MFI and varicoceles

[Beaglemum91]

Hi all,
So there are not many threads on MFI so thought I would start one and see if anyone had any advice and wanted to share experiences.
We knew my DH had a varicocele as it was found when he had kidney stones. He was in the USA then so they didn't investigate it or do anything. We knew this could affect his fertility so got him tested after we'd been trying to conceive for a while and he had low results.

Hi, my DH had a varicoele. His DNA frag was 52% and in our first round we got no embryos - all arrested day 5 which indicates male issues. After the op (3 months after) his DNA frag dropped to 23% and in subsequent ivf we’ve gotten good embryo rates so I would get your DH a DNA frag test and then look into getting the varicoele embolized if it’s high before doing IVF.

@Anyoneelsewilldo thank you. We were already recommended to have ICSI and just finished our first cycle with with unsuccessful first transfer. We've been told the varicocele is unlikely to affect his numbers but havent been offered a DNA frag test? We're completely private so I'll have a look into getting one! We would also have to have the surgery privately and it looks like it would be equivalent to a round of ICSI for us so it's a tough decision!

@Beaglemum91 I found for us it didn’t massively affect his numbers but his sperm count did double - for us the diffeeence has been in embryos. Before we sorted the varicoele out embryos all collapsed day 4-5 which is due to sperm quality but our last two rounds we got 5 top graded blasts. definitely get the DNA frag test and see what that’s like and that might inform whether you want to go forward with the embolization.

Re the DNA frag test some clinics don’t ‘believe’ it as it’s a newer innovation but for us and so many people on here it’s been a clear game changer. Jonathan Ramsey is the top guy for this in the U.K. if you’re going private anyway it could be worth going to him for DNA frag to him alongside an analysis.

I’d you want more information on this there are a few good podcasts with Jonathan Ramsey as a guest discussing male fertility on ‘The Fertility Podcast’ with Natalie Silverman.

Good luck

My hubby had the surgery 3 weeks ago. I'm ok fertility wise but he was diagnosed with a grade 3 varicocele. Urologist thinks it's worth while in our case as it's v large. T was low and FSH was high suggesting his brain knows his balls are not producing enough so the FSH is trying to fix. We hope to see an improvement in a few months

Hi, cannot stress enough how important it is to get a dna sperm fragmentation test done as focus will go from there. Dr Ramsay and and Dr Yap best in UK, agree. So glad we’re under them now as NHS treatment was so well meant / caring but didn’t give us any answers after failed IVF attempt. DH and I figured we didn’t need sperm frag test because no one had said fragmentation would be treatable and we already knew his morphology and numbers were bad; that’s why we were doing the IVF with ICSI, right? Then, like others here, lo and behold the 5 fertilised eggs became 1 ‘poor’ and 1 ‘average to poor’ by day 4 (indicating male issue) which they went ahead and put back inside me. It didn’t work. Now we’ve gone private, under Dr Yap through the Lister, paid for the fragmentation test and result was bad: 46%. We ordered Proxseed antioxidants supplements online - this is what your husband will be told to do and it’s no harm to take according to dose on packet anyway. Today have found out after testicular ultrasound that DH has a cyst and a varicocele (inflamed veins affecting blood supply - we had no idea this might be a thing) which we’ll prob pay to have surgically removed as Google seems to say that will help quality of sperm massively. I’d say, don’t keep putting yourself through costly IVF rounds without spending the money to investigate and possibly treat the problems on the male side first. Btw, Dr Yap has also mentioned other options (new methods which we’d need to sign to agree to trying) like extracting the sperm directly from the testes in the day of the egg harvest (this way the sperm has spent less time exposed to toxins in the testes so healthier - that’s the theory anyway). So there’s lots of hope for you - just get focusing on exactly what’s wrong with DH first. Sending you a big hug, as I know how tough this journey is... we’ll both get there!

100% @KnockingForty it drives me mad clinics ignore DNA frag. I left a clinic for their refusal to even let us get the test. It’s the most important advancement in male fertility in the past decade

So good to hear everyone stories!

We weren't advised to get a dna frag test but after looking into it it's something I'm investigating ourself. We can't got to Dr Ramsey etc as we are in the North. There are not many urologist in this area but our clinic are investigating this for us. We reason were questioning the varicocele surgery is because it seems there's only really a change made if its a bad one and his isn't, you can't even see/feel it from the outside abd apparently fixing them generally causes little change. He has been recommended to start antioxidants which he now has and they've said next time to not abstain so the sample is fresher to overcome to issue.
Unfortunately when DH was young and reckless in the USA he smoked and drank a lot and was a regular cannabis user for a few years when he was in with the wrong crowd and they believe much of the damage is due to that and long term. He's devastated but its now weighing up what is and isn't worth spending thousands on. Its such a tough decision and there is such a lack of independent research and knowledge in this area

@KnockingForty I had read about the surgical extraction as a solution in a study recently and our clinic do offer that. Apparently when they looked at the sperm of infertile men taken from the testes against the ejectulate it was about as healthy as a normal fertile males sperm we might consider that for one of our rounds to see if it makes a difference.

@Beaglemum91 can I ask how you’re getting on? My DH has a varicocele and we have a couple or more weeks before we’ll have an appointment with recommendations and dna frag results etc.

Hi guys, so thought I’d do an update on here. So my DH had his varicocele embolised in April. You have to wait about 12 weeks and get dna frag test again which we did results show massive improvement. He’s gone from 46% average down to 30% average dna frag; most brilliantly, the proportion of ‘high’ dna damaged sperm has gone down from 38% to just 4%! This is the result from just one, small varicose that they said they might as well remove if we could afford it + about 10ms on Proxeed antioxidants + ejaculating every day for 20days and then abstain for 24hrs and then giving sample. So… we’re doing our second IVF with IMSI at the Lister hospital. I’m currently day 4 on the hormone injections. It’s all ahead of us. Must admit I thought I’d be taking this in my stride now, the journey has been so long and you get so good at being philosophical (when you’re not arguing or crying about it! There’s a lot of that too!) but I’ve been v anxious and scared as we’ve started this attempt. While those results were amazing and such a ray of hope, particularly for DH, and I am excited and being as positive as possible, I dread the possibility of it not working. It’s so, so hard. Anyway - wish us luck, as I do for you, ladies - I’m so sorry it’s so hard, painful, expensive and generally sh*t! All we can do is take our best crack at this, all of us - big hugs to anyone needing it who is reading this, Xx

Hi KnockingForty, I hope your journey is going as well as possible and thank you so much for sharing your experience. Do you mind me asking how large your husbands variocele was? My partners is 3.1 which apparently is 0.1 over what it should be so we're debating whether or not to get it embolised. His DNA frag results are pretty much the same as your husbands were pre treatment.
Thanks so much

My husband got the double whammy of having a grade 3 varicocele but when we paid privately to embolise it the consultant couldn't get to the right vein, said it happens to 10% of men. £4000 down the drain. We went into ICSI with the dread of DNA fragmentation over our heads so DH ejaculated every other day or at most two days for 3 months before, took proxeed or wellman, wore shorts and stopped drinking coffee and alcohol. We got 7 eggs, all mature, all fertilised, and ended up with three top quality blasts, and 3 good quality, 5 of which now frozen and one transferred. Yet to know result as in TWW but if this fella and a few others of the frozen don't work and we need another round we will have to get the sperm surgically extracted, in case the embryos gave issues once transferred. Its such an awful diagnosis because one urologist believes it makes a difference and the next totally doesn't, been frustrating. Hope all goes well with your journeys ladies!

Imisscoffee2021 - wow, what a journey you have been on. I will keep everything crossed for you. Good luck! DNA fragmentation is such a tricky one.

Hi,

I cannot stress enough how important it is to treat varicoceles. After a semen analysis in late 2019 showed extremely poor results, I went from being told that my only option would be IVF to my wife falling pregnant naturally in December 2021. I found the varicoceles myself and asked my Dr to refer me for a scan. 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. I was told at the scan I had ‘moderate’ varicoceles in both testicles. The NHS will not help you with male factor Infertility so I went to Dr Ramsay. He confirmed my varicoceles could win awards and I had a grade 4 in the left testicle and grade 3 in the right. Again, I was told by my Dr (NHS) they won’t treat my varicoceles for fertility reasons so I made out they caused me huge discomfort. I was then referred for an embolization. On the day they could only treat the left one and I had this done in May 2021. I was tested by Dr Ramsay just after 3 months and my semen analysis results were unbelievably improved. I was on the cusp of a normal result across the board apart from morphology. There is a myth that circulates that you can’t improve morphology and it’s just that, a myth! Dr Ramsay said I can improve it by having the other varicocele treated and he also found an infection (through a specific test) that was also treated. Before I could get the right side varicocele treated (which I still had done in feb 22) my wife fell pregnant naturally in December 2021. Varicoceles cause heat in the testicles and heat is the worst thing for healthy sperm production. The infection I said was found cause inflamed cells which is also means extra heat and it’s these factors that cause poor morphology and bad sperm production. My attitude was, before my wife and I spend potentially tens of thousands on IVF, I’d rather spend a few thousand trying to fix myself and it paid off. I’m not for one second that it will be this straightforward for every man but if I didn’t get them treated and see a specialist (andrologist more so than urologist) I believe I would not be where I am now.

I really hope this helps anyone and feel free to ask any questions.

We also saw Mr Ramsay. He diagnosed my husband’s varicocele after we found out he had high DNA fragmentation (45%). 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). I have no doubt that the varicocele was the cause of our issue. I only wish we’d seen a urologist sooner and saved all the heartache!

I hope this is helpful to anyone out there as MN was a fantastic resource to me when we were struggling with TTC.

Hi @Catsnkidsistheplan - I hope you are well.

My husband has just had the same diagnosis and has been recommended surgery. I just wondered how you we're getting on? Did the surgery improve things?