Azoospermia and Variceole

[IslaO]

Hi everyone,

DP and I have been TTC for a year and recently got some fertility tests done. Our world came crashing down when he was told there was zero sperm in his sample.

We now have to come to terms with a long and difficult journey ahead. He is going to have another SA done and we will see where we are from there.

However, a few years ago doctors found a small variceole in one of his testes. I guess my question is, has anyone had experience of both of these things? Are they always linked? Is our chance of genetically having our own children zero or possible?

Never, ever thought I would be in this situation.

DP and I are in exactly the same situation. 3 Semen analysis have shown azoospermia and has a left varicocele. Have been told the varicocele does not cause infertility but certainly does not help. We saw Mr Ramsay who ran some tests to look at chromosomes and y-microdeletion to see if there is something there causing the azoospermia. Luckily DPs bloods are all ok.

He has recently had the varicocele embolisation and will repeat semen analysis in 3 months time to see if he has sperm. If he still has azoospermia then will have a micro-tese. Which are small biopsies to obtain sperm directly from the testes.

So it is still possible to have your own children, don't lose hope just yet. But if you haven't already, I would look at getting chromosomes and y-microdeletion checked.

Feel free to DM me if you want to chat more x

Hi

I am also another one in this position. It is a really tough journey but don't panic - it isn't the end of the road.

You will need to go through lots of tests to gradually eliminate things, including:

• hormone blood tests (get these booked in ASAP with your GP)
• genetic blood tests to eliminate Y chromosome deletion, the cystic fIbrosis gene and other genetic conditions that can cause infertility
• a physical exam by a good urologist (they will check cor example to see if your DH has all his tubes)
• an ultrasound to start checking for blockages.

From my learnings from going through this journey it seems if it's hormonal, they can provide hormones to help rectify it. If it's a blockage, they can try to fix the blockage or surgically extract sperm for IVF.

My advice is to buy a pad, list all the tests you need and start ticking them off. Get a folder and start keeping copies of any test results together. If you can afford any of the tests privately, start researching local clinics. I would recommend your OH start taking supplements for his sperm like Proxceed too. It takes 3 months for sperm to regenerate so any changes you make today will start showing in three months.

Also just want to give you a big hug. It really is hard to go through this

@lemons44 and @WhiskeyInTheJar33 im
so glad I’ve just read your messages- I didn’t get a notification so didn’t think I had any replies.

i am based in Ireland but I think I’m going to book in with dr Ramsay. He seems to be the best of the best and I want to cut to the chase. @WhiskeyInTheJar33 does he go ahead with all the tests there and then or is it more appointments and waiting lists?

are your DPs getting varicocele treated as the first port of call?

also- I can’t figure it out from Dr Google.. do varicoceles cause obstructive or non obstructive azoospermia?

how long has your TTC journey been? I’m trying a year and now I feel like we have so long ahead of us!

@IslaO Mr Ramsay was lovely! If you email his PA Allison she books an initial appointment with him and also books an appointment at the doctors laboratory 30mins after your appointment for all the bloods and tests Mr Ramsay recommends. The doctors laboratory is about a 10 minute walk from his Devonshire street clinic in London. He had a 6 week waiting list just for the initial appointment when we saw him in February. The chromosomes bloods takes 4 weeks to come back, so we booked a follow up for 6 weeks after to go through results. On our follow up, mr Ramsay wrote a prescription for anastrazole to help DPs low testosterone levels and gave us a form for repeat bloods 5 weeks after starting. We were able to book the bloods at the doctors lab ourselves. The follow up after this was over the phone. He didnt need to follow us up further as we are now under our local hospital for IVF.

Mr Ramsay didn't feel varicocele treatmrent was needed however as we are now under NHS for IVF they want to make sure everything has been treated before going ahead, to give us the best possible chance of retrieving sperm, whether that be via surgical sperm retrieval/micro-tese or via a normal sample.

From my googling varicoceles tend to cause NOA but I could be wrong. Obstructive tends to be the vas deferens is missing.

My TTC journey has been (in short): off the pill Feb 2020, TTC from June 2020, first went to GP July 2021, I had saw gynae/fertility clinic Dec 2021, DP saw Ramsay Feb 2022, referred for IVF in April 22, seen in IVF clinic June 22, varicocele embolisation August 22.

It's been a long process but we have time on our side and my AMH is higher than expected. We have a follow up in 3 months to do SA to see if sperm in sample has returned following embolisation. If not and still azoospermic, then we will probably go private for IVF as our CCG does not fund IVF for non-obstructive azoospermia.

Hi @IslaO

I'm really sorry I realised that in my message before I totally forgot to say the most important point, which is that my DH has a varicocele. It was found on the ultrasound. However they still think that the cause of my DH's azoospermia is actually a blockage and to be honest haven't even mentioned this varicocele. I only know that he has a varicocele because it says it on the ultrasound report. I think it's something like 10% of all men have one so they are quite common. On Dr Ramsays website it says not all varicoceles affect sperm production. So it's worth keeping in mind it might not be that causing the azoospermia.

I am not an expert but my understanding is it would be classed as non obstructive as the issue is more that the varicocele heats the sperm up killing them off? But I will let @WhiskeyInTheJar33 advise as she is obviously more experienced in that area 😊

We also saw Dr Ramsay. We are not local to him (although more local than you). We had a 6 week appointment wait. It is normally 4 weeks but he also had a summer holiday booked. In the mean time whilst we were waiting we got my DH's hormones tested from the GP and genetic tests from a local private clinic (these genetic tests take one month as they monitor DNA growth... it's called a kariotype test).

This meant when we went to Dr Ramsay we already had those test results to show him. We went to the Beaconsfield clinic to see him. On the day he did a physical exam on my DH, and sent my DH for an ultrasound with his colleague. My DH then did a semen sample and we went and had lunch for an hour whilst they analysed the result and then went back to hear Dr Ramsays verdict and recommended next steps.

He is extremely good but my advice would be to go to him with as much information as you can. For example if you know your OH has a varicocele from an ultrasound then try and get a copy of that to show Dr Ramsay.

Hope this helps.

Oh sorry @WhiskeyInTheJar33 I cross posted with you!

Thank you so much for all of this! You sound so organised and level headed about it all. I’m in awe- it’s a week to the day since our news and my head is spinning.

my AMH came back as 18.. was too floored by the SA to ask if that was good or not but hoping no comment is good news.

for the embolism, did you just do this through a urologist on the NHS? Funny that dr Ramsay didn’t think that was needed as a first step. Varicoceles seem to really divide medical opinion!

@lemons44 thats my understanding. It was explained to me that varicoceles are like little radiators and sperm does not like heat, which causes damage.

@IslaO That AMH seems ok to me. The embolisation was organised by a urologist in the IVF clinic in the NHS. Mr Ramsay didnt want us paying for something that would necessarily change the outcome. The research for varicolcele embolisation is divided, you can have them treated and they return 2-6 months later. As the NHS are doing this, DP was happy to have it done.

We've known about the azoospermia for 13 months now, I have spent soo much time googling! Driving my DP mad! Its help me feel more in control. Its good to know your options and be informed. Mr Ramsay kept calling me "professor" 😂He gave me some invaluable advice for when I saw my gynaecologist and said I may need to fight for my referral for IVF and said "do whatever you can to get your foot in the door".

My gynaecologist (he was the one who ultimately had to refer us for IVF) said he wasn't going to refer us for IVF because "your partner has no sperm so need a sperm donor". I said excuse me, just because he has azoospermia does not mean we need a donor!!! He replied "yes you do, he has no sperm!". I replied "listen, with all due respect, you are a gynaecologist. Azoospermia means he has no sperm in his ejaculate, which does not mean his testes are not producing sperm. He can have surgical sperm retrieval via micro-tese and we have been given a 50:50 chance of success" I also suggested he read up on NICE guidelines and the local CCG IVF criteria. He did finally agree to refer me. DP was mortifed 😂(I work in the NHS and deal with consultants/doctors on a daily basis)

So all in all, if you know your stuff, demand extra tests, referrals etc to get the answers you need.