insights as to whether it will work or not, and if it works, whether it will make much difference to his numbers. No mention of the surgery being beneficial for other health matters. So we are currently deciding what to do. I personally think its not worth bothering at this stage... It's been such a long, draining investigation, and I desperately wanted to avoid IVF but its done now, so if need be, I can do it again.... Wishing everyone lots of luck with their own situations!

We’re currently under Tet Yap at Guys, like @K8dferXdder . Can I ask what happened after the tests for you? It’s been years for us now, I’m nearly 40, multiple failed transfers. ICSI hasn’t worked, basically, so I’m hoping Mr Yap will give my husband some kind of plan so we can try again. He has ASA.

Most of the results were fast except dna frag (private, came back with very good results), I think it goes off to Ireland.

@Twi nice to hear your story, I’m not optimistic for us at this stage but good to hear it worked for you. We’re hoping to do IMSI next time (also Lister), previous attempt was not good, they couldn’t do it.

Most tests for us were done already via the NHS fertility clinic. Tet Yap did do few more tests but he sent us straight for embolisation. The plan is also IMSI at Lister. He did a semen test this week and we are hoping for improved results. He suggested DNA fragmentation test 3 months after the embolisation. He also suggested daily ejaculation cycle I think with semen freezing to make the semen sample large enough to do Imsi. Hope this helps and good luck!

Thanks @thislittlebird @K8dferXdder @AnaB123 @Twi @xnyl ! There's so much on Mumsnet about Dr. Ramsay but not much about others, so that is really helpful. I had my first baby naturally at 37 within a few cycles of trying. Been trying for number 2 for almost 2 years now with no luck, thinking it must be my age. Had a consultation at Kings's a few weeks ago and DH's semen analysis was dire, so they think that is the cause of the problem. They said we should see an andrologist and that even ICSI will be a challenge with his numbers. Still can't get my head around how in the space of a few years a man's count can go from good enough to conceive naturally to barely sufficient for ICSI! Wasn't sure what to expect going forward - what tests are likely to be requested, etc so your insights are really helpful and appreciated!

Hi I understand your concern, it is probably pure luck that you conceived naturally. Same happened to us actually, we tried 3 cycles (2 icsi and 1 frozen) and had 1 miscarriage from the frozen one. Situation was bad but Tet Yap put him on Clomiphene 25mg daily or 50mg every 2nd day plus the vitamins, we got Impryl and fall pregnant naturally at the age of 41! Don’t give up! We found out with a pregnancy test 1 day before his embolisation that I am pregnant! Can you imagine… but he still went for it.
You need to understand what is causing the parameters to be low. Sometimes it is just a simple infection that can be treated by antibiotic but there are soooo many causes so I am sure the andrologist will investigate and find the cause. Just make sure the andrologist that you go to specialises in fertility as the rest were telling us embolisation will not make a difference etc but we still wanted to have it. The top 3 names are dr. Ramsey, Tet Yap and Suk Minhas, at least I heard successful stories from people being treated by them.

I feel like we’re the only people who never get an answer to why DH’s motility is low. I guess it’s the antisperm antibodies and there’s no fix for them. But we’ve just been told to go back to ivf by Yap, which is fine, but we really wanted a chance naturally. I guess that’s too much to ask all these years in. We saw Ramsay too in 2021, everyone just ‘clears’ you to start ICSI.

Did Yap not suggest IMSI? We were told we will do IMSI with multiple ejaculation cycle where multiple batches of fresh sperm is frozen so there is enough for IMSI. But I guess every case is different… don’t stop trying!

@K8dferXdder we’d already planned to do IMSI with our clinic, but couldn’t do it last time because there wasn’t enough good sperm. I think we’ll likely freeze a sample while it’s all so good, but just thought he’d possibly suggest something else to improve matters.

@Twi When you say your "DH had the treatment" what treatment was that?

Thanks @K8dferXdder , interesting that you had a positive outcome pre-embolisation with just the supplements and drugs. When your partner was initially assessed, did they think the varicocele was the main cause of the problem, or did they think there were other factors too?

Hi @Ecdysiast my partner was investigated under the NHS IVF clinic initially where they did some hormone tests (FSH, LH, Prolactin, Testosterone) and X-ray of his men parts and his Testosterone came low, so they started him on Clomiphene and vitamins. The X-ray showed the varicoceles on both sides (that’s what the NHS urologist said) so he was diagnosed with Oligospermia caused by bilateral varicoceles (meaning on both sides). So at that point we were without any hopes we can conceive naturally and we didn’t try much. We went through rounds of ICSI, all unsuccessful.
When I started reading deeper in this forum plus the private IVF clinic suggested we see a good reproductive urologist, we went through the process. Our hope was that they treat his varicoceles and we knew probably even after the treatment he will not reach 15million count, so our hope was to improve the DNA fragmentation, which we never tested anyway and we had a plan to do IMSI next time for better outcome.
the reproductive urologist put him on Clomiphene again and vitamins and 2 months later the test was positive. I think it was all matter of trying enough every second day during ovulation etc which we previously didn’t do much. it was pure luck that we were still on holiday mood and at that month we just enjoyed ourselves a lot 😄 plus we were lucky in the sense that his right part was functioning well and produced healthy sperm. This was later confirmed on the day of the embolisation that he only had varicocele on the left side.
he was tested by the private urologist for some infection and few other bits that I don’t remember but the doctor was sure varicoceles are causing the heat up of the sperm that is worsening the quality.
my point is even with low count it is possible to achieve pregnancy. I don’t know what was his count exactly in that month but 5 months earlier it was still 3 million. Also I guess my hormones were functioning well for successful pregnancy even though I am 41.
there are so many factors but don’t be discouraged by what the doctors tell you. When something is meant to happen, it will happen. Obviously do seek for medical help as just trying for too long without success is also not an option… and keep enjoying yourselves even when you think there is no hope 🙂

@thislittlebird Sorry to hear there is no solution for the antisperm antibodies :( Will it not help if the extract sperm from his testicle directly rather than through ejaculation? Maybe ask the fertility clinic what they can do for you.
if they give steroids to suppress our immune systems, can they not give the same to men? I really hope you choose a good clinic that will give you the positive result. ARGC, CRGH, Lister… all seem to be good clinics in London. If this doesn’t help, a lot of people have gone also abroad maybe Turkey for treatments? Wishing you all the success with the next round 🤞

@K8dferXdder thanks. I don’t think it does, the antibodies are in the seminal fluid. At least no one has said that’s an option, it seems to be the most mysterious version of MFI, but does explain why his sperm don’t move. Tet Yap just said go back to icsi as planned.

There is some research into steroids for it, but it seems the clinics aren’t on board with it and they just keep saying so ICSI.

We’re with the lister, just done another EC. 9 mature eggs fertilised normally so we have to see if any of them want to be embryos. Even then, my hopes are low at this stage.

@thislittlebird wishing you all the very best in this cycle! We were also with Lister before and they are really good! Fingers crossed you have successful pregnancy 😘

@K8dferXdder thanks!