The Case of the Month is an actual patient of The Turek Clinics.
He sounded exhausted and desperate when I first spoke to him. Out of money and out of breath, he swiftly recounted all that the couple had been through trying to conceive. After trying at home for 2 years, they sought help. Proceeding to a “low tech” approach, they did 6 intrauterine inseminations (IUI), all of which failed. They then cranked things up and took the “high tech” road and failed two IVF cycles. Now regrouping, he stated: “Since my wife keeps checking out fine, Doc, I’m wondering whether it’s me!”
Seen as a telehealth patient in our new Maybe It’s Him™ Program, he initially checked out pretty well: reasonably good semen analyses along with a reasonably “fertile” lifestyle, including a balanced diet, and regular exercise. Gee, what more can a guy do?
But, ah the exam’s the thing. He had a big ole’ honking varicocele around the left testicle. Could this simple, innocent, nontender, bag of worm-like veins be the cause and the cure to their awful infertility struggle?
We did a “deep dive” on the sperm and it came up soaking wet. Indeed, his sperm DNA was heavily fragmented and its epigenetic profile was muddy at best. “It’s could very well be your sperm,” I told him. “Let’s try beefing it up.”
I placed him on antioxidant supplements and offered to repair that dang varicocele. There is pretty good evidence that when men take preconception, antioxidant pills, their partners are more likely to get pregnant and less likely to miscarry with IVF. The data is so compelling that the Feds are doing a randomized trial of male antioxidants to prove its effectiveness.
But what about the varicocele? Can surgery to remove it really help out here? You bet. We published that repairing varicoceles can:
- Reduce the level of technology needed to conceive, from “high tech (IVF), to “low tech” (IUI) to “no tech” (sex).
- Be equally as cost effective (read “cheaper”) as IUI for achieving a pregnancy and generally far more cost effective than IVF.
More recently it has been shown that fixing varicoceles can also improve IVF outcomes and can allow couples to conceive more easily even after IVF has failed. All due to shaping up of the tiny little, oft-ignored critters upon which our species depends for its survival.
His varicocele repair went well. He went home that day and was back to work on Monday. After 4 months, his sperm count and motility crept up into the normal range, but better than that, the “quality” of the sperm had really improved. There were now better players on the field.
“We took your advice, Doc, stayed at home and tried, tried again. I remember you saying that the average couple takes 7-8 months or so to conceive after the surgery. We did it in 5…that makes me above average, right?”
“No,” I said. “That makes you great.”