Arie Parnham, MBChB, FRCS (Urol)
Consultant Urologist and Andrologist at The Christie NHS Foundation Trust, The Christie NHS Foundation Trust
The slight problem with examination is that if you go to one doctor, he may say that he feels something and then you might go to another doctor who does the same thing and say that he is not convinced. If it’s visible, then it’s visible, that’s quite easy, but the ones with a grade 1 or maybe even grade 2 where you get a bit of discrepancy, and people struggle. Therefore, the best thing to do is to get an ultrasound scan where the parameters can be measured and checked.The EAU (European Association of Urology) Guidelines classify as a varicocele a maximum diameter of more than 3 millimetres in the upright position. In other words, standing during the Valsalva manoeuvre with some reflux (the blood is going the wrong way) for more than 2 seconds. An ultrasound scan is a bit more accurate than an examination. If there’s a suspicion of a varicocele, an ultrasound scan would be advised, and it should be done by someone who’s used to scanning testes and looking for varicocele and would do something similar to what’s described in EAU guidelines.
The answer to that is no, I don’t think it is. One semen analysis to another can vary quite significantly. It depends on so many other different factors. For instance, if you have an illness over some time, then in between those or just before a semen analysis, you can find a significant change in your fertility. You might find that your sperm count goes down, your motility goes down, it might change your DNA fragmentation.
If you look at DNA fragmentation while you get it, that’s still something that’s been worked on, but it’s looking at things like these environmental factors such as heat which is part of varicocele’s contribute to increasing the temporal or poor temperature regulation of the testicles, so it’s not abnormal. When we do semen analysis, we just don’t do one, we do several because then we get a bit of an idea and a trend of what is going on with your fertility.
I’m not sure if it necessarily would. If you look at what you’ve described there, I’d suggest that you’ve got a varicocele, and you’ve got your antibodies, I couldn’t definitively say that it would make a difference to that level. If you’ve got infertility, and that’s been ongoing, then preparing your varicocele would likely improve your chances going forward.
Not usually. The fact is that usually your the veins themselves aren’t working properly, and as a consequence of that, they don’t repair themselves. Most of the time, they don’t. You can do certain things to help mitigate against your varicocele. For instance, some people find that wearing a kind of snug underwear can sometimes help, but then that equally has the opposite effect of heating your testicles which you don’t want. It depends on what your problem with your varicocele is. If it’s fertility-related, then the answer usually is you probably need it correcting.
You can get it on the NHS. I think you have to find certain centres that will do it. If you’re referred to your local fertility unit on the NHS, then they should be able to offer you at least one of those options that we’ve discussed today. Whether that be embolization or Microsurgical varicocelectomy. The answer is yes, you can.
As I said at the beginning, in men, overall varicoceles occur in around 1 in 7 in men, so they are relatively common and certainly, they’re more common in people who’ve got infertility.
They probably are over time, and just as varicoceles in women are more common as you get older, varicoceles will be the same, you would imagine they would be more common in older men as well.
DNA fragmentation is kind of an evolving area within male infertility. While you’re getting this kind of variation in advice is probably, because it is evolving, and I don’t think there are any definitive answers on this. We know that if you’ve got a higher DNA fragmentation rate, your chances of having successful IVF or ICSI is lower. That would be one reason why you might find that doesn’t work. These studies are small, they’re not like massive studies with hundreds or thousands of patients, so you can’t definitively say that.
As far as I’m aware, there aren’t large randomized trials looking at it, so I guess it depends on what you’ve got. If you’ve got a varicocele, and you’re having issues with conceiving naturally, then I guess one of the things you might want to consider is a varicocele repair but will it make a massive difference, no one could promise you that if that makes sense.
That’s a difficult one, but the short answer is no. There’s not any obvious way to reduce our antibodies. Many people will say dietary supplements and things like that, but there’s no convincing way that I’m aware of.
They can, and it depends on what you choose. If you choose surgery, that’s probably your best chance of it not coming back. Based on the data that’s available that somewhere between 0 and 4% of them coming back. So, the answer is yes, they can, that’s the case with any surgery, and nothing’s ever 100%, but that’s probably your most reliable way. The recurrence rates and embolization are between 4% and 11%, so they’re not vastly different.