Talk to me about varicocelectomy (long w/ research)

maggie2324

So we met with the MFI uro who decided after 4 months of antibiotics, it was time to do a semen culture. So we will do that this week and have the results in 1-2 weeks. He said that he doesn't expect anything to come of it, but just in case it finds something that needs a different antibiotic, we should try it.

Then he said that our only option if we didn't want to do IVF was a varicocele repair. He said its somewhat of a longshot, but he codes it as varicocele not infertility so insurance usually pays for the $4600 procedure. Everything that he and my RE say points away from the surgery. Apparently it RARELY helps morphology.

I decided to do my own research on google scholar and I'm finding more pros than cons. One study said that the median improvement on morphology was 3.6%, with 63% of men having improvement.

Another one said that it helps with count most when men have a concentration between 10 and 40 million/mL (which we do), and that when there was a dramatic increase in count, motility and morphology improved as well. 

A third one says that motility, total motile sperm, number and percent of normal Kruger forms all significantly increased. Volume and forward progression didn't change. With the morphology, the heads became more normal, while tails and midsections remain unchanged (our problem is with heads).

sbrowns08

Hey there! My husband had the surgery last March. We were dealing with low motility and borderline-low morph. Since the count was generally normal-above normal, we opted for the surgery.

Recovery was pretty rough, and we didn't see any results until about 6 months post surgery. In fact, his 4 and 5 month samples were worse than prior to surgery.

Interestingly enough,  morph is the only area where we have seen consistent improvement. It went from 4-5% prior to surgery to about 17-20% now. The specific area of improvement was in tapered heads, which is a sign of varicocele damage. (For example, prior to surgery if he had 95% abnormal morph, 70% of those were tapered heads).

Count and motility increased for a while, and then sort of dropped off again. I didn't get pregnant and we moved on to IVF (there is some evidence that I have some IF issues as well though). We're glad we did the surgery though, as we know there is also evidence that it also improves the integrity of the sperm's DNA as well. 

It's a tough call and I wish you luck with whatever you decide. Feel free to ask more specific questions, I hope I can help!

Trish11278

It is very rare that surgery helps with morph but there are cases that it does.  My husband got the surgery but we decided to do it mainly because of his extremely low testosterone levels, which can cause future issues.  In our mind, if it helped with MFI it would be an added bonus but we weren't getting our hopes up. 

Prior to DH's surgery, his motility and count were borderline "normal".  His morph was only 4%.  After the surgery, he was monitored a couple times and noticed a climb in all areas.  By the time he was released from his uro, his motility and count were amazing and his morph jumped to 12%.  The uro believes that it will continue to climb up to a year after the surgery.  

Now we are one of the lucky ones that it did help his MFI.  I would not have had DH get the surgery if we were just looking at MFI.  We were mainly concerned about his low T-levels and wanted to fix that before that caused any other issues.  It is something to consider because there is a chance and most insurances do cover it because it is not characterized as IF.  

GL with what ever you decide.  If you have any other questions about the surgery, please feel free to send me a PM.