Can varicoceles cause male infertility?

Hello,

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I went through your query and understood your concern.

I went through your reports (the attachments removed to protect the patient's identity). Varicoceles are classified as grade 0 (2 to 2.5 millimeters), grade 1 (2.5 to 3 millimeters), grade 2 (3 to 3.5 millimeters), or grade 3 (more than 3.5 millimeters). There are various other gradings, but the Valsalva maneuver is performed to increase blood flow and check for flow reversal. But without Valsalva, if the size is less than 2 millimeters, and the patient is asymptomatic, then it is considered normal for the person. If symptomatic, then surgical intervention is recommended.

I hope this has helped you.

Thanks and regards.

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The ultrasound Doppler for the scrotal area shows the presence of a 3-millimeter left epididymal cyst in your case. The presence of a left epididymal cyst indicates that there is a collection of cystic fluid in the epididymis which is basically the outlet of sperm ejaculation. If there is a collection in the tract, then it can cause outflow obstruction leading to decrease sperm counts in men.

If there would have been cysts on both sides, then there are chances that the patient may have azoospermia or no sperms in ejaculate. But the cyst does not hamper the ability of a male to have intercourse. However, it can definitely cause a decrease in sperm counts.

The remedy is surgical removal of the epididymal cyst but there are chances that there may be future production of epididymal cysts again. So that has to be kept in mind as there are no ways to actually prevent their recurrences.

I hope this has helped you.

Thanks and regards.

Hello,

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Blockages can cause a decrease in semen quantity, yes. But if only one is blocked, then it should not cause infertility as the other is open. Fallopian tube block can be checked with either hysterosalpingography or sonosalpingography. It is good to learn that you are taking supplements, and you may continue them. However, a semen analysis report would help us learn about your status.

Regards.

Hello,

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If the epididymal cyst is not in the middle and not blocking the duct, then it would not cause any decrease in sperm count for the sperm coming from that side of the testes. As your cyst is at the head or tip so it really would not block the passage, and chances of low sperm count due to an epididymal cyst is unlikely in your case. You may get the semen analysis done and can follow up with reports.

Regards.

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Your report shows oligoasthenoteratozoospermia, which means low concentration per ml + slow-moving sperms + abnormal morphology of sperms. With abnormal forms of 98 percent and only 2 % normal sperms, the chances of conception are very low. Of the total sperms, only 20 percent are motile; the rest are immotile (which is depicted by no value in the report). One thing which they have not mentioned is if any pus or epithelial cells are seen in the semen, which indicates the level of infection in the semen and which can be the cause of such abnormal counts. You may get a semen culture and sensitivity as well to check for possible organisms causing the infection. Nevertheless, this is treatable and shall take a minimum of three months of treatment to restore sperm count and quality with medications. You may follow up with a video consult if you seek a prescription for medicines.

Regards.

Hello,

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You would need to get a semen culture and sensitivity test done. The presence of sperm indicates that there is production. But the sperms produced are either subjected to an environment like an infection where they get deformed or a warm environment where the overall quality and morphology of the sperms are hampered. With the present reports, your next option would be an ICSI (intracytoplasmic sperm injection) procedure which is IVF (in vitro fertilization).

Thank you.

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The causes can be multiple, and if no organic cause is established, then the reason remains genetic or stress-induced. The recovery of teratozoospermia will take 90 days as new sperms would develop under treatment with antibiotics followed by sperm energizers and multivitamins.

Regards.

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During the evaluation, the semen has to be liquified at room temperature. After checking the liquefaction time, the semen drop is mounted over the slide and then evaluated, so there are chances that sperms can become immotile, but not all. If they cannot cope with laboratory conditions, they will not be able to cope with the intravaginal environment. The fructose level in semen is also important as it is the food for sperm. Genetics cannot be commented upon unless screened, but it is unlikely in your case where sperms are produced but have turned abnormal and died. A mini IVF (invitro fertilization) is not an option. IVF ICSI (intracytoplasmic sperm injection) would be best for you.

Regards.

Hello,

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They should have mentioned fructose - present or absent because, in the absence of fructose, sperms cannot survive long at all. Also, if seen, pus or epithelial cells should be commented upon at least by saying not present. The sperm energizers, CoQ 10, and multivitamins shall not work if an infection is present and we do not treat it first with a course of antibiotics. Once ruled out with culture sensitivity, then you can continue with the medicines for three months to seek a reversal. But without that, it would not be prudent on my part to suggest energizers and multivitamins blindly. This is treatable.

Regards.

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The symptoms of burning micturition or pain in the penis or base of the penis are all usually associated with infection of the urinary tract - bladder or urethra but not the testicles. The symptoms of testicular infection manifest if the inflammatory reaction secondary to infection is more, and then it can present as painful testis or orchitis, or swelling in the testis. Nevertheless, a second repeat semen analysis with culture sensitivity would be a good idea to remove any bias. Also, prefer giving your sample after three days of abstinence from sex and ejaculation.

Regards.

Hello,

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In that case, just repeat the semen analysis from a different laboratory and also get a culture sensitivity; maybe the present report is wrong. If no cause is found, the counts would ultimately be attributed to stress or idiopathic cause. In either case, the treatment line would not change for you.

Regards.

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1. Please repeat the semen analysis again from another laboratory, as we would have two reference reports from different laboratories. Also, semen culture and sensitivity would be mandatory because in case we find an infection, then supplements and energizers would not be much helpful.

2. Clomid (Clomifene) can be held in the treatment, yes, and it is a part of treatment in different infertility regimens.

3. It is treatable as long as the testicles do not stop producing sperm at all. So have faith.

4. As far as supplements are concerned, you are on the right track and can use CoQ 10, L-carnitine, zinc, selenium, vitamin-D3, and Clomid, but in prescribed dosages to revive your sperm quality, but after a course of antibiotics as discussed.

Regards.

Hello,

Welcome back to icliniq.com.

1. As there is no concrete evidence of infection, we can go with no infection, but I suggest culture sensitivity anyways.

2. Good motility is more than 80 %, and in abnormal forms, less than 4 %. With these parameters, the chances of IUI success can increase manifold if timed properly with ovulation.

3. I do not think surgery is required for the size of your varicocele.

Regards.

Hello,

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Firstly, there are no yes and no facts about infertility. If one cause is contributory in one, the same cause may not be responsible in another man. So one has to treat every individual differently. There are men who, despite high motility and good counts, cannot conceive even naturally, as the chances of conception during each cycle are only 28 to 32 %. With IUI (intrauterine insemination), the cervical and the vaginal factors are removed, + rapidly progressive sperms are concentrated in a three ml post-wash sample (where, again, the count and quality matters), and even then, the success rates are between 38 to 43 % universally. So it is recommended that for idiopathic causes, the counts, quality, and motility should be improved first medically before opting for an IUI even. For understanding, there are cases where women got pregnant even naturally with poor sperm morphology. Still, the fetal heartbeat never arrived, or the case turned into a case of chemical pregnancy. So the WHO guideline is fine, and they recommend more than 40 percent rapidly progressive, but again, chances of success remain between 38 to 43 percent.

Regards.