I've been doing some research on possible causes of low sperm quality in men. I'm curious to know if anyone else can confirm if this is true, or give any experience.
I found some research about how Varicoceles, the abnormal enlargement of the scrotum caused by dilated veins, can cause male factor infertility. Something like 50% of men who have this are infertile. I'm thinking about seeing if our GP can refer my husband to a urologist to test for this. Any thoughts?
Hi. I can’t give any any advice on varicoceles but I can give you some about urologists based on my experience. My husband was diagnosed with azoospermia on every sample he gave. The gp ordered the sperm samples to be taken and our fertility doctor then went through the results with us. The first step they did was do a full genetic panel on him to check if he was a CF carrier or if he was missing or had extra chromosomes. When nothing showed up on that, he was referred to a urologist to see if they could locate a reason why he had a zero sperm count like a blockage somewhere or something missing. They did an ultrasound scan which is internal as well as external. My husband was then referred for surgical sperm retrieval with a low chance of finding anything. We were lucky and they did find some which they put in the freezer whilst we waited for or cycles to start. Depending on the results of any tests you have would depend where they refer you to next but we found the urologist very helpful. It rules out a few things, but it does extend the time you will be waiting before you can start treatment. Hope this helped. If you have any questions, feel free to ask x
Hi my partner was diagnosed with varicocelle and they offered him an operation but said there was a 50 percent chance that he would end up with chronic pain. As a result of the condition he has low motility and low count. Now we have done ivf and are going into FET. I'm not sure if that helps but I can ask him any questions if you have any xx
Hello, my husband had one which was quite large and causing very low sperm count, motility etc. He chose not to have the surgery but had a procedure where they stemmed the blood away from the varicocele which aimed to shrink it. He was then recommend by the urologist to take proxeed plus which boosted his count. I am now pregnant after my second transfer. We also got 7, 5 day blastocysts and 11 out of the 14 eggs collected were fertilised. So there is hope! Good luck 
p.s all of this happened within 9 months.
Hi. My husband was diagnosed with varicocles during our fertility journey. He also had low sperm count and motility. It wasn’t confirmed but told it could be the reason for it.
He had tiny coils put in but it didn’t changed his sperm count or motility but we now have a 21 month old after 4 attempts of ICSI.
Yes, my partner had it.
They cause DNA fragmentation, so you need a COMET test first.
My partner had surgery to remove the Varicoceles and the DNA fragmentation was reduced by 20% and we had more blastocysts x
Hi Mojitoito,
As you might have seen on another post of mine, my husband was diagnosed with two varicoceles. One huge one and one moderately sized one (there is a sizing system, but I can remember the official numbers). We were living in New York at the time and his Urologist (affiliated with major university medical center, i.e. very good doctor!) let us know that the benefits of the surgery for men who had small to moderate sized varicoceles wasn't always worth it as the effects on sperm were sometimes negligible.
However, as my husband had one huge one our doctor recommended surgery. We took the leap as we felt that anything that would increase the quality and count of my husband's sperm would give us a leg up in the actual IVF process. The logic is the better the sperm, the less rounds you might end up doing.
We are both so pleased he went ahead with the surgery as his sperm count, quality and morphology improved hugely, almost 700%, (along with many other tactics we put into place) and are about to start our first egg retrieval towards the end of June.
I hope the learning process isn't stressing you out too much. It's an upsetting time, but rest assured there are often so many medial treatments and lifestyle changes that can help!
Feel free to message me anytime.
xo Elise Mac
Thanks Elise. Yes, I did bookmark your post for reference. There is such a wealth of info here, I'm having a hard time keeping track of it all! We've been waiting for so long to see a doctor, but it seems like the wait is not over so I think we need to start being proactive by changing our lifestyle and seeking other types of treatment - like in urology. I will probably have questions along the way! My husband count is good (29 million/ml). But 85% immotile - which is actually a 10% improvement from 1.5 years ago, and we haven't really done anything to achieve that! He also has a 2% morphology which I think is low. I'm still pretty new to the UK system, but I suppose my husband should speak with his GP about his sperm analysis report, and see about getting referred to a urologist?
Hi Again,
I am very new to the NHS as well and it has been a learning experience for sure! As far as I understand, referrals come from the GP, so I believe that is the correct route to go to see a Urologist. I found that our IVF doctor in New York (not here in the UK) pressured my husband into freezing his sperm immediately and not seeking further treatment to potentially improve his count/morphology/motility--which I find odd--but hopefully your husband can get some answers (and maybe even some solutions) as to why his motility and morphology are low.
As you probably know, all the steps of the process to medical care and IVF inevitably take time. I started my husband and I on a healthier, more IVF friendly, lifestyle path over two years ago when we got his diagnosis and I am so glad I did as our bodies had time to adjust and improve as a result of the changes. Also, it took him quite awhile to kick his lifelong smoking habit (!). It takes a minimum of three months for sperm to reflect changes and even longer for a women's eggs.
Now we are heading into our first egg retrieval in early July and I am sure we did everything we could to make it count!
Wishing you all the best!
xo Elise Mac
Thanks Elise! My hurdle now is how to ease my husband into that conversation about lifestyle changes - not that he has a bad lifestyle (he doesn't smoke or drink). But I guess we won't know if supplements and a new diet will work unless we try it and get tested 3 again months down the line, right? He took supplements for a while, but would forget one day here, one day there, and eventually stopped. But I think I need to keep him accountable by taking care of my own fertility health simultaneously. Maybe at some point I can get him to change his underwear to looser boxers! haha. Anyway, we will try for a urology referral this week.
That is great your husband is already on the healthier side! I made sure to explain to my husband (fiance at the time) the benefits of the vitamins and supplements I was preparing for him and also bought him a day/night/weekly pill organizer that he loves. Now he sets out each 'day portion' with his breakfast and I always remind him in the evening. It took a bit for him to pick up the habit and now my reminders are a loving joke as he definitely doesn't need them. I think it does our minds a lot of good (hello placebo effect) to know that we are both trying our absolute best to make a healthy child. We feel like a true team in the face of infertility and it has felt amazing to turn such a devastating diagnosis into a way to strengthen our relationship.
Anyway, I hope that helps a little bit! Good luck with the Urologist!
Hello, My partner was diagnosed with a Varicocele in December after a referral from our GP to the urologist (this took about 6 months). It sounds as though they only offer surgery if it can be felt standing up rather than needing a scan to see it, as others have said - if it is larger than more chance in the surgery working apparently. He has low count and first test low morphology but second test this went up to normal - only thing we changed was he started taking wellman tablets and stopped drinking. He is on the list for surgery - it was meant to be in February but was cancelled. We are also on the IVF waiting list through NHS. Urologist said surgery will hopefully help as his results are 'boarderline' but our fertility consultant says the surgery is not a treatment and should go forward with IVF also. We are just doing everything we can/they tell us to, we have been TTC for 18 months.
I am sorry for your trouble and cancelled surgery! What great news that the morphology improved with Wellman and reduced drinking. I feel like IVF doctors tend to poo poo anything other than IVF itself as a solution to improving ones chances at conceiving. I find that frustrating as the human body is a very sensitive instrument that is typically receptive to changes in diet, lifestyle, medical intervention, etc.
When they found the varicoceles on my husband, our IVF doctor (who I loved) said the surgery wasn't worth it and that we should push ahead with IVF. But I felt that it was wrong not to seek medical advice from the specialist who knows that area of the body better than anyone else, i.e. the Urologist, and to go with his advice.
I am so glad we took our medical future into our own hands, as opposed to rushing down the IVF route. I guess what I am trying to say go with your gut and don't let anyone pressure you into rushing into IVF when there way be other pathways that could better your chances!
Hi, did the surgery go okay with your husband? I know what you mean! Feels as though our fertility consult really did dismiss the surgery. However the urologist has said that the surgery will hopefully help us conceive naturally so we are going with his advice and having the surgery - once everything eases with Covid and he is allowed to have the surgery. The urologist said that the wellman tablets wouldn't do anything, but fertility doctor said to take them (honestly I feel like they just don't agree with anything) so my husband is just doing everything each of them say - think he's just desperate for something to work.
I feel like that is a smart decision! I think each medical speciality doesn't think highly of others, which is fine with me when the education and choice is up to us. Man if I had let people's opinions (expert or not) guide me in this path, I would still be trying to "relax" and "not try" to have a baby. Yuck!
My husband had never undergone anesthesia before, so the surgery was definitely scary for both of us--but it went perfectly okay, thank goodness. The recovery was painful, but he didn't even need to take the majority of his pain medication. His activity was limited for a few weeks (from sofa time to no exercise, etc.) but when he was recovered he never looked back. There have been no residual effects on him outside of his improved fertility. So worth it!
As you probably know, once he has the surgery it will take at least 3 months to see improvement in the sperm. I've read that the maximum benefits are seen about 1 year later on average. In our experience we really focused on enjoying life, adventuring and having fun during this wait. Thankfully, we lived in another country, then got married and honeymooned during this period so it flew by. It was such a blessing not to focus on having a baby and IVF, for a time, as we all know how stressful it can be. And that was before COVID-19 came around--ugh.
Anyway, I wish you the very best in your husband's surgery and journey moving forward!
xoxo Elise Mac
Thank you for this, it has given me some hope, I haven't spoken to anyone who has gone through the surgery before. All the best! X
Hi, sorry to butt in on your conversation but some of the things you have mentioned throughout this conversation are so true and also intriguing.
I recently found out that I have poor semen (other than volume being normal everything else was bad) so you immediately start researching why?/how?/can I improve it?
I immediately started to change my lifestyle by not taking baths, eating a ton more fruit and veg etc whilst waiting for our fertility clinic appointment. We knew it would be a few months due to COVID-19 so I was trying to get ahead of myself. I would say a few months before I had my Semen analysis I felt a few differences in my left testicle compared to the right one and It obviously gets you feeling around etc. I won’t carry on with details but when researching what it could be I came across varicocele and seemed to fit quite a few symptoms.
2 days ago we had our telephone consultation with the consultant from the fertility clinic who, after a few questions and going through my wife’s results (which they were happy with) steamed steamed straight into IVF. He didn’t even suggest anything else, he said that IVF would be our best chance and let’s just crack on. I was quite shocked to be honest as I was at least expecting to be asked to do another semen analysis as I’ve only had 1 and I’ve read and been told from all angles that you always have a 2nd one to clarify accuracy. I then went onto tell him that I had a concern regarding varicocele to which he just suggested I visit my GP to be referred to a urologist as there is no proof whatsoever that it improves fertility.
I guess what I’m trying to say whilst venting my frustration is that I thought more would be done to source my problem or look into things that CAN help in any way, if only minor because surely improving my count still contributes towards our chances of successful IVF? Let’s say I did have a varicocele, I then got it treated and my sperm was to return to a normal reading surely that’s better as I could either improve my chances of conceiving naturally or improve my chances at IVF all from a little referral to a urologist and/or a Scan 🤷♂️
I think any male suffering from fertility issues should have a scan mandatory! I wonder how many men could have fixed the problem with a minor operation but didn’t bother because an expert told them it won’t help. I’ve read online that a correctly treated varicocele can improve sperm count alone by up to 700% so surely that’s worth looking into!!
Well, just like you did/are doing I’m taking it into my own hands, we can’t start IVF yet as my wife has to get her BMI down a little to get NHS funding so during this down time I’m getting a scan hopefully next week to see if I do have anything wrong down there and I’m about to start a course of a fertility supplement.
Sorry for the long post but it was nice to
See someone with the same sort of attitude towards this as me. Can I lastly ask....you said your partners sperm improved after his operation. Just how good was the improvement from count to motility etc if you don’t mind answering.
Thanks
Thanks for this post, CJM89 - you're not butting in at all! Your experience with the fertility clinic writing off the possibility of varicoceles is what I'm afraid my husband and I will go through too. We are having our initial consultations with a private clinic and NHS next week, and I am planning to ask about whether seeing a urologist would help at all - but I see that they totally ignored that option when you brought it up. What this the NHS? Or private? We would much rather get pregnant without having to go through the burden/cost/wait of IVF, so if there is anything we can do in the meantime to improve his sperm, we would like to do that.
Side note, my husband did call his GP to ask about seeing a urologist to improve his sperm and his GP basically said it wouldn't do anything... can you let me know if you are able to get to a urologist via your GP? I know the private clinic we are going through offers urologist consults, so we may end up doing that if our GP won't help us.
Keep it up, and best of luck!!
So we were referred as NHS patients but the clinic deals with both private and NHS patients and by all accounts is supposed to be one of the best about, apparently.
In regards to getting to see a urologist, I contacted my doctor and they have sent me for a scan and if the results warrant a urologist then they will refer me.
You mentioned the burden/cost/wait having to go through IVF and that is my exact thoughts on it. I really thought a bit more would be done to try and improve my sperm but it was straight to IVF. I was quite shocked.
No advice given on change of lifestyle, I had to prompt the idea of fertility supplements, when I questioned 2nd semen analysis the response was ‘you can have one if you want one’
When I raised my concern of a possible varicocele the response was that there’s no proof it helps and I could visit my GP if I wanted to check it out.
I make the consultant sound completely dismissive and although it felt that way somewhat, I can’t help feel he’s speaking from experience and maybe stats don’t support trying to improve men’s semen and that’s why he’s jumped straight into IVF but what he doesn’t realise is that if the one and only free round on the NHS were to fail, he said it’s roughly 5.5k a round thereafter and when you read stories on here of some people having 8 rounds of it, that sort of money is no joke along with the time you have to wait to become a parent!
Like i said before, working on improvements may bring it to a standard to conceive naturally or could at the least, heavily improve chances of fewer rounds of IVF or chances of successful IVF in general so more effort should definitely be made!
It does amaze me that if the male is the issue then seeing a urologist should be mandatory as male reproductive organs is one of their specialties!
There is enough proof for me after research that dates back to the 19th century that varicocele is a factor of fertility issues and once treated CAN hugely improve sperm count and quality and even if this is only in ‘some’ cases that’s enough for me to persue it and at the very least, rule it out.
I think you guys are doing the right thing and if you don’t try you’ll probably forever be wondering ‘what if?’ Which is why I will also exhaust every option to try and improve.
I wish you the best of luck and hope things work out!
Hi CJM89,
Thanks so much for sharing your thoughts and experience! As I expressed in my post above, it was a pretty frustrating/yucky feeling to be reminded, first hand, that the IVF world is a business just like any other business. Now my experience above did occur in the US, which is way worse in terms of privatizing and commercializing healthcare...but I did find it mildly shocking that two medical specialties (fertility doc and urologist) that absolutely should be working together, could have such differing opinions of each other's recommendations.
The way our urologist put it to us was this, 1) You could go straight to IVF, do a number of cycles and potentially have trouble with sperm quality throughout or 2) Do the surgery and start IVF later on with higher quality sperm and a much better chance of success. The option was very clear to both my husband and I. Our urologist even said he had a few patients who had spent YEARS and nearly six-figures on the IVF track and only reached the urologist afterward to then find a solution to their issues. That was simply appalling to me.
Our fertility doctor treated our situation (terrible sperm and my husband's age and my one ovary) with this emergency mentality. As if we needed to start IVF yesterday, or else we were doomed. It was a bad feeling to have. I understand the logic in his perspective, but I am SO glad we took our chances in delaying to give ourselves a fair and fighting chance when we finally made it to IVF. In addition to the physical space to improve our bodies, the mental time to process our plight and prepare ourselves and our lives for the emotional rollercoaster ahead, while strengthening our relationship--was everything.
Now the big caveat regarding varicoceles is that even our urologist said that undergoing the surgery had mixed results for patients with small to medium sized varicoceles. My husband had one extremely large one (G3) and a second large one (G1)--so he was the prime candidate for the surgery. I can see why doctors might poo poo the surgery when the varicoceles are minor...the clinical data just isn't there to support it (apparently).
To answer your question about my husband's post-surgery sperm results. I don't the exact numbers on the post-surgery motility--but it had improved so much so that our London IVF doctor was very pleased and very optimistic. His pre-surgery numbers were 17% total motility/7% progressive motility. So low!
The fact that your doctors didn't recommend/order a 2nd sperm test doesn't sound good. Every single doctor we've met with in the US and UK has encouraged retesting on multiple occasions as so many factors can effect the results and more than one test is needed to establish an accurate analysis. Also, I am kind of shocked when doctors don't recommend lifestyle/diet changes to improve outcomes--especially when it comes to male and female fertility. It is SO important!
I am sorry you are meeting with difficulty in trying to advocate for your best path forward--but keep on keeping on! You are definitely in the right frame of mind. We have to be our own advocates. Informed, open-minded and constantly examining whether the path set out for us by financially incentivized doctors is truly the best one for us.
Best,
Elise Mac
I completely agree with everything you’ve said. It is a business and I suppose if they sent every patient away for a year to investigate problems or change their lifestyle etc they wouldn’t make any money from IVF.
It is very strange that different doctors differ in opinion which proves my point that you should be referred to specialists in that field before writing off any possible problems/treatments and disregarding their potential importance.
Luckily, I’m not the type to just roll over and accept things and I’m willing to try anything and do anything to try and find out what’s going on.
In regards to my consultation.....not being asked for another semen analysis really did surprise me as I thought I’d be straight back up there for another go but I thought to myself seen as we’re not starting yet, I’d prefer to give it a few more months and see if my lifestyle changes have impacted it in any way.
Thanks for your story and best of luck on your journey!
Hi Rain415 , EliseMac , and anyone else who might see this.
I had my husband call our GP this morning to talk about this semen analysis test results and ask about seeing a urologist. He got his results back in February, but never got the chance to discuss the results, they just put in our referral to the fertility clinic straight away.
She basically wasn't very helpful, gave us phone numbers to call the infertility clinic (who of course is not answering right now), and said she doesn't think she should refer him to a urologist until we see a fertility doc. Is the only way for him to see a urologist? through the referral of the fertility clinic?
Its just that, I know its going to be months before get to see a fertility doctor, so I'd like to see if urology might be able to give us some answers in the meantime. How did you get your appointments?
Thanks ahead.
Hi Mojitoito,
I am sorry I missed your question above. My husband received his urology care while we were in the US--so I apologize that I don't have an answer for you. I hope that you've found some answers in the meantime!
Sorry I missed this! If not too late we were referred by GP. My husband booked an appointment and told him he thought he had a varicocele, GP looked through his sperm results and referred to urologist. Maybe we were lucky to have this referral but it might be worth going GP. Our fertility clinic has made it clear that they are separate to the Urologist. They think surgery won’t do much and urologist thinks supplements fertility clinic have proposed won’t do much. He’s been told to have the surgery even if it doesn’t help fertility as the varicocele has now impacted the left ball making it smaller. I’m sorry your having so much faff with this but your doing the right thing questioning and asking the consultants. Will warn that it took us 5 months to get a urologist appointment and with a different hospital as ours we’re not taking new patients. I would perhaps go back to the GP.
Thank you both! We have consultations with 2 fertility clinics next week so I will bring this up. Hopefully one of them might support this and we can get in with a urologist!
A friend of mine was diagnosed with varicocles. He also had low sperm count. It could possibly be the cause of it.
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