Please forgive my long post as well as my lack of knowledge on all the blog acronyms. I tried being as detailed as possible since I really appreciated others who were also really detailed in my search for information on Vericocele based infertility. Also, hopefully by not using the acronyms, when people google some of the things I discuss, they will more likely come across this post.
My wife (currently 28 ) and I (currently 29) had been trying to conceive for ~20 months with zero success, not even a positive pregnancy test or a late period. We had even tried Clomid for 5 months.
I remember while growing up and attending my annual physicals, the doctor had made a comment about something in my testicles but it was a non-issue at the time. Being somewhere around the age of 12, I didn’t think much of it since the doctor said it was a non-issue. Fast forward through my teenage years I had always noticed that my testicle was kind of lumpy and veiny, but didn’t think much of it since the doctor during my annual physical through high school never really mentioned it.
After trying to conceive for 12 months and doing as much research as possible as to why my wife and I were having a hard time, I came across Varicocele as maybe a possible condition that I had. Doing a self-check, I seemed to have met the criteria (i.e. it felt like a bag of worms and kind of looked like it too). I set up an appointment with a general doctor and asked him about it, and while he admitted he wasn’t a specialist, he said it seemed fine but ordered me to do a semen analysis anyways. I did the analysis and while I hit a “passing” grade for everything but motility, it was only just over passing (Vol: 2.6 mL (norm>1.5), Count: 24mil (norm>15mil), morph: 4% (norm>3%), motility: 34% (Norm>40%)). We didn’t do anything further since I had passing grades and my first doctor said he thought it looked fine, we just continued to try and took Clomid.
My wife did an HSG test and everything looked good on her end. We were concerned about her family history relating to thyroid problems, but those tests came back fine (her mom has Hashimoto).
So three months after my initial appointment, I went ahead and made an appointment with an urologist who specializes in male factor infertility and sure enough, I had a bilateral varicocele, a grade three (out of three) on the left and grade two on my right. The doctor also noted that my left testicle was about 40% smaller and wished to do an ultrasound, another semen analysis, and a testosterone and FSH blood-work test. He did the ultrasound and confirmed that it was indeed 40% smaller (my left was 29.6mmx16.6mm and right was 36.6mmx22.2mm). My blood work came back and I had a testosterone level of only 283 (average for my age should be ~600) and an FSH level of 2.4 (norm between 1.5 and 12.4). My second semen analysis came back similar as the last one except this time the morphology was below average and motility was just above (Vol: 3.0mL; Count: 27mil; Morph: 1%; Motility: 44%). My new doctor mentioned that while my values did exceed the passing levels, he still considered them much lower than average and what he liked to see. Based on the above he recommended varicocele surgery and we went ahead and did it.
Before I discuss the surgery, I do want to comment on the low the testosterone issue. Some side effects of low T, besides issues with semen, are depression, lack of energy, loss of muscle mass, increase body fat, decrease in bone mass, and mood changes. I had being dealing with depression (prior to trying to conceive, in which the lack of success didn’t help), as well as a significant lack of energy and got pretty out of shape over the last 3-4 years. I also lost interest in doing things that I used to love and stopped meeting up with my friends. This could possibly be related. I would recommend for anyone with a varicocele to also get your testosterone tested as well, as it has other underlying issues.
The surgery that my doctor recommended, which also has had the largest amount of statistical success (based on a paper he sent me titled “treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique” by Selahittin Cayan published in 2009) was subinguinal varicocelectomy (I’ll let you google it instead of me trying to explain it). Due to the risk of inflammation, he would only operate on one side at a time, so my surgeries were split up one month apart. The first surgery, which was on my grade three left, was only supposed to take 1-1.5 hours ended up taking 2.5 hours because of the severity of the vericocele. He mentioned that the veins were wrapped around my testicle which was the reason for not growing as large as the other one, and the thick veins with hot blood were ultimately acting as a sweater to my testicle, keeping it too hot. He expected that my testicle, now free, will grow to the correct size, and in three months he hopes that my semen levels will all increase. The surgery on the right side was less difficult as it was less severe and it only took 1 hour. The recovery was to wear a jock strap and ice for about a week and to not lift anything over 10 pounds for 30 days. This was my first major surgery and the first time I have had anesthesia. I don’t consider myself a tough guy, but I really didn’t have any pain. I took the pain killer for the first 3-4 days after surgery and after that was completely off of it. I was only in discomfort when I was in the motion of sitting up or down, or bending at the waist. I also had to walk slowly so I didn’t stretch the incision. I was lucky because my wife took great care of me, and I didn’t really have to do anything. Both of my surgeries were on a Wednesday, so I took off Wednesday through Friday of that week from work. When I returned to work that following Monday, I was not in any pain, I just took it easy and tried not to bend over. The one thing though that I was not expecting, which was from the anesthesia and pain killer, was the constipation. Since I was not supposed to strain, it was really difficult. I started taking Colace stool softener a couple days after which helped, but still really hurt coming out. For the second surgery, I was ready and the doctor told me to start taking Miralax the night after my surgery and I didn’t have the constipation issues. Two weeks post op I was nearly back to normal body movements in zero pain and was back to lifting things again after the 30 days. I went for a run and had to wear the jock strap for extra support. Three months post-surgery, I was to go back and meet with my doctor to retest my testosterone and semen values.
Now to the part that you are probably most curious about, did the surgery work? Two weeks after the first surgery, it was the optimal time to try. I’m not going to lie, it didn’t feel great, there was still some swelling on my pen is (it didn’t hurt if I let it be), but I got the deed done. Two weeks later, I had the second surgery, and then two weeks after that, we got our first positive pregnancy test! The question is, was it from the surgery, or is it just coincidental since it should have taken 3 months from the surgery to see healthier sperm? Impossible for me to say, but since we had no luck after nearly 2 years and while on Clomid, I would argue yes. So all in all, it was absolutely worth it. Not only because we now have a bun in the oven, but also because it fixed some other underlying heath concerns for me. We are now 21 weeks along upon posting this.
My three month check-up included a testosterone test which saw an increase to 422, up 49%. It’s still not at 600 which is the average of my age, but an improvement and will hopefully continue to climb. The post-surgery semen analysis resulted in the following results: Vol: 3.7mL (norm>1.5; 1sttest:2.6mL; 2nd test:3.0 mL), Count: 175mil (norm>15mil; 1st:24mil; 2nd:27mil), morph: 2% (norm>3%; 1st:4%; 2nd:1%), motility: 30% (Norm>40%; 1st:34%; 2nd:44%). As you can see, the count increased 6 fold, however, only being 3 months post surgery the motitlity and the morphology hadn't quite imporved yet.
Like everyone else, we had a lot of questions and concerns that were cost related so I figured I share those as well. I have blue cross blue shield PPO insurance through my work. My insurance plan does not cover infertility treatments, but does cover diagnostic testing so many of our initial tests were covered after a copay. All my semen analysis, blood work, ultrasound, etc. were covered, but I’ll list what was billed to my insurance company:
- Wife’s HSG test – $1500 (covered by insurance)
- Clomid - $25 after insurance
- Scrotum ultrasound – $338 (covered by insurance)
- Semen analysis – $270 (covered by insurance)
- Testosterone test blood work - $322 (covered by insurance)
- Varicocele surgery – I had this surgery at a surgery center, so I received a separate bill from my doctor who did the surgery, the surgery center, and the anesthesiologist. For this, I had to pay my deductible first ($500), and then only 20% of the remaining total.
o Surgery center: Billed to insurance: $17258, discounted down to $2236 (yes, that is an 87% discount (I don’t understand the world of insurance pricing)). I paid a total of $847.20 (this included my $500 deductible that won’t apply to the other two), my insurance paid the rest.
o Anesthesiologist: Billed to insurance: $3091.50, discounted down to $1419.80. I paid $283.96.
o Doctor: $1976, discounted down to $1190.56. I paid $201.20
o Total for surgery: $1332.36