Varicocele diagnosis -- need to vent/worry/etc.

[belovedbride07]

DH finally got his diagnosis -- bilateral varicocele -- and I need to get this off my chest.  I know I've been irrationally sad since we found out (this isn't that bad in the grand scheme of things), but there has been a sort of finality to a real diagnosis that I have found much more jarring than I expected.  Also, I just had a birthday and it has been hard/disappointing to see be a year older and realize that parenthood is not coming when we thought it would.

The doctor is recommending surgery, but says it is is entirely up to us; he thinks it is more likely than not that it will help, but of course there are no guarantees.

DH wants to go ahead and do it, especially since it can take 3-6+ months to see results.  I'm a little more hesitant; I don't go in for my saline sono until June to see what's up with my funky cycles, and from there we will schedule bloodwork and the HSG, so it will be months before we know if there is anything on my end that indicates this isn't going to happen without intervention on my end (in which case, if we're skipping straight to ART, maybe DH could avoid surgery).  But on the other hand, if DH could get his numbers up, maybe IUI could still be on the table...

The more we talk about it, the more I am on-board with just doing it now.

The other consideration is that DH may be changing jobs within the next few months.  He already talked to the doctor about it and he isn't concerned about the insurance issues, but it's just another hassle.

We just want a baby!  Why do our bodies have to be so difficult!

[jewel]

Well, I responded a bit in the other thread, but I'll give you some more details here....

How bad was the SA? Vericoceles don't necessarily mean infertility.

At the time of our dx, my husband was seeing one of the top urologists in the state of California. She recommended surgery, but said that at his age (late twenties at the time), it was much more likely to be unsuccessful. By then, she said that the veins are usually too stretched out to return to normal size, so even once the blood is circulating properly, the amount of blood naturally flowing through the veins keeps the testicles too warm to really improve counts.

We went through with the surgery long before we started TTC. There are a few options for surgery, and he went with an incision in his neck, with a ton of tiny metal screws placed in small arteries in his lower abdomen, blocking the flow of blood from the problem areas. The surgery itself was completely successful, in that the misflow of blood was corrected. The vericoceles looked on lot better, and were smaller, but definitely didn't go away. My husbands numbers stayed basically the same, so in terms of fertility, the surgery was a failure. The doctor wasn't surprised, but thought the effort was worth it.

Depending on the type of surgery your husband is looking at, the risks are typically very low. My husband was out of work for one day, and back to normal the next. The process was incredibly easy. It wasn't even an option for us not to try.

Age does make a difference though, if you're looking at the possibility of IVF. I don't remember the details, but my doctor showed us a chart of IVF success based on age of the mother. It played a part in our decision to try less invasive options first, because based on my age, my chances of success with IVF were the same at that date, as they will be next year. If I was getting close to the decrease, we would have been more aggressive from the start.

Everyone has a different outlook on TTC, especially when you have known issues. Mine is - living with no regrets. When we come to decision-making times, I always approach it with the though of 'which direction would I be more likely to regret' which usually leads us into trying almost anything. I would have regretted not trying the surgery. I would have regretted not trying a few rounds of clomid/IUI ($190/ cycle vs $15,000 for IVF). I can live with failures much more easily when I can tell myself - at least we tried everything we could. I just hope that we end up with a baby somehow, and this will alll quickly be ok.

Good luck. Give yourself a little time to process it, research options, etc. It's still raw for you, but it gets easier.

[G22]

Jewel gave some good advice.

My H was diagnosed with left varicocele last spring. Because he is military, and our insurance is through that, they wanted us to try the cheaper less invasive option first. Which was for him to have the repair surgery, before going straight to testing me. So he did it last July. We were told, it would probably not change any of his numbers, and it didn't.

He had an incision on the left groin area that they went in through to fix it. He was out for about 2 weeks, but part of that has to do with his job and the strict rules around being fit for duty. He felt OK to go back after a week though.

I am glad we did it, in case it had worked. Its just one of those stepping stones we chose to try. It didn't work, so we then moved on with my testing. Neither of us regret at least trying it.

[belovedbride07]

Thank you both for replying.

His numbers were 1.7 mil and 10% motility, so not good at all, but it's better than zero. We're 28.

It's good to hear that it's not completely stupid to go forward before my testing is done; the doctor didn't mention anything, but I had read that that is the "correct" course of action.  As usual, must stay away from Dr. Google!

[jewel]

Apr 28, 2013 19:41:12 GMT -5 belovedbride07 said:

Thank you both for replying.

His numbers were 1.7 mil and 10% motility, so not good at all, but it's better than zero. We're 28.

It's good to hear that it's not completely stupid to go forward before my testing is done; the doctor didn't mention anything, but I had read that that is the "correct" course of action.  As usual, must stay away from Dr. Google!

Has he had more than one SA? If not, you really need a couple more to know what you're working with. One test alone doesn't mean a whole lot. My husband has had over 10 tests. One time, he had 1.5mil and one time he had over 20mil. All of the other tests came back between 4 and 9. Neither the 1.5 nor the 20+ gave an accurate picture, but had we only done that one test, we wouldn't have known otherwise. Those could have been a random fluke, lab error, etc. It can even vary day to day. My husband did 2 within a week once, and there was a difference of over 3 mil.

Also, some situations (fever, sitting in a hot tub), can overheat sperm and kill them. If your husband had anything like that during the past few months, it could have drastically reduced his count, and can take 3-4 months to recover.

1.7mil and 10% mot is not good, but it is something. I wouldn't hitch your wagon to that number just yet though. I'd really have him test again in a month or 2, and maybe a month or 2 after that. If you do plan to move forward with surgery, I'd also do that sooner rather than later. (and a hint - our insurance only covers varicocele repair as a medical issue, not a fertility issue. The doctor helped us with this, and under the report of "testicular pain" the surgery was covered)

[belovedbride07]

Apr 28, 2013 20:09:06 GMT -5 jewel said:

Apr 28, 2013 19:41:12 GMT -5 belovedbride07 said:

Thank you both for replying.

His numbers were 1.7 mil and 10% motility, so not good at all, but it's better than zero. We're 28.

It's good to hear that it's not completely stupid to go forward before my testing is done; the doctor didn't mention anything, but I had read that that is the "correct" course of action.  As usual, must stay away from Dr. Google!

Has he had more than one SA? If not, you really need a couple more to know what you're working with. One test alone doesn't mean a whole lot. My husband has had over 10 tests. One time, he had 1.5mil and one time he had over 20mil. All of the other tests came back between 4 and 9. Neither the 1.5 nor the 20+ gave an accurate picture, but had we only done that one test, we wouldn't have known otherwise. Those could have been a random fluke, lab error, etc. It can even vary day to day. My husband did 2 within a week once, and there was a difference of over 3 mil.

Also, some situations (fever, sitting in a hot tub), can overheat sperm and kill them. If your husband had anything like that during the past few months, it could have drastically reduced his count, and can take 3-4 months to recover.

1.7mil and 10% mot is not good, but it is something. I wouldn't hitch your wagon to that number just yet though. I'd really have him test again in a month or 2, and maybe a month or 2 after that. If you do plan to move forward with surgery, I'd also do that sooner rather than later. (and a hint - our insurance only covers varicocele repair as a medical issue, not a fertility issue. The doctor helped us with this, and under the report of "testicular pain" the surgery was covered)

No, he's just had the one SA so far.  I had him ask the doctor about getting a second one done, and he said that with numbers that low it's obvious that there is a problem so there isn't much value in doing it again right now.

We've run through all of the lists of "things that reduce sperm counts," and he wasn't doing any of them 3-4 months before the SA.

[azurely]

I'm sorry

I have no experience with a variocele, but try not to let it get you too down. A diagnosis means you have something to fix, and that is a good thing for sure. It sounds like surgery is a decent option, and like others said, at least then you will know you have done everything you can. It might not work for everyone, but maybe it will work for you. good luck!

[KaraOrNot]

No advice (well I do ditto the recommendation for a second SA, just to verify the numbers), but I wanted to say hugs and good luck.

[jewel]

belovedbride07 - I think it's important to trust your doctor, but I also think it's crazy to take any one abnormal test result as gospel. My RE retested everything that came back outside of normal. I'd be really unhappy with any doctor if they told me that there was no point in retesting (not just for IF, but for any medical issue). I think you should insist on another test, just to be sure.

[speyedr]

Apr 28, 2013 22:23:56 GMT -5 jewel said:

belovedbride07 - I think it's important to trust your doctor, but I also think it's crazy to take any one abnormal test result as gospel. My RE retested everything that came back outside of normal. I'd be really unhappy with any doctor if they told me that there was no point in retesting (not just for IF, but for any medical issue). I think you should insist on another test, just to be sure.

I agree with this as well! DH did his first SA through my ob/gyn and then went on to see a urologist. The urologist wouldn't agree to any other testing until he had done a second SA just to make sure the first wasn't a fluke.

[belovedbride07]

Apr 28, 2013 22:48:09 GMT -5 speyedr said:

Apr 28, 2013 22:23:56 GMT -5 jewel said:

belovedbride07 - I think it's important to trust your doctor, but I also think it's crazy to take any one abnormal test result as gospel. My RE retested everything that came back outside of normal. I'd be really unhappy with any doctor if they told me that there was no point in retesting (not just for IF, but for any medical issue). I think you should insist on another test, just to be sure.

I agree with this as well! DH did his first SA through my ob/gyn and then went on to see a urologist. The urologist wouldn't agree to any other testing until he had done a second SA just to make sure the first wasn't a fluke.

Thank you both for sharing your thoughts; I'll discuss it with DH and suggest he might want to call the doctor and ask him to order another test.

ETA: Okay, that was quick.  DH agreed to call the doctor and ask him to order another test.  Obviously it won't change the varicocele situation, but if his numbers are something closer to normal than they were on the first lab maybe we'll want to reconsider surgery.