Varicose vein

[Uknownothing]

Hi all,

I have a query or would like your input really.
Background:
MFI - good count, borderline motility and 0% morphology.
ICSI - x3 failed. Good fertilisation. Poor development. No blasts. All drop off by day 3.
Jonathan Ramsay after second cycle failure discovered high DNA frag (49%). Provided with an antibiotic course. Not much change after this as DNAF dropped to (47%).
We now went to Turkey to research into other clinics to cycle there. The Urlogist has suggested my husband take a scan (scrotal Doppler test). We agreed as we had not had this scan done under JRamsay.
The results have come back showing a varicose vein on left testicle.
I guess I’m asking if anyone feels it is worth emobolizing? The Urlogist in Turkey just called and said it may make a difference and that it is up to us.
i am curious why this was not done by JRamsay. He had done a physical examination but not vis ultrasound.

Bump!

It is my understanding that varicocele's can be quite common and don't always cause issues. When my husband had a scan when he saw me Ramsay they graded it and the grade can indicate how bad it is.

However I am not sure if a varicocele impacts on DNA frag? I thought the main issue with a varicocele is that it impacts on sperm count as the extra blood flow warms the testicles and kills the sperm? I could well be wrong though.

Thanks for responding @lemons44

i was told the varicocele on the left testicle measures at 2.5mm. Not exactly sure if this means it is big or not. The urologist mentioned it is 50/50 if it’ll make a difference and was quite ‘meh’ about it.

I was put in two minds as I was curious as to why JRamsay did not flag this up. Though my husband’s count was decent so not sure if that is the reason. Upon googling it is also showing mix results.

Hi @Uknownothing

Not sure I will help much yet but my husband had a varicocele discovered, after we had been trying for 9 months to no avail. His count was borderline, below normal motility and terrible morphology (0.8%).

His urologist said he needed it removed, and it most likely should make a difference. It's fairly common, some go unnoticed, some cause a dull ache etc.

He had it removed in December and we won't be testing until 3 months after so I can't advise if it's helped yet or not.

I have heard it can cause DNA frag because the varicose vein is essentially causing stagnant blood flow, and the vein is not able to do it's job properly which is removing the toxins from the testicles. This apparently can affect the sperm's health.

We have private health so our decision was quite easy in going ahead with the removal.

Hope you find an answer :)

Thank you @FernaFrey
Can I ask how much this cost you approximately?
I am not too sure if we can get this on the NHS.

@Uknownothing You can have varicose veins fixed on the NHS, though I’ve no idea what the waitlist is like. My husband has one and was offered treatment but decided not to as the GP said it shouldn’t affect fertility and it seemed quite an invasive treatment for little gain.

I’ll also add that we have had tests with a private clinic and they also haven’t been concerned by it. I don’t know what size it is, though, but it can be felt between fingers, and causes the occasional ache. (It gets worse when it’s ‘out of use’, if you will, so TTC has been a good remedy for the discomfort he’d previously felt 😅.)

I would be surprised if it was large and Jonathan Ramsay didn’t pick it up. My dh saw Ramsay and also Tet Yap over the course of a few years and both were unconcerned that his small varicocele was the problem. We were planning to pursue embolisation just in case it would help, and the urologist we saw at Guys was also keen to work on it. In hindsight, I’m glad we didn’t. We discovered quite late that DH’s issue was antisperm antibodies and an embolisation could have potentially made that worse, and finally (in Feb 2023) we picked up on why his motility and vitality were so poor (average to low morphology but improved on impryl; normal count).

I guess I would suggest ruling everything else out first, maybe getting any tests done you haven’t had to date first, trying all the tactics to improve sperm quality. Or at least finding out if it is large, as if it’s small it’s unlikely to be the issue afaik.

@GreenTurtle75 thanks for the response. They have not written on the report what the actually size is but they have given it a grade 1. I will look into the NHS as from what I’ve seen the cost can be eye watering.

@thislittlebird thanks for the informative response. That does actually give me more peace of mind than the urologist did :p
what is the test for anti sperm antibodies may I ask?
I guess as a grade 1 the vein will be small and from what I have read online the surgery can be invasive.

@Uknownothing no problem. I think the official test is called the MAR. Our clinic picked it up for us. Our second round (first with a private clinic) went terribly after DH had had covid. So a few months later we got them to do an SA a month before we were due to start again and an embryologist called to flag up that his sperm were clumping and that meant he had antisperm antibodies. They then put some measures (a solution to ejaculate into to stop them clumping/being attacked, less time between sample collection and egg collection) in place for our third round and it went so much better, and was successful to date (I’m 27.5 weeks pregnant now after 7 embryo transfers). It’s definitely worth asking your clinic about, if they’ve looked for it already or if they could look if not.

As far as I’m aware, for a case like my husband’s, the surgery could have made his ASA worse (vasectomies can also result in ASA, as another surgical example) so we probably did well to avoid the embolisation. But it does work for some people, I suppose it’s a lot of trial and error to establish if it’s worthwhile.

@Uknownothing , just came across your post and I was wondering how you got along?

We are in a similar position, same size varicocele as you. Have you seen Dr. Ramsay in the end?

Also, out of interest, was the varicocele ultrasound done lying down?

Following as we are in a similar position

Hey,
I have stumbled across this thread hoping to find others who have seen DR Ramsay. We have recently been to see DR Ramsay and he did complete an observation on my OH and then sent him for an ultrasound, blood tests and hormonal tests. The ultrasound showed 2.9mm veins which is 0.1 below the cat of having varricose veins. Dr ramsay advised that going for surgery is long and pricey so if we can avoid this it is best.

Prior to the consultation my OH completed the SA and DNA frag test, the dna showed approx 46% but he was not prescribed any anti biotics for this? Im starting to question why this may be. My OH also has low sperm count and motility. He has been prescribed a hormonal tablet also used for women with breast cancer and menopausal. Im concerned as the bloods wernt reviewed before prescribing the medication, altho it was stated it is to check for changes and will be used as a guide.. surely they would need to be reviewed first?

Does anyone have a positive story in regards to the medicaition being successful for count/motility/morphology and dna frag.

Any feeeback is deeply appreicated. The entire process is so costly its exhausting, to think this may just be the beggining of a lenghty process is very upseting.

I feel the NHs have failed males who are going through infertility, theres no help, no advise, no guidance, no referrals to see speciapists its ridiculous.

Would be great to hear from anyone else with similar experiences. It does seem like oestrogen suppresants are being prescribed in some cases, anyone with any success?