Varicocele treatment - surgery or embolisation?

[PurpleCrocus]

Hello all!

So we're currently have ICSI due to unexplained infertility, with possible mild male factor due to borderline-low motility and morphology.

My partner recently saw a urologist who has diagnosed a varicocele (big thanks to people on this forum for suggesting we check this out!). The urologist said there are two options: surgical or embolisation. The first is done by the urologist, and the second by an interventional radiologist. Both are day case procedures.

Does anyone have any experience with either of these? Were you given an option and, if so, why did you choose the way you did? Did you find any good resources or research comparing the two?

Thanks in advance everyone, any thoughts are much appreciated! 😊

P.S. We now have a couple of frozen embryos from our first ICSI in July, and are due to have our first FET this month (I couldn't have a fresh due to OHSS). So we have a bit of time to get the varicocele sorted and then allow 3 months for sperm regeneration, but are still hoping to get cracking on it ASAP!

[DianeArnold Partner Nurse Fertility Network UK]

Hi PurpleCrocus. Well done re your embryos. I think I would go for the surgical option. I’m sure some others who have actually had both options will come forward and explain wh6 they chose what they did. Good luck to him with whatever he decides and for the FET when you have it. Diane

[PurpleCrocus in reply to DianeArnold]

Thanks Diane 😊

[Rain415]

Hi, my husband had the surgical option in 2021. This was the only one available to us on nhs. So don't know much about the other one. Like you we had a frozen embryo as well and we had the transfer after the surgery which worked. The surgery was a day procedure. He recovered well. Test after the procedure showed his count more than doubled (that was our issue count and morphology) and the morphology increased from 2% to 5%. Good luck with everything! X

[PurpleCrocus in reply to Rain415]

Glad to hear things went well for you! Also that the surgery did improve your husbands numbers! Thanks so much for getting back to me 😊

[soccerkt6]

Hey lovely, so happy for you that you have a couple of frozen embryos and also found out about the varicocele sooner rather than later! My husband had the embolisation procedure last year and it went super smoothly. We had it done by Dr Steven Moser (he’s a consultant at Guy’s and St Thomas’ but also does private procedures at The London Clinic) who’s an IR that specialises in varicoceles and I can’t say enough good things about him. He was super knowledgeable and kind and just a pleasure to work with.

The reason we went with embolisation was because it was less invasive, had a much shorter recovery time than surgery and it seems that when surgery fails, the next step is embolisation anyway. And Dr Ramsay, the urologist that we saw, didn’t even suggest surgery and recommended just to go with the embolisation. I think as I’ve mentioned before, we conceived naturally a few months after the procedure, so it def made a huge difference in our case.

Good luck! xx

[PurpleCrocus in reply to soccerkt6]

Thanks so much! It was very much presented to us as an "either/or" type thing, so it's interesting to hear that embolisation seems to be the step after failed surgery! That really does make it feel like we should go straight for the embolisation! We also don't have a radiologist at the moment, so I think we'll look into Dr Steven Moser - your recommendation is pretty convincing!

Yeah, we would never have thought about the varicocele thing if it hadn't been for this forum, and then the more I read the more it seemed like we should just check it out! And I'm glad we did! We decided not to pause our ICSI (we're not getting any younger!) but thought we'd go ahead with getting the varicocele sorted, because who knows if things will work.

It's awesome that you managed to conceive naturally! That's such wonderful news! I obviously hope our FET works this month, but that gives us an extra bit of hope for if things don't go to plan!

Thanks again 😊