Varicocele research - ugh!

Yes, it's 1:30am and I'm still up!

Now that Christmas has passed, the process of preparing for our next appointment with the fertility specialist has begun...

The previous appointment ended with the news that repairing DH's varicocele may improve sperm quality, but wouldn't do anything to improve pregnancy chances... very much one of those "huh?" moments!

I've just spent ages trying to track down articles and try to make sense of them...:wall: :throw_computer: I'm so frustrated!

My acupuncturist suggested one that ACCESS had up... only I found that you need to be a member and I am not... and my next acupuncture appointment is on the 12th, with the FS appointment on the 11th! :confused: And then there's the articles you find that could be really relevant and useful - but you can only get the abstract and need to pay US$25 to read the full article!

I've had enough!

BW :asleep:

Hi Butterfly Warrior,

My DH had a varicocele and he had an embolisation done. 75 days later he had a SA done and everything had increased. The main problem was 0% morph which jumped to 29% and then another 3 months later jumped to 31%. We were over the moon, of course. It's now been 5 months since getting those great numbers and we're still not pg though. I don't know what to do.

Anyway, I just wanted to write and say hi and see if there's anything I can answer for you. I did heaps of research before my DH had his op. There isn't a lot out there unfortunately, and the doctors all seem to have different opinions on the issue.

It's all very confusing, which just makes it harder doesn't it??

I hope you're feeling ok.

Sam

Thanks, Sam!

I think we've pretty much decided that we'll have the repair done... unless there's some issue with me that means we'll need IVF anyway. In that case, our clinic doesn't charge extra for ICSI, so there doesn't seem to be much point.

The only tricky bit is that DH is leaning more towards the embolisation, but his current specialist only does surgery. I notice you are in Sydney... which specialist did your husband see? We've been given a name, but as we are in Windsor and the specialist is in Hurstville, we'd prefer someone closer if possible!

BW

Hi BW,

My DH had the embolisation done at Kogarah Private Hospital, so a bit of a hike for you... There must be some way of finding someone that does the embolisation closer to you... I'm not sure how though. My acupuncturist gave me the name of our doctor, maybe yours can recommend someone?

GL with it, it's such a rollercoaster ride.... I can't wait till it's over.

Sam

That was the name given to me by the acupuncturist!

DH has me driving in to Rozelle from Windsor weekly for acupuncture (doesn't want me to stop, even when I've been frustrated, and it has certainly helped with my state of mind if nothing else), but complains and grumbles about having to see a specialist about the same distance away even though it wouldn't be anywhere near so often!

BW

Hi BW,

Which acupuncturist do you see in Rozelle? That's where I go. I see Leah @ Rozelle Acupuncturist Centre.

The doctor that was recommended was very good. My DH had his op at 3pm but they made a mistake and he didn't go in till about 4pm, and we left the hospital at about 6pm I think. It wasn't too bad. And that's it, you don't have to go back again. The recovery is much better for the embolisation compared to the surgery. My DH had the op done on a Friday afternoon and went back to work on Monday. All he had was a bit of a sore neck.

How long have you been TTC'ing?? Have you been all checked out??

Sam

:eek: I see Leah too! She's lovely!

We've only been TTC for 12 months... but only 2 months in I had a false positive pregnancy test in the middle of a 78 day cycle. In investigating what happened then we discovered that I have PCOS... We started treatment for that, and the gynecologist sent DH for a SA, only to discover that he has a triple defect... Eventually we found out that he has a varicocele. I was very unhappy with the first specialist as I don't think I was checked out fully and I sometimes doubt the PCOS diagnosis, but there's definitely something going on! People don't just have 80+ day cycles and fail to respond to clomid for no reason! We've recently changed specialists, had our first appointment just before Christmas and have had loads of tests done. We go back on the 11th to hopefully find out where to go from here.

DH is curious to know what caused your DH's sore neck from the procedure?

BW

Hi BW,

WOW, I knew you were going to say that! She is lovely. I've been seeing her for almost a year. We've been TTCing for 15 cycles now, but it's only been 5 cycles since my DH got his improved numbers. My DH had a triple defect too! Now his count is a little low, but not by much.

So has this 2nd specialist found why you have such long cycles and don't respond to clomid?? I hope it's good news on the 11th.

When they do the embolisation they go in through the neck and go down to just above the testes, then they insert coils into the vein to the varicocele to block blood flow to it. It's quite incredible. Your DH will be left with just a puncture wound on his neck, not even any stitches!! My DH found that is neck was a bit sore where they went in, no other discomfort at all!

We're trying this month, which will then be 6 months with good sperm numbers. We have an appointment with our FS at the end of this month to maybe start with IUI.

It's been such a horrible experience, I just want it to be over!!!

Sam

What a small world it is! I'm now wondering if I've ever passed you in the waiting room!

DH is now a little freaked out about going through the neck - what we had read about the procedure had them going through a vein in the leg. Does that mean they actually go through the heart?

I haven't heard anything about what the specialist has found... and I'm a little scared to call and ask about the blood test results! I'll wait until the appointment, when I'll have DH with me. Leah thinks that the clomid won't work for me as my eostrogen levels appear to be low - I don't have any tests to confirm this, so it will be interesting to see how the tests match up with Leah's thoughts. She really seems to know her stuff, so I would be more surprised if the test results disagreed with her!

It truly is a nightmare! I could cope with knowing I had a problem as with my complete absence of a regular cycle for my entire life, I always suspected. But when we got the news about DH, it was like we'd been physically attacked - it was very, very shocking! However, the elation when we discovered that the source of DH's problem was something that could be repaired was equally extreme!

Good luck with your FS appointment, although I'm hoping even more that this month is successful and you won't need that appointment! I'm almost afraid to ask who your FS is! We see David Knight at Next Generation Fertility.

BW

It is a small world isn't it? How did you end up at Rozelle for acupuncture if you live in Windsor? We might have passed each other?? My appointments are always early Saturday mornings.

Tell your DH not to worry - it's not a problem. The doctor told us that he likes to go in through the neck because then it's just straight down to the testes. If he goes in through the leg then it's not a straight line to above the testes. Something like that. No, they don't go through your heart. Honestly, it's over so quickly, it's incredible. My DH was a bit nervous, but they drug them up so they don't know what's going on, it's quite funny!

Is there something they can do to improve your estrogen levels? At least if they know what the problem is you can work with it. When you don't know you just feel helpless don't you? I wish you lots of luck for the 11th. :)

I know what you mean about the SA results - we were absolutely devestated when we got 0% morph!!!! I felt like my life was over... I really didn't cope well at all. Luckily DH stayed positive, somehow?! I just hated all of the waiting, waiting to see the doctor to find out if it was a varicocele, then waiting for the appointment to get it fixed, then waiting for the 3 months till the improved results... god it was terrible!!!! It's certainly a rollercoaster ride, and not a good one either!

Our FS is Ric Porter at IVF Australia. He's close to my work, which makes it easy. Thank you, I too hope that we fall pg this month and don't need our appointment with him.

All the best for the 11th.

Sam

Sammi Jane, did you ever encounter any of the resistance towards varicocele repairs that we have? Our FS thinks it is a complete waste of time and said that while it does improve sperm quality, it doesn't improve pregnancy rates. But the studies he was basing that opinion on were including men with tiny little varicoceles and normal semen analysis. The ones that dealt with men with big, easy to find varicoceles, triple defect and normal hormone levels found that not only did it improve SA, but it did also improve pregnancy rates and it's much more cost-effective than IVF/ICSI.

I think they can increase my eostrogen - either that or give me injections of FSH directly so that I can grow eggs rather than using drugs like clomid which try to trigger the body into producing FSH for itself. It's not an area I've read much on - I've been more focussed on the varicocele lately.

BW

Hi BW,

We didn't see a FS until after the embolisation was done. We went to a urologist who found the varicocele and who wanted to do surgery to fix it. We then went to the guy that Leah recommended in Kogarah Hospital and had the embolisation done. We then had an appointment with a FS who, after looking at DH's results, said that he agreed with us having fixed it, although he thought the surgery was the better option (not the embolisation). I was quite surprised because I had heard they thought it was a waste of time. I think because DH had the triple defect he thought it might improve something. Well the results speak for themselves, although we're not pg yet.....

It was a very difficult decision to make because everyone we spoke to told us something different. Leah was recommending the embolisation, the urologist recommended the surgery, other things I read said neither would get us pg. It was really hard to feel confident about what we were doing. In the end I decided we just had to choose something and do it, and ignore everyone else.

It is amazing what they can do though isn't it? They can make you ovulate if you don't... it's pretty incredible. I'm sure they will be able to help you.

GL on 11th. Let us know how you go. :)

It's a very difficult area! It's nice to know that we aren't the only ones who have to face the repair or ignore question... and then the surgery/embolisation option if you do decide to repair... Not that it makes the decisions any easier.

The way I figure it, anything that improves sperm count, motility and morphology has got to make it easier to get pregnant! And some reading I have done suggests that leaving the varicocele alone will just make things get worse and worse over time. My DH's effected testicle has already shrunk somewhat, which is rather disturbing!

Hopefully both of us will be successful soon.

BW

I know what you mean. I wish there was something I could do to fix it for both of us!!! I agree with you - whatever you can do to improve the sperm quality has got to make it easier to fall pg.

GL, I hope you get it repaired soon and see great improvements 75 days later!!! And get your BFP not long after that!

Hopefully 2007 will bring what we so desperately wish for - motherhood. :)

my DH had huge improvement in count, morphology etc after having his repaired, his count actually shot through the roof. We did however, need ivf in the end as we both had problems, but he doesn't regret having it done at all, our philosophy and that of my gynea is that it would increase the odds while we weren't ivf-ing

All the best

Hi Jane,

I remember 'chatting' to you a while ago about varicoceles. You were a help to me back then, thank you. I'm so happy to see that you're pg. Congratulations!!! You must be over the moon. I hope you have a healthy happy pregnancy.

Congratulations!

Sam

Thanks Sam, we are very excited, DH is sure having the embolisation done has helped us along the way.

I can see what you guys mean about the resistance towards having it done, I think the biggest problem which our andrologist told us, is the lack of research done on the topic. Apparently due to the nature of infertility and the length of time that would be involved, not enough people are willing to participate in any research. I have heard so many positive stories along the way where guys have had the repair or the full surgery and had such positive results. I must say that it was something I was worried sick about, I just wanted to get on with IVF if I had to go down that path and stop wasting time, looking back even though we did need IVF I am still glad he had it done.

Thankyou to you both for your insight on the topic of varicoceles!

I was getting really frustrated by the research that the FS handed us. When much of the research involved men with sub-clinical (only detectable by ultrasound) varicoceles, and/or men who already had normal sperm counts - it seems blatantly obvious to me that of course correcting those varicoceles wasn't going to improve anything! There is very limited research out there on men who have large varicoceles, triple defects in sperm and normal hormone profiles - I've encountered quite a few studies that were abandoned because they couldn't get enough participants!

Jane, did your husband have the embolisation or the surgery?

I think that if we need to have IVF anyway for my issues, then we won't be worrying about the repair, DH seems to be positively terrified of it now after our last FS appointment!

BW

Jane, did you fall pg on your 1st IVF? Congats again!!

BW, please tell your DH not to be terrified. My DH was fine. It's all over so quickly and there's no pain, just minimal discomfort for a couple of days. Of course it's up to you, but we thought it was worthwhile fixing the problem for all future babies! :D It might help your chances with IVF also, or mean not needing ICSI. Your appointment on the 11th Jan will help I'm sure. GL !

Sammi Jane, just thought I'd give you an update on where we are at with the varicocele.

At the FS appointment we found out that we would need to do IVF+ICSI. The FS says that because of my PCOS that they'd do ICSI anyway as they get a better response, and repeated that he didn't think it was worth worrying about the varicocele. I've now got 4 weeks on the pill to try to get my insulin levels under control - it's not good when you can surprise the specialist with your blood test results!

We had an appointment with Leah the following day - DH doesn't normally go but he did this time, just so we can talk things through. We'll be going ahead with the varicocele repair, and the ICSI. The short term plan is to use the IVF to get me pregnant ASAP (:pray: ), and long term work towards getting my hormones under control and DH's sperm sorted so that hopefully we won't need to go to such drastic measures with subsequent pregnancies. We'll be going with a local doctor, though - we've found one that does embolisations only about 20 minutes from here, which sure beats the hour and a half from here! Meanwhile, Leah is wanting to get hold of DH so he can be turned into a pincushion too! :lol:

BW

Hi there BW

My DH has low sperm morph also, but it was not suggested that he had a variocole. What is it, and how is it diagnosed?

Thanks,
Kim

Hi Kim.

A varicocele is basically a varicose vein in the scrotum - it essentially cooks things and messes up the sperm that way. Our's was picked up as DH had a triple defect - low count, low motility and low morphology. I'm told that it's the triple defect, with an emphasis on the low morphology that could indicate a varicocele. It basically feels like a bag of worms in the scrotum.

There's 4 conditions that need to be met for a varicocele repair to be worthwhile.
1 - it is a large varicocele - there are some small ones that can only be detected by ultrashoud, they aren't likely to cause any problems at all.
2 - semen analysis is not good. If your SA is already normal, then repairing the varicocele isn't going to do anything
3 - male hormone levels are normal. If they aren't, then it indicates that the infertility/sperm problems are from some other source
4 - female partner is either fertile or has an easily correctible cause of infertility.

We meet the first 3, but fall down in a huge way on number 4. Even though we are going IVF, we think that having better sperm to start with should make the job easier, and there's always the hope that my problems will reduce with time and careful management.

Sorry for the overload of information - I've done a lot of reading on this! (bugs my FS that I have :rolleyes: ) If you're at all worried, it might be worth checking out.

BW

Hi BW,

Thanks for the update. That sounds like a great plan, and I'm so glad to hear you've got a doctor nearby that will do the embolisation.

Well, it sounds like you're on your way to getting your BFP!!! And who knows, No.2 might happen naturally!?!

You must be feeling so relieved to actually be doing something instead of waiting for tests, waiting for doctors appointments, and worrying about what is going to happen. I'm happy for you!

When is your DH having the embolisation done?? He will be fine, I hope he's ok about it.

Thanks for letting me know, I have been wondering how you're going.

:)

It does feel good to finally be heading somewhere, even though in some ways it does feel as though we have stopped for the moment - it's very hard to think of yourself as TTC when you are on the pill, but also nice to know that the scientists and doctors will take care of everything from here - it reduces the stress of wondering whether we BDed at the right time or not! I do also feel good about the fact that Leah is agreeing with the FS on everything apart from the repair - I've really come to trust and value her opinion on these things, probably to the point where I am more willing to trust her instructions than those of the FS, which probably seems odd if you don't know Leah like we do!

DH has to get a new referral and still wait for an appointment. He gets the referral this evening and hopefully he'll be able to make the appointment with the specialist today. Hopefully once that has happened it won't take long to get the embolisation done as he already has the ultrasound from the old specialist.

I hope you have success soon in your quest for the ever elusive BFP.

BW

It must be weird TTC and being on the pill, but I guess those scientists know what they're doing! I hope it all happens quickly for you.

I know what you mean about trusting Leah. When we found out my DH had a varicocele we were being told all sorts of different stuff and I decided that we had to choose one person that we were going to listen to and ignore all others. We listened to Leah and did what she said. It seems to have worked in that DH's numbers are now normal (just low volume) but we're still not pg!!! Hopefully soon....

Let me know how your DH goes with the embolisation. I remember when we booked in there wasn't much of a wait so I hope it's the same with you guys.

Thank you, I hope we get a BFP soon too. This is our last cycle of trying naturally. If it doesn't happen this month we're off to try IUI.

Take care. :)

Thanks for that BW!

I had a bit of an emotional breakdown last night about everything! I think you can only be positive and block things out for so long and then it hits you! I think its partly had to do with the fact that AF arrived and well, its the last one before my app to start IVF, and you kind of get a little hopeful. And its also partly to the fact that im really SCARED! I dont know how my husbands low sperm morph is going to affect our chances at IVF/ICSI?

Do you guys often wonder- how many times will I need to do this? When is it going to be all over and I can be normal again? I know I do, and I think about it a lot lately!

I get really annoyed at my DH because he just doesn't want to educate himself on what his prob is. I do sooooo much research for him, and yes he reads it but you need to fight it don't you? He has resigned himself into thinking- "well this is what Ive got, and I cant change it"- And this really ticks me off!!!

Anyway I just needed to let all that out! As Im feeling pretty miserable today!
xx Kim

Also BW what FS are you seeing as I see that your in Sydney also?

Ta, Kim

Kim :hug: it is hard! And men do deal with it differently to us!

There's a book called swimming upstream which is absolutely fantastic! It explains to us how the blokes are feeling, and explains to the blokes how we are feeling - I have found it to be wonderful!

There's a thread in general conception which discusses it (but it keeps falling off the front page!). If you google "swimming upstream the struggle to conceive" (the full title), you should find the web site for it as the first link where you can order it online. It's not very expensive, and it seems to be written in such a way that men will find it easy to read (light hearted and funny). I can't recommend it enough, and DH is even reading bits of it now without having to be asked or badgered into doing it.

To be honest, I don't know how the bad sperm is going to effect our IVF/ICSI chances, while we are going to do what we can so that there is better sperm there for them to use, the FS didn't seem too bothered by it.

We see David Knight at Next Generation Fertility which is in Parramatta. It's still a long way to go for us (we are at Windsor), but there really wasn't anything any closer. The great thing about NGF is that they don't charge extra for ICSI. Most other clinics charge an extra $500 on top of the other IVF charges, and there's no rebate for it. Even the Westmead Fertility Centre (public, non-profit IVF clinic) charges extra, and even though their overall charges were much lower, it was going to cost us more to go there with paying extra for ICSI. The other great thing with NGF is that we were in for our first appointment in just over a week - no long wait at all even though we got in just before they closed over Christmas. I don't know whether that was just very lucky or not, though.

Men seem to work things out in their heads by themselves, while women need to talk it through a lot, it does make it harder to deal with it alone as a couple without external support. Kim, think about joining us in one of the buddies threads - I've found that support to be absolutely amazing and helpful.

More big :hug: hugs for you, Kim. I'm sorry for the epic post - I seem to be in a very verbose mood today. I hope there's some shred of information in there that you will find useful. Feel free to keep in touch, too.

BW

Hi Kim.b

Where are you in Sydney? My FS is fanstastic, he's in St Leonards. If that's handy I'll give you his details.

I completely understand your 'breakdown'. I have one every month when AF arrives. It's horrible. This is our last month before starting on IUI so I'll be devestated I'm sure.

Yes I wonder when it's all going to be over. I wonder why I'm having to go through it in the first place! I wish that I was like those people who never know anything about infertility. They don't know how lucky they are. I'm sure once we're pg we'll be back to normal, or at least I hope so!!

How long have you been trying? My DH has become much more interested in what he can do to improve things as time has gone on. He's tired of waiting too, finally!! They can be difficult sometimes. And I think it's hard when it's their problem so to speak, there's times when I feel very much like it's all his fault, which is unfair but sometimes I can't help it.

Let it out - it's better out than in!! But then keep your chin up, try not to feel too miserable. Try not to think about what you don't have, but think about what you can do NOW to make it happen. ie, exercise, eat well etc. and feel good in that you're working towards your goal, that you're doing everything you can to make it happen!

You will get your dream of being pg!!! :)

Thanks Sammi,

Its good to know there are others who feel the same way! My story briefly is that I had a lap done last feb. They found adhesions over my left Fallopian tube, a tubal cysyt outside my fall tube and mild endo. They fixed everything and sent be away with a 'everythings fine now' speech. But when my DH had a SA done his morp came back normal except for his sperm morph- which one test showed 3% normal forms and the next @ 5% normal forms. BUT- we were still told by very good FS that this was OK and that we could still conceive- well I didnt! I went to see another FS in Nov last year who told me that this Sperm morph was not good and we would need IVF/ICSI to conceive. Why is it that two highly qualifield FS led us to believe there wasn't a prob, and another to tell us we needed ICSI. I feel like I have WASTED AN ENTIRE YEAR! I could have been starting IVF last year- another thing that is really annoying me!

Anyway I have lots of worries: a- to I trust my FS who was also my surgen that my probs are fixed? He was very positive about it but who knows and b- how difficult is it going to be for my DH sperm to be successful?

Thanks for the vent I really need it today!

xx Kim

Kim, the other thing that you may find useful is the acupuncture centre that both me and Sammi Jane go to, it's in Rozelle, which is an hour's drive (usually a bit more) each way for me, but I just won't be without it now, it has been so helpful. Google the Rozelle Acupuncture and Chinese Medicine Centre - they specialise in infertility, IVF support, etc, and may have some suggestions of what you could do to help out your DH, and yourself.

BW

Thanks for that!

I have spoken to the nurse at the FS who suggested that chinese herbs/accupuncture should be spoken about with my dr first as some herbs etc aren't good to take while doing IVF. But my DH has made an appt with a place in Paddington that I have been too also that does the same thing! But I will look into the Rozelle practise it sounds great!

Thanks,
Kim

Kim.b, it's very frustrating when experts tell you different things isn't it? I don't know how a FS could have told you that 3% morph is ok. Although, in saying that I have read about a number of women who have fallen pregnant with lower morph, but it would take a while.

Could you have a HSG done to check that your tubes are clear etc for your peace of mind?

I agree with BW, I would definitely see an acupuncturist to get their opinion on your DH's numbers. Ours is great, but I'm sure the one you've got is good too.

When are you starting IVF?

Sam x

Im going to see my new FS this Friday, hopefully starting IVF ICSI straight away. By the way could I have the name of the accupuncturist you go to in Rozelle.

Ta,
Kim

The two acupuncturists at the centre are Jann and Leah. Both Sammi and I see Leah. I can never remember how to spell her surname, though!

BW