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SA results after varicocele embolization


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#1 danalori

danalori
  • Member
  • 377 posts
  • Location:Vancouver, BC
  • Dx:Male Factor
  • My Clinic:Genesis

Posted 05 September 2010 - 09:59 AM

Hi Dr. Said,

First, thank you so much for volunteering your time on this forum. An expert in male fertility will be deeply relevant and much appreciate here.

Prior to conceiving our daughter through IVF/ICSI in 2007 my husband's urologist detected a varicocele. Our diagnosis was male factor, and our RE in no uncertain terms told us not to bother with an embolization, and showed us a booklet he kept (handily) next to his desk citing a meta-analysis which showed that there was no evidence of improvement in conception rates.

After our attempt to conceive a 2nd child through ICSI failed, he went ahead and got the embolization, figuring there was nothing to lose. Here are his results:

Volume: still low at 1.4 (but the urologist attributed that to the unromantic nature of sperm collection!)
Concentration: 53 million (was 12-14 million before)
Motility: 75% (65% forward progression) (was b/w 25-40% before)
Morphology: 2% (was 0-1% before)
Everything else (liquefaction, viscosity, etc. was all normal

I was very surprised that the urologist, who I should add specializes in male fertility and consults with the fertility clinics, recommended trying naturally and said the semen quality was good enough to achieve a pregnancy. He really downplayed the morphology and said that it is not a good test, and that morphology is thought to be a "soft indicator" of infertility.

As pleased as I am about the results, I'm also not willing to try for 6-12 mos as he suggested before doing a final round of IVF. I'll be 36 in a couple months, and time is not on my side! I should add that the SA was just done at a regular lab rather than the more sophisticated one the fertility clinic uses. Would it be worthwhile to pay to get one done at our clinic?

Please share with me your thoughts on how we should move forward.

Thanks!
me: age 36; DH: age 36
Male Factor
IVF #1 June 2 - BFN
FET Sept.14/07 - 2 8 cell embryos transferred
Beta on Sept.28/07 - 918 BFP!!
Beta #2 Oct. 5/07 - 19,584

It's a GIRL!! Ava Lily, born June 13, 2008
FET September 2009 BFN
Fresh IVF/ICSI cycle November 2009
BFN
*thud* Natural BFP December 2010
8 week u/s - one perfect bean with a vibrant heartbeat = *love*

#2 Dr. Tamer Said

Dr. Tamer Said
  • Scientific Advisor
  • 134 posts
  • Gender:Male
  • Dx:N/A
  • My Clinic:ReproMed

Posted 09 September 2010 - 01:06 PM

Routine semen analysis has been and remains the main pillar for male fertility evaluation. However, the test and its interpretation is not devoid of controversies. In fact, it is very common to overinterpret the results. It is certainly worth it to invest in a proper semen analysis done by a professional who specializes in these tests. Unless the technician has a lot of experience in this area and undergoes routine proficiency testing, you will not be able to rely on the results.

In general the results of the semen analysis should not be interpreted as absolutes. Certainly a semen analysis with the numbers indicated above does not show any abnormality. Even the low morphology reading does not indicate that it is impossible to get pregnant. However, there could be other factors that were not tested such as DNA fragmentation and antisperm anitbodies that could impede your chances of getting pregnant.

The main question here is whether you can afford to wait for few months to allow for natural conception. I guess you will be the best person to answer this question with the help of your RE. It may be that a wait period of 6 months will negatively impact your IVF success rates or it may not. The answer to this question will determine how you can move forward.

I hope this helps, please let me know if I can be of further assistance.

Regards,

Tamer Said :)
Tamer M. Said, MD, PhD, HCLD(ABB)
Director, Andrology Laboratory & Reproductive Tissue Bank
The Toronto Institute for Reproductive Medicine - ReproMed
56 Aberfoyle Crescent, Suite 300
Toronto, ON M8X 2W4
Email: [email protected]