Infertility and Varicocele: Key Insights for Couples

Q: Infertility and Varicocele: Key Insights for Couples

Jason： Regarding your question： 1. <br>Significant improvements can be achieved by adjusting physiological factors： maintaining a regular lifestyle, avoiding irritant foods, and exercising regularly. <br>2. <br>Any testing method is acceptable as long as there is an improvement c

Infertility and Varicocele

Hello Doctor, I have been trying to conceive for several months without success.
In September 2011, I underwent a semen analysis at an obstetrics and gynecology clinic, with the results showing semen volume: 6 ml, sperm count: 51 x 10^6, motility: 78.4%, morphology: 4.5%, and atypical forms: 2% (according to Kruger’s strict criteria).
While the sperm count and motility were acceptable, the sperm morphology was quite poor (normal is above 14%).
Subsequently, I visited a urology clinic where, after a physical examination and ultrasound, the doctor informed me that I had bilateral varicocele (2.7 mm).
He suggested that surgery is only necessary for varicoceles larger than 3 mm and recommended a follow-up examination.
In December 2011, I had another semen analysis, with results showing semen volume: 8 ml, sperm count: 81 x 10^6, motility: 70% after 1 hour, and morphology: 81% (but this was a general morphology assessment, not Kruger’s).
Since the results were good, the urologist advised me to relax and continue trying.
I would like to ask the doctor: 1.
The obstetrician-gynecologist believes that abnormal sperm morphology is unlikely to improve with medication or exercise and recommends proceeding directly to in vitro fertilization (IVF), stating that artificial insemination would also be ineffective.
Is it really impossible to improve? 2.
During the period between the first and second tests, I took traditional Chinese medicine and some supplements (zinc, arginine), which seemed to improve the results.
However, due to the different testing methods (general morphology assessment vs.
Kruger’s), could there be such a significant difference in the results? Which one should I trust? 3.
With a varicocele of 2.7 mm, although the doctor suggested that surgery is not necessary, would surgery lead to significant improvement in morphology? Would you recommend proceeding directly with surgery?

jason, 30~39 year old female. Ask Date: 2012/01/28

Dr. Xu Weikai reply Urology

Jason: Regarding your question: 1.
Significant improvements can be achieved by adjusting physiological factors: maintaining a regular lifestyle, avoiding irritant foods, and exercising regularly.
2.
Any testing method is acceptable as long as there is an improvement compared to your previous data.
3.
Generally, surgery is recommended for varicoceles larger than 3mm.
The more severe the varicocele, the better the improvement in sperm quality after surgery.
Of course, if a varicocele measures 2.7mm and surgery is performed, there may still be some improvement, but it will not be as significant as the improvement seen after surgery for a varicocele measuring 5-6mm.
In other words, given your situation, the benefits of undergoing such surgery may not be substantial.
Note: Based on your semen analysis, particularly the second one, natural conception should be possible.
It may be a matter of timing or possibly an incompatibility with your wife's bodily fluids (your wife may have specific antibodies that attack your sperm), which could warrant further testing.
Additionally, stress may also be a factor; consider taking a long vacation away from work and home, timing ovulation, and planning for a vacation of at least two weeks, as this often leads to pleasant surprises.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses should only serve as a reference; if necessary, it is important to seek medical attention at a healthcare facility.
This response is from Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2012/01/28

More Info

Infertility can be a challenging journey for couples, and understanding the underlying factors is crucial for effective management. In your case, the presence of varicocele and abnormal sperm morphology are significant considerations. Let's address your questions one by one, while also providing insights into the broader context of infertility and varicocele.

1. Can sperm morphology be improved through medication or lifestyle changes?
Sperm morphology refers to the size and shape of sperm. Abnormal morphology can impact fertility, as it may affect the sperm's ability to fertilize an egg. While some studies suggest that lifestyle changes—such as improving diet, reducing alcohol consumption, quitting smoking, and managing stress—can have a positive effect on sperm quality, significant improvements in morphology specifically are less likely to be achieved through medication alone. In many cases, if morphology is significantly abnormal (as indicated by Kruger’s strict criteria), assisted reproductive technologies (ART) like in vitro fertilization (IVF) may be recommended.
2. Differences in sperm analysis results:
The discrepancy between the two sperm analyses you underwent may stem from the different methodologies used. Kruger’s strict criteria are more stringent and provide a more detailed assessment of sperm morphology compared to standard semen analysis. Therefore, while your second test showed a higher percentage of normal forms, it is essential to consider the context of the testing methods. In general, Kruger’s criteria are more reliable for assessing the likelihood of natural conception. It would be prudent to discuss these results with your healthcare provider to determine the best course of action based on the most accurate assessment.

3. Impact of varicocele on sperm morphology and the necessity of surgery:
Varicocele, an enlargement of the veins within the scrotum, is known to affect sperm production and quality. While your current measurement of 2.7 mm is below the threshold for surgical intervention, it is essential to note that varicocele can contribute to abnormal sperm morphology. Surgical correction of varicocele (varicocelectomy) has been shown in some studies to improve sperm parameters, including morphology, particularly in men with significant varicocele. However, the degree of improvement can vary widely among individuals. If you and your partner are considering assisted reproductive techniques, it may be beneficial to consult with a urologist specializing in male fertility to discuss the potential benefits of surgery in your specific case.

In summary, while there are avenues to explore for improving sperm quality, including lifestyle changes and potential surgical intervention for varicocele, the decision to pursue ART should be made in consultation with your healthcare providers. They can help you weigh the benefits and risks of each option based on your unique circumstances. It’s also important to maintain open communication with your partner throughout this process, as emotional support is vital during the journey of trying to conceive. Remember, infertility is a common issue, and many couples successfully navigate these challenges with the right support and medical guidance.

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