Well, it turns out Mr. E had a varicocele after all. It really pays to get a second and even a third opinion.
When our TESE kept getting pushed around and delayed, I got very upset and had a little breakdown. I told my mom that I needed her to please find me a counselor (who was an answer to prayers). Fortunately our IVF clinic had a recommendation for an Infertility Counselor. If you even have the slightest impression that you could use someone to talk to, I highly, highly recommend that you ask your clinic for a recommendation.
After making an appointment with the counselor, my mom suggested that maybe my panic/anxiety/severe discomfort was less related to my impatience and possibly related to the doctor we had chosen to do Mr. E’s TESE or even to the fact that we were doing the TESE too soon. I’m so glad she said that because she was right.
We decided to pay the $500 for a phone consultation with world famous Dr. Peter Schlegel at Weill Cornell in NYC. He does microdissection TESE 4 times per year for 2-3 weeks each time. So if you want to go to him, you’ll be working around his schedule.
Anyway, it was December 2012 and we tentatively planned to do the mTESE in March 2013. At the end of the phone consult he asked me to send the CD of Mr. E’s scrotal ultrasound so he could verify that there was no varicocele.
Keep in mind that Mr. E had been examined by both the RE, the local urologist, and the radiologist who looked at the ultrasound pictures. All of them said that he did not have a varicocele.
Low and behold, Dr. Schlegel looked at the images and said he does have a varicocele. He said we did not have to repair the varicocele prior to doing mTESE. He also gave us a 50/50 chance of finding sperm during mTESE.
We decided to do the repair for two reasons:
1) to improve Mr. E’s quality of life: fertility aside, varicoceles can lead to low testosterone later in life.
2) repair of varicocele can bring back sperm in azoospermic patients in 5-10% of cases. Or increase the chances of success during mTESE in 5-10% of cases.
So in March 2013 we went to NYC, stayed in the Helmsley Medical Tower (the hospital’s hotel with full kitchens), and had the varicocele repair done (subinguinal, not embolization) by Dr. Schlegel. After surgery, he said Mr. E’s varicocele “was actually quite large.”
That was 5.5 months ago. Dr. Schlegel requires at least 6 months between surgeries.
Starting 2 months after the surgery, we’ve been doing monthly semen analyses. At the 3 month mark we had another scrotal ultrasound (which came back with “no evidence of varicocele”) and bloodwork.
The bad news is that we still don’t have any sperm, but Mr. E’s testosterone went up over 200 points from his lowest and over 100 points from his highest. For his long-term quality of life, I think this is a great improvement. His FSH also went up. I don’t know if that’s good or bad. Sounds bad (FSH goes up when the body is telling the testes to make sperm), but I’m really not sure.
As far as recovery, Mr. E was in hardly any pain at all. One thing that I think helped a lot is that he took a few doses of Celebrex the day before the surgery. We were also very diligent about following instructions: resting for several days, but walking a little (no blood clots allowed!), setting timers to change ice packs regularly (every 3 hrs), wearing the jock strap for 3 weeks, and not lifting over 10 pounds for 3 weeks.
For those who are interested, Dr. Schlegel’s fee for the surgery was $8,000. The anesthesiologist fee was fortunately covered by insurance. It was over $2,000. Including flights, hotel, and meals, we spent almost $14,000.
If we could choose to do it all over again, I think we definitely would.
Here’s an interesting study about the role of varicocele repair in infertile men.
As I’ve said before, I’m not a doctor. The point of this blog is to tell you our story (you’re not alone!) and to help you brainstorm with your doctors on a treatment plan. Remember, YOU are your best advocate! Nobody cares whether you have a baby more than you. Do your research. Read as much as you can. Good luck on your journey!