Varicocele Repair to the Rescue

The case of the month is an actual patient of The Turek Clinic.
“You should considering fixing what might be the problem,” I told them on their first visit. They stole a glance at each other and then looked back at me, glassy-eyed and in disbelief.
“Doctor Turek, with all due respect, we have failed IVF twice. Do you really think this bag of veins around my husband’s genitals is causing our infertility?”

What Happened?

They were both young, in their early thirties, and very anxious to have children.
“All my friends were having kids, and several used IVF, so I felt comfortable doing this when it wasn’t working at home,” she told me.
He had a fairly low sperm count and motility, picked up by her gynecologist on a routine semen analysis.  Half deflated, he told me: “I’m a numbers guy. Based on what I had, we were told that IVF is the best option.”
However, when it failed several times, they felt the need to regroup and consider other options. Since his only evaluation was a semen analysis, they did some research on-line and realized that a real male infertility evaluation was a bit more than that.
On their first visit, I agreed that his healthy lifestyle is not contributing to the problem. “You are the pinnacle of health,” I told him. “But…you also have a large left-side varicocele on physical exam.
“But, but…how come I didn’t know this?!?” he responded angrily.
“Because, Honey, all we had done was a semen analysis that was ordered by my doctor,” she chimed in.
I went on to explain how a large varicocele could affect the sperm counts and motility, but could also influence the “quality” of the sperm by impairing DNA integrity. Either or both of these issues might cause infertility. Even if the low semen numbers were overcome with IVF, the sperm “quality” issues could still affect their ability to conceive with IVF.
I mentioned our published research that showed that if he were to fix the varicocele, it would take an average of 7 months to conceive, which simply reflects the biology of sperm production.
“I’ll give you 5 months, and that’s it!” she told me with a deadpan face. “After that, we are heading straight back to IVF.”
“Deal!” I said and fixed the varicocele a couple of weeks later. An hour of surgery, two or three pain pills, a couple of days of rest and he was back up and running.
I received a call from him a little over four and half months later. He was in the hallway of the IVF clinic, speaking quietly with his hand over the phone:
“Doctor Turek, we are here enrolling in our next IVF cycle. The doctor here asked about my wife’s ovulatory cycle and she told them that it’s usually very regular but this month, she’s a couple of days late. They ordered a stat pregnancy test and guess what….it’s POSITIVE!”
“Great news! I said. “Be sure to send me a holiday card!
Chock one up to good old-fashioned, fix-it-if-it’s-broken, medical care!