What to do / where to start? varicocele?

[WhiskeyInTheJar33]

DP and I have been TTC for nearly 2 years. I am 33 he is 30. My tests have come back with slightly raised testosterone but no PCOS and am being referred to gynaecology. DP's SA show no sperm (azoospermia) and has a varicocele, he has been referred to urology but the NHS wait times are 38-44 weeks. I don't feel I can wait this long!

We are considering paying privately to see mr Johnathan Ramsey. We have me told to expect to pay £1000 initially for consultation and investigations. Any further treatment I suspect will cost several thousand more.

IVF on the NHS will only find 2 cycles if DP has obstructive azoospermia and not non-obstructive. If it's down the the varicocele, this would come under non-obstructive.

We have money saved to fund several cycles of IVF/ICSI but debating whether to use some of it to see Mr Ramsey and get going quicker because of my age.

Any suggestions? Or has anyone has seen Mr Ramsey and had varicocele treatment?

🤦🏻‍♀️ excuse all my spelling mistakes... it's too early in the morning! 😂

Anyone?

I didn't want to read and run! My DH also has a varicocele size 2.8mm which I think is classed as low grade? how big is your husbands? It all depends if the varicocele is the sole reason for the poor SA as some urologist would debate that they don't have a impact on SAs as there is limited studies to support this.. my DH has his first urology appointment NHS next month after being referred last month, could he ring up his local NHS trust to see if there's any cancellations?

I've heard really good things about that Dr Ramsey guy on here too and I'm sure there's plenty of success stories with people going to visit him, may it be worth going down the route of IVF ICSI on NHS before private rounds? As they can be used as trial rounds to see how you respond and if they don't work your private funded rounds will know not what to do :)?

@kaylsd thanks for your reply. DP has another ultrasound this week. I've asked him to get a copy of the report so that we can actually see measurements etc. DP can actually feel his varicocele so am assuming it's quite big.
He's been asked to wait until Wednesday before calling for appointments so if he hasn't heard by then I'll be ringing the hospital every week.
That's good your husband is being seen soo quickly after referral. Where abouts in UK are you if you don't mind me asking?
I'd like to use the NHS rounds as a trial before actually funding our own but feeling more and more like we won't qualify if it's the varicocele causing it.

[quote WhiskeyInTheJar33]@kaylsd thanks for your reply. DP has another ultrasound this week. I've asked him to get a copy of the report so that we can actually see measurements etc. DP can actually feel his varicocele so am assuming it's quite big.
He's been asked to wait until Wednesday before calling for appointments so if he hasn't heard by then I'll be ringing the hospital every week.
That's good your husband is being seen soo quickly after referral. Where abouts in UK are you if you don't mind me asking?
I'd like to use the NHS rounds as a trial before actually funding our own but feeling more and more like we won't qualify if it's the varicocele causing it. [/quote]
Hopefully things go well for you guys for the repeat scan! I'm not too sure about the IVF front for if you guys are candidates on NHS but there's various techniques they can do to abstract sperm surgically to do the ICSI so you do have options and I can't see why that wouldn't be offered as a treatment offer on the NHS cycles? Hopefully your DP can have the varicocele removed or treated with embolisation and be the source of your problem with the poor samples 🤞🏻🤞🏻

That is a long old NHS wait time! We were told ours would be around 12-26 week wait for urology referal but given there is no IVF funding anyway in our region we decided to go to Ramsey. I can definately recommend him, but the costs do rack up... We have been seeing him for 3 months and spent £2k so far on tests and consulting, £5k on varicocele embolization and would expect atleast another £1k on retesting & further consulations before we start IVF with ICSI. The embolization was only this week, so we have a 3 month wait to see if there is significant improvement, but so far I feel like it has been worth the money. It is alot, but we feel like we are in safe hands, and doing everything we can to treat the cause rather just rush into IVF and go through the disappointment of failed cycles. (I might feel very differently in 3 months if nothing has worked to improve things though!) Best of Luck x

@Brightside27 thank you for your reply. I contacted Mr Ramsey's secretary. She quoted £280 + allow £900 for further investigations. Which is fine. It's the further costs and treatment for varicocele that will obvious eat more into our savings, which I ideally would like to save for IVF. At the same time he seems an amazing doctor and would like to be in the best possible position if we were to fund IVF in the future.
I have a gynae appointment in December. So am thinking we might hold off seeing him until then. Mr Ramsey has a 4-5 week wait at the mo so much quicker than NHS.

I'd be interested in hearing about your results in a couple of months time! Fingers crossed it's successful for you!

My partner has his embolisation on the NHS in September. He waited a few months for the first referral and then the embolisation was booked for just a few weeks later. It is important to know that the NHS will NOT treat a varicocele purely for fertility purposes so I suggest he says it causes him pain.

In addition I strongly urge you to seek urologist treatment before wasting valuable IVF rounds. Varicocele can massively affect the quality of sperm so just because you have some there for treatment, you could end up losing all of your embryos due to bad quality sperm.

We’re seeing Jonathan Ramsay during our 3 month wait just to check for any other potential issues.. he immediately found a bacterial infection that could also be affecting the sperm. Yes he’s pricey but he is quite honestly worth every penny for me! Good luck!

@Cece1908 thank you for your reply.
DPs varicocele does cause him a lot of pain. He's been to GP several times about it over the years and they do nothing! DP is not one to push. Ive just pushed him to get a second semen analysis done (his GP was again reluctant) as NICE guidelines suggest a second asap after azoospermia is found🙄.
We will definitely be seeing a urologist before starting IVF. Just deciding do we wait until Aug22 for NHS or pay privately.

It’s so difficult because the NHS just have no interest in treating male factor infertility, they push straight for IVF.
We went straight for private IVF as due to a silly rule in our ccg policy both of us had to have lived in our area for 3 years (he’s lived here his whole life) but we bought our first house in early 2020 so I haven’t and they declined us
Our private clinic actually told us they wouldn’t do ICSI until he had his varicocele treated (and antibiotics as he had a large amount of white blood cells in his sample which indicate infection)
We’re now waiting for his 3 month follow up in December, keeping everything crossed for atleast some improvement to start IVF in January! They said it’s highly unlikely we will ever see a good enough improvement to fall naturally but with 500,000 total count and 0% motility they wanted us to atleast try x

@Cece1908 fingers crossed for your follow up. Hopefully you can start IVF in January!
I hear so many men get treated for infection following semen analysis. I have no idea what else was tested during his first sample! Was just told no sperm. Trying to get DP to get a copy of the report but don't want to keep nagging him 🤦🏻‍♀️. I've just booked his second analysis so will see what those results say. I hate this waiting game.

Hello!

Did you find any success with the treatment of the varicocele? We're in a similiar position and finding it hard to process and figure out what to do next.. treat the varicocele or head straight for ivf! Any advice or learning welcomed! Thank you x

PS if you have had success, would you mind sharing before and after SA results if you have them? Not sure if our starting base is too low ahhh x

@Summerdays90 hi
@Cece1908 yes how did your 3 month follow up go??

We decided to see Mr Ramsay in the end as NHS wait times were long. DP has been diagnosed with non-obstructive azoo. We have been referred to our local hospital for IVF. They said I have time on my side and my AMH is good so they are now embolising DPs varicocele this month. We will then will wait 3 months. Will still need IVF and probably ICSI but will hopefully be in a better position which will improve success rates.

Hi all,

wanted to see how things progressed on your end? We are waiting for a consultation for my husband with urologist. We know he has bilateral varicocele so will probably need operation/embolision. Has anyone done it through NHS or the only option is private? How much is the treatment? Trying to work out costs etc.
our 2 ICSI cycles failed but we haven’t tested DNA fragmentation but we think it will be high.
thank you!

Hello!

We were in the same position as you. The waits to Urology were so long.

We went to see Mr Ramsey in London and my partner has a moderate to severe varicocele on the left at 3.2mm and mild on the right at 2.2mm.

We tried to go through the NHS and complained of pain, was sent for an ultrasound where this was confirmed. The person performing the ultrasound said there was nothing to be done for varicoceles except medication!!! My partner was then told the same by his GP....

We went for a consultation at a private NHS hospital and he said he could absolutely refer on NHS for treatment but that they would only treat the left side, he didn't know if it would make any difference and he was unsure on wait times. He was not a fertility specialist though. We left feeling a bit meh to be honest:

In the end; we decided to pay privately. My partner is booked in next week in London! We are paying about £2700 but still a lot cheaper than other quotes we've received. We didn't want to wait any longer and my partner has just been totally deserted and no one seems to have a clue on the NHS with any male related fertility issues sadly - his GP said his sperm results weren't bad when there was 1 million TMSC! We don't think this will change the outcome for us in terms of needing IVF, but we will know we've done everything we can beforehand to get the best outcome. We plan on seeking IVF/ICSI 3 months after the procedure next week.

Hope this helps, let me know if you have any more questions - will keep you updated x

Hi @feelinglost22 would be very helpful if you send me that place with that price as most are double! You xan PM me if you son’t want to share widely. Would really appreciate ☺️

On the recommendation of someone else on here; we looked at Wexham Park Hospital. There is also Derby Private Hospital. Both similar priced and both NHS hospitals with private/self funded sections too, but these seem to be cheaper than actual private places x

Hi @K8dferXdder DP had varicocele embolised just over a month ago. We had it done on the NHS as the hospital we have been referred for IVF said it was worth doing to see if they can improve things. It was a 6 week wait from being assessed initially. We have a follow up 3 months post embolisation for repeat SA. If DP still has azoospermia then we won't qualify for NHS funded IVF, so will go private.

Sending you best wishes! Hope the embolisation helps!

Have they said they won't fund microTESE? It's such a mixed bag isn't it in terms of funding/knowledge and who you get referred to and what they will agree to do! A lot of the policies are quite unclear too. A woman I have been speaking to has been pushing for microTESE and they have agreed to do both the embolisation and then the microTESE - she kept pushing for it and they finally got referred to a specialist at UCLH who agreed to do both (without any fight!) so keep trying if you have the fight left and depending on timescales and your position etc!

Sending you love and best wishes on your journey xx

@feelinglost22 I am going to try and push for the funding for microTESE (I've read the policy and DP meets criteria). It's the funding for IVF we don't meet. Our CCG doesn't fund non-obstructive Azoospermia. However I've also read the NHS won't fund part if you're combining with private, so I have no idea what we're entitled to but will certainly push for what I can depending on wait times (I don't think I can mentally/emotionally cope with waiting much longer).

I know exactly what you mean! We're in the same boat re not wanting to wait any longer! Best wishes xx

Thank you so much for your replies, we will definitely try the NHS route for the embolization or Private Medical insure- whoever agrees to do it quicker! 🙄My husband also was prescribed in the past Clomiphene which helped a bit, hoping to have this again in the meantime while waiting. @WhiskeyInTheJar33 did he had to “have pain” for NHS to consider the embolization or purely for fertility it was also fine?

Hi again, who prescribed the clomid for your husband? Was it a fertility specialist?

My partner currently taking anastrazole but seen lots of other men have clomid too! Not sure how we would get a prescription though? Thanks xx

@K8dferXdder it was purely for fertility reasons. Although he does get some mild pain very occasionally.

@feelinglost22 my DP is also taking anastrozole. I wondered about adding in clomid. I was going to ask Mr Ramsay but we ended up seeing an NHS urologist at our IVF hospital and she said to stay on anastrozole and see how embolisation goes.

Thank you!

I'm worried that once he stops taking anastrazole - his numbers may worsen? But surely he can't take them forever?

We got a prescription via Mr Ramsey too - not sure what to do when it runs out?! It would be ideal if we had enough to see us through the 3 months post varicocele embolisation?!

Xx