Varicocele and dna fragmentation & dr ramsey

[Flora14]

Hi I was just wondering if anyone has seen that their partners DNA fragmentation improved after having varicocele treatment?

I have had 4 failed transfers and we have recently found out my partner has got 26% fragmentation he has a varicocele so we wondering if that's a factor and whether we should get it fixed but we get told conflicting things as to whether too.

Just wondered if anyone perhaps got better quality embryos with IVF or or got pregnant with IVF after having the varicocele treated and DNA fragmentation reduced? Were you advised IVF or icsi for fragmentation?

Also I know doctor Ramsey is considered one of the best urologists for this in London and it's about £300 for consultation but I just wondered if he did say that my partner needed his varicocele treated does Ramsay do that himself in london? or does he refer you to somebody else? Does anyone know how much that surgery would cost?

Thanks in advance sorry for all the questions x

[Llizzie]

We saw Mr Ramsey in December - my husband has poor quality so my husband did a comet test and also had a physical exam. He found varicoele and an ultrasound detected ingnuinal hernias.

Surgery wasn’t recommended to us as my husband has heart and vein issues so it’s too complex, but we found the consult really helpful and my understanding is he does operate.

Giving my husband a space where he could investigate what was affecting his fertility was worth it, even if there was no medical intervention at the end.

We’re about to start IVF ICSI to see what happens but we’re realistic about whether it will work as his fragmentation scores are bad (52% average).

[Flora14 in reply to Llizzie]

thanks for reply - did he give any advice to lower fragmentation naturally?

[Llizzie in reply to Flora14]

We’d already been on a bit of a mission by the time we had DNA frag. We improved count from 3mill to 13mill and motility from 12% to 44%. Morphology stayed at 2% in both analyses so the best guess is hernias and varicoele are just cooking the sperm.

We cut out processed foods and went mainly Mediterranean diet which was the biggest thing. Since then husband has gone alcohol free and stopped the hot baths and cycling and he’s on proceive max. They also picked up two infections in the latest semen analysis so I’m hoping that course of antibs will have also helped alongside the sacrifices he’s made.

We thought clinic would say go straight to donor but they said to give things a chance and see what happens. Feels like we’ve given him the best chance without resorting to complex surgery given his heart condition. Mr Ramsey is attached to our clinic so I’m considering another consult when we have the results of this cycle.

[soccerkt6 in reply to Llizzie]

Hi Llizzie

Could I ask which tests your husband had done to check for infections? I know there are several options - some semen analyses and some urine tests - so just curious which you did. xx

[Llizzie in reply to soccerkt6]

He had an infection screen at the same time as semen analysis. We did a bunch together but I’m pretty sure infection screening is done with urine samples. They found urea plasma and gardenerella and treated with antibiotics. x

[Flora14 in reply to Llizzie]

Hi Lizzie I just wondered if you can remember the cost of any of the extra tests he got done like the ultrasound etc? Thanks

[Llizzie in reply to Flora14]

£300 for the ultrasound and another £800 for the additional analysis - that included a Comet test, infection screen and a repeat semen analysis. A lot I know.

[Shirazlover2013]

Hi flora, yes we are patients of Dr R and my OH had a category 4 varicocele that we got embolised last year. Feel free to have a read of our history in my profile. Our dna frag results initially got worse which was confusing so may have been linked to possibly having covid after the surgery. But since then results are better(ish) and are now apparently ok for a near 40 year old man. The comparison scale on the reports is from a control group of men in their 20s who have fathered 3 children on the first try, in other terms super fertile sperm!! So anyone comparing their results to that will look bad.

Dr R doesn’t perform the surgery himself he referred us to a specific surgeon at a London hospital who he works closely with. We claimed ours under private health insurance (varicoceles often cause discomfort 😜) but I think the underlying cost was about £5k. Feel free to ask me any other questions xx

[Flora14 in reply to Shirazlover2013]

5k wtf!! we dont have priate insurance. did you find any supplements etc helped lower it? we only have 4% morphology too.x

[PaulaDag in reply to Shirazlover2013]

Hi Shriazlover2013, which private health insurance are you with? I am trying to get a Dr R consultation and tests/investigations covered via our Vitality insurance. We haven't seen him yet but trying to book but unsure which clinic/hospitals will be covered. Which clinic did you see him at and did the tests also get covered?

Thanks xx

[Aquarius_hope]

Thank you so much or sharing these stories ladies xx

It’s really important that men’s fertility is also looked at during our ivf journey... but that often isn’t the case !

[Flora14 in reply to Aquarius_hope]

nope we get blamed for everything dont we.x

[LauraEW]

Hi Flora, my OH had a very large varicoele that he got embolised on the NHS so I would check with your doctor to get an NHS referral if you can. My OH still had poor DNA frag but this was only tested a few years after the surgery when we decided to see Mr Ramsay so I can’t say if the surgery improved it. However he put us on a supplement and diet program which we saw huge improvements- so much so that I am currently 10 weeks pregnant naturally! You can see our full story in my bio. I would 110% recommend seeing Mr Ramsay - I wish we’d done it sooner xx

[Flora14 in reply to LauraEW]

thanks so much- he seems to have links with a nutrionist then? i suppose we have to pay to speak to them or get a plan?? cause £300 consult not enough lol. weve already lost 25k!!x

[LauraEW in reply to Flora14]

Yes he did refer us to a nutritionist, another cost but again totally worth it. I think from memory it was around £150, you only need 1 appt. Same here, I think we are at the £30k mark and people ask us why we aren't married - wedding budget - not going to happen...!! xx

[Flora14 in reply to LauraEW]

What supplements did he recommend for you? Yeah we are not married either x

[PaulaDag in reply to LauraEW]

Hi LauraEW, did you see Dr Ramsey via the NHS or privately ? I've been trying to book for my partner but is secretary seems to indicate he doesn't work for the nhs anymore. If you paid privately what were the costs for the tests? xx

[LauraEW in reply to PaulaDag]

Hi Paula, we saw him privately. Tbh I can't remember the exact costs as it was a while ago now and I try not to keep a budget tally as it's too depressing! I assume it depends on the range of tests, but I think all in all for us it was around £2k (tests & appts) xx

[waitingg]

Hi Flora,We saw dr Ramsey after numerous fails and he was brilliant. Felt like it was the first time someone listened and explained about the male side of things. He ran tests on my husband which weren’t cheap but they found 37%ish dna frag and a varicocele. He had the varicocele removed- it was very expensive but could have been done on nhs (this was pre covid though) if we had waited.

We did a nutrition plan, imsi on the next round, along with immune treatment on our side and we had our little boy from that round.

I think he works alongside the Lister and does some of the direct sperm retrieval if that is needed.

He has done an Instagram live with Melanie Brown in the past which I guess will be on her Instagram which might be useful to watch. Lots of luck xx

[Flora14 in reply to waitingg]

how much did you pay? i dread to think. what percentage do they advise sperm retrieval do you know? ok thanks i dont use instagram but will look her up. did you retest after getting it treated then and now what it went down to?x

[waitingg in reply to Flora14]

I think it was about £5k - it was a lot. I'm not sure about the percentage and sperm retrieval i'm afraid - i'm not sure if it is determined just from the DNA frag percentage. We retested about 4 months later and it only had decreased a few percent so I was disappointed, especially for the cost! But we were told it can take 6months - a year to change for some people. Who knows. I definitely think IMSI helped a lot to by pass some of the DNA frag issues. Does your clinic offer that? x

[Flora14 in reply to waitingg]

Can you remember how much the extra test cost you just so I have a rough idea? I think we will probably need ultrasound. X

[try2020]

Hi Flora, my husband has reduced numbers (9mil/ml), he also has a small varicocele. Once we found out he had MFI we asked about getting the varicocele fixed and both IVF clinics we spoke to said there is no evidence it will improve chance of success and his GP said he would only be referred for treatment if it was causing him pain, basically they won't do it to treat his MFI. As we have to do ICSI we were also advised a DNA frag test result would not change the strategy. But I do think it's really important and have read a lot by Dr Ramsey (the IVF babble convo on male infertility was great). So just in case he has a degree of frag he is taking a sachet of proxeed plus in the morning and an impryl at night. Also frequency of ejaculation is really important. Waiting too long means they can be hanging about in a hot/toxic waiting room degrading. For men with OATS there is evidence that waiting less than 12/24 hrs is best! Good luck 🧡

[Flora14 in reply to try2020]

sorry whats oats? we have been told you cant take impryl with any other supplements??nyes how frequent should ejaculation be? is it every other day? does your partner ice the balls???lol. yes i fear the gp wont refer my partner they are crap with him and once they know we have had fertility treatment they dont want to know. i think he is going to have to start getting some pain!!!!lol but we need to know first if its advised to have treated and thats were ramsey comes in. i also wanted to see figures of before and after if anyone had any.x

[Flora14]

sorry whats oats? we have been told you cant take impryl with any other supplements??nyes how frequent should ejaculation be? is it every other day? does your partner ice the balls???lol. yes i fear the gp wont refer my partner they are crap with him and once they know we have had fertility treatment they dont want to know. i think he is going to have to start getting some pain!!!!lol but we need to know first if its advised to have treated and thats were ramsey comes in. i also wanted to see figures of before and after if anyone had any.xx

[Flora14]

thanks for the replies everyone - i just wondered if anyone had been told what the % fragmentation would need to be to have sperm retrieval???also anyone who hasnt already seen this and maybe has had a varicocele repair got any before and after numbers after having it treated?

thanks

[soccerkt6 in reply to Flora14]

Hi Flora

I could be wrong but I don’t think surgical sperm retrieval is determined solely by the fragmentation numbers. I think it has to do with determining where in the process the sperm is being damaged. If the damage is happening during ejaculation, then sperm retrieval from the testicles can help. But if the damage is being caused earlier on (by an infection or something else), then sperm retrieval won’t necessarily change things.

I think you’d need a consult with Dr Ramsay to help determine the answer xx

[Flora14 in reply to soccerkt6]

Oh ok yes I thought that all DNA fragmentation happened when ejaculating and so sperm retrieval always better but good point. I think ours must be through ejaculation thougho as he has been tested for infections in semen and found ecoli but had it treated . Pass with the varicocele I'm guessing it's that it's not helping x

[Flora14]

Also sorry I meant to say were you recommended icsi for high DNA fragmentation? I know they can't tell if a sperm is highly fragmented by looking at it so sometimes I wonder if normal IVF would be better as surely the least fragmented sperm would win and fertilise the egg?

[Flora14]

I just wondered if anyone could remember how much the extra test cost them? Jyst so I can prepare myself lol thanks.Also any supplements that helped improve your to fragmentation? Thanks

[Flora14]

hi everyone just thought i would update - had apt with ramsey and to be honest feel pretty shit after it - he was nice enough but basically made me feel like it was all my fault and all my eggs that were bad and the blame was with me!we literally spent hardly any time talking about my partners sperm, he is 43 and has 26% dna frag,(said this would probably improve a little with surgery but this was literally all the discussion we had on it), 4% morphology and a large varicocele but ramsey basically rubbished all of that and said he didnt think that was the issue and those numbers were in fact good compared to the men he sees......never any pregnancies through natural or ivf x4 but i refuse to believe the issues we have with the sperm could not also be a factor as well as my older eggs now (now 38). spent the whole time talking about the treatment weve had more than anything and what to possibly try like pgs etc, didnt get to ask any of my sperm questions cause it was literally like he had already decided it wasnt sperm and blame was with me which made me quite angry- everye gg ive released over the 4/5 years wouldnt have all been bad and i know the morphology is on low side of normal - if it was 2 or 3%we would be told its abnormal so i dont get why an extra 1% makes it magically ok.

like i say he wasnt horrible he was pleasant and actually had people skills unlike other doctors but it felt very one sided and ironically not much focus on my partner but hey us woman get the blame for it all dont we.