
Hi Doctor, I Know Varicocele Is Common Among Men And

I know varicocele is common among men and I recently got diagnosed with having one when one day I felt a lump in my left testicle and went to the ER. They just did a physical examination and let me know I have varicocele but didn't mention which grade of it I had (1,2,3,4,). I would like to have children one day and I am deathly afraid of surgery so I don't think I would be open to the idea of having a removal procedure. What are the chances that my varicocele would cause infertility? My varicocele has never hurt. My scrotum and testes don't hurt either. I asked my general doctor for a semen analysis (she is also a gynecologist) and she told me the only time varicocele would effect infertility is if I was in extreme pain, which I'm not. Is this true?

I know varicocele is common among men and I recently got diagnosed with having one when one day I felt a lump in my left testicle and went to the ER. They just did a physical examination and let me know I have varicocele but didn't mention which grade of it I had (1,2,3,4,). I would like to have children one day and I am deathly afraid of surgery so I don't think I would be open to the idea of having a removal procedure. What are the chances that my varicocele would cause infertility? My varicocele has never hurt. My scrotum and testes don't hurt either. I asked my general doctor for a semen analysis (she is also a gynecologist) and she told me the only time varicocele would effect infertility is if I was in extreme pain, which I'm not. Is this true?
Only a semen analysis would determine if you need surgery or not.
Detailed Answer:
Good day!
Thank you for being with 'Ask A Doctor' service!
I'm sorry to hear that you have varicocele. if the varicose here is seen on the physical examination easily in the emergency room then it is considered a grade three varicocele.
Varicocele is seen in 10 to 15% of men and it doesn't follow that if you have varicocele you will have problems with fertility. Although among men with infertility 1/3 of them has varicocele. It is also been shown that lower grade varicoceles do not cause infertility but I do not agree because pain and the grading of varicocele don't correlate really well.
So, if you have a grade 2 or grade 3 varicocele then it may cause infertility or problems in their semen parameters.
I'd suggest you push through with your semen analysis to determine if you have sub-optimal semen parameters and if you do have abnormalities in the test then I think varicocele surgery will be the best for you.
Let me know if I can assist you further.

Only a semen analysis would determine if you need surgery or not.
Detailed Answer:
Good day!
Thank you for being with 'Ask A Doctor' service!
I'm sorry to hear that you have varicocele. if the varicose here is seen on the physical examination easily in the emergency room then it is considered a grade three varicocele.
Varicocele is seen in 10 to 15% of men and it doesn't follow that if you have varicocele you will have problems with fertility. Although among men with infertility 1/3 of them has varicocele. It is also been shown that lower grade varicoceles do not cause infertility but I do not agree because pain and the grading of varicocele don't correlate really well.
So, if you have a grade 2 or grade 3 varicocele then it may cause infertility or problems in their semen parameters.
I'd suggest you push through with your semen analysis to determine if you have sub-optimal semen parameters and if you do have abnormalities in the test then I think varicocele surgery will be the best for you.
Let me know if I can assist you further.

Yes. it improves semen parameters 80% of the time after surgery.
Detailed Answer:
Yes, varicocele surgery will improve semen parameters if it is abnormal 80% of the time.
Regards

Yes. it improves semen parameters 80% of the time after surgery.
Detailed Answer:
Yes, varicocele surgery will improve semen parameters if it is abnormal 80% of the time.
Regards




Isn't there any other alternatives to surgery? Like embolization?
Also, since varicocele are very common in men, 10-15% like you said, do we have percentages as to how common each of the 4 grades of varicocele are?

Isn't there any other alternatives to surgery? Like embolization?
Also, since varicocele are very common in men, 10-15% like you said, do we have percentages as to how common each of the 4 grades of varicocele are?
Home sperm test is not reliable. Surgery still better than embolisation.
Detailed Answer:
thank you for your follow up question. the sperm analysis home kit only checks for the number of sperm if it says that its normal then just says that you have more than 20 million sperm per ejaculate however other test should be done like motility and morphology which is commonly affected with patients with varicocele.
men who present to fertility clinics have a varicocele prevalence of 20–40%, whereas 80% of men with a varicocele diagnosed during adolescence are fertile. wherever there is no epidemiology regarding different grades because low-grade varicoceles are subclinical.
alternatives to surgery would be embolization good that procedure also has its own complications. surgical correction still has the highest success rate and the lowest recurrence rate.
mobilization has a success rate of 80% while micro surgical approach as a was a success rate of 95%.

Home sperm test is not reliable. Surgery still better than embolisation.
Detailed Answer:
thank you for your follow up question. the sperm analysis home kit only checks for the number of sperm if it says that its normal then just says that you have more than 20 million sperm per ejaculate however other test should be done like motility and morphology which is commonly affected with patients with varicocele.
men who present to fertility clinics have a varicocele prevalence of 20–40%, whereas 80% of men with a varicocele diagnosed during adolescence are fertile. wherever there is no epidemiology regarding different grades because low-grade varicoceles are subclinical.
alternatives to surgery would be embolization good that procedure also has its own complications. surgical correction still has the highest success rate and the lowest recurrence rate.
mobilization has a success rate of 80% while micro surgical approach as a was a success rate of 95%.

Abstain for 3-5 days.
Detailed Answer:
No that is not true. varicoceles affect all aspects of semen parameters being lower sperm concentration, lower total sperm count, lower proportion of spermatozoa with normal morphology, lower total count of normal spermatozoa, and lower proportion of motile spermatozoa.
I suggest doing a full abstinence for 3 to 5 days to be sure we are getting good results in a sample would be a representative of your semen parameters.

Abstain for 3-5 days.
Detailed Answer:
No that is not true. varicoceles affect all aspects of semen parameters being lower sperm concentration, lower total sperm count, lower proportion of spermatozoa with normal morphology, lower total count of normal spermatozoa, and lower proportion of motile spermatozoa.
I suggest doing a full abstinence for 3 to 5 days to be sure we are getting good results in a sample would be a representative of your semen parameters.


My home test came back positive but like you said that only tests the number of sperm and not the motility or morphology. Obviously you would know better than online sources, but I read off Google that if the sperm count for varicocele when normal then chances for just the motility or morphology are not likely. Is this true?
Also, the clinic said to stay abstinent for 3-5 days. Is it okay if I still have sex or masturbate without ejaculating? Would that effect the results at all (if a little bit of pre-cum comes out).

My home test came back positive but like you said that only tests the number of sperm and not the motility or morphology. Obviously you would know better than online sources, but I read off Google that if the sperm count for varicocele when normal then chances for just the motility or morphology are not likely. Is this true?
Also, the clinic said to stay abstinent for 3-5 days. Is it okay if I still have sex or masturbate without ejaculating? Would that effect the results at all (if a little bit of pre-cum comes out).

here are my semen paramaters. If I am reading this correctly then it looks like everything is normal but I could be wrong. I did notice in the note section it says abnormal viscosity. what does this mean?
my results normal values
Volume: 3.8 mill 1.5 mill or greater
Concentration: 29.8 mill >= 12 mill
Total Sperm Count: 113.24 mill >= 33 mill
Motility: 44% >= 40%
A 12%
B 18%
C 14%
D 56%
Forward Progression: 2.5 2-4
Liquefaction: <45 <60 minutes
Viscosity: ABN Abnormal/normal
Agglutination: 2 1-4 1-isolate<10
2-moderate 10-50
3-Large>50
4-Gross all
Round cells: - <=5 million/ml
Post wash result:
volume - ml
concentration - million/ml
total sperm count - million
motility - %
Total motile count - million
Forward progression -
Morphology 9% >=4% Kruger Strict Criteria
above 14% (normal)normal/fertile
5-14% (good prognosis) subfertile/fertile
0 to 4% (poor prognosis) subfertile
Notes:
Viscosity abnormal

here are my semen paramaters. If I am reading this correctly then it looks like everything is normal but I could be wrong. I did notice in the note section it says abnormal viscosity. what does this mean?
my results normal values
Volume: 3.8 mill 1.5 mill or greater
Concentration: 29.8 mill >= 12 mill
Total Sperm Count: 113.24 mill >= 33 mill
Motility: 44% >= 40%
A 12%
B 18%
C 14%
D 56%
Forward Progression: 2.5 2-4
Liquefaction: <45 <60 minutes
Viscosity: ABN Abnormal/normal
Agglutination: 2 1-4 1-isolate<10
2-moderate 10-50
3-Large>50
4-Gross all
Round cells: - <=5 million/ml
Post wash result:
volume - ml
concentration - million/ml
total sperm count - million
motility - %
Total motile count - million
Forward progression -
Morphology 9% >=4% Kruger Strict Criteria
above 14% (normal)normal/fertile
5-14% (good prognosis) subfertile/fertile
0 to 4% (poor prognosis) subfertile
Notes:
Viscosity abnormal
Varicocele is not causing infertility in your case.
Detailed Answer:
good day and thank you for sharing your semen analysis results.
yes as far as i can see from your results everything looks normal. what's important is the number and morphology of sperm cells.
the viscosity is a very variable parameter and usually changes from test to test. the most common cause of hyperviscous sperm is dehydration.
based on these results i don't think that your varicocele is causing any problems to you or. your fertility

Varicocele is not causing infertility in your case.
Detailed Answer:
good day and thank you for sharing your semen analysis results.
yes as far as i can see from your results everything looks normal. what's important is the number and morphology of sperm cells.
the viscosity is a very variable parameter and usually changes from test to test. the most common cause of hyperviscous sperm is dehydration.
based on these results i don't think that your varicocele is causing any problems to you or. your fertility


Also, should i be concerned that my motility is only 4% away from the "below normal" range? Do we have numbers on what the average motility rate is?

Also, should i be concerned that my motility is only 4% away from the "below normal" range? Do we have numbers on what the average motility rate is?
You have 4% morphology in your motility is more than 40%
Detailed Answer:
these are the normal values from WHO
WHO reference range
Total sperm count in ejaculate 39–928 million
Ejaculate volume 1.5–7.6 mL
Sperm concentration 15–259 million per mL
Total motility (progressive and non-progressive) 40–81 percent
Progressive motility 32–75 percent
Sperm morphology 4–48 percent
from what i saw, i think all your semen parameters are within the normal values as set by the w h o.

You have 4% morphology in your motility is more than 40%
Detailed Answer:
these are the normal values from WHO
WHO reference range
Total sperm count in ejaculate 39–928 million
Ejaculate volume 1.5–7.6 mL
Sperm concentration 15–259 million per mL
Total motility (progressive and non-progressive) 40–81 percent
Progressive motility 32–75 percent
Sperm morphology 4–48 percent
from what i saw, i think all your semen parameters are within the normal values as set by the w h o.



Healthy balanced diet and regular exercise.
Detailed Answer:
there are no studies that shows if there will be a decrease in motility through time because of varicocele.
regular exercise and a healthy balanced diet would go a long way to maintain your fertility and supplements that includes anti oxidants would also help like vit c, vit a, vit e and zinc

Healthy balanced diet and regular exercise.
Detailed Answer:
there are no studies that shows if there will be a decrease in motility through time because of varicocele.
regular exercise and a healthy balanced diet would go a long way to maintain your fertility and supplements that includes anti oxidants would also help like vit c, vit a, vit e and zinc


Also, what does the Liquefaction result mean? The normal range says over 60 minutes but mine says over 45 minutes. Would this be a huge issue?

Also, what does the Liquefaction result mean? The normal range says over 60 minutes but mine says over 45 minutes. Would this be a huge issue?
Her liquefaction is normal at less than 60 minutes
Detailed Answer:
in terms of the liquefaction anything less than 60 minutes is normal so i wouldn't give much thought about it. liquefaction is where in the enzymes in the semen causes the fluid to be less viscous. you may have healthy enzymes that's why your liquefaction is much faster than the normal range but like i said this is commonly seen and more than be a problem .
in terms of alcohol binging everything is ok as long as it is done in moderation and not done very often. you have a healthy semen based on your semen analysis and i would advise you to just continue what you're doing in the past because you have a healthy sperm at this point in time and i don't expect you to have an abnormal sperm anytime in the future based on all available data that we have but of course only time will tell.

Her liquefaction is normal at less than 60 minutes
Detailed Answer:
in terms of the liquefaction anything less than 60 minutes is normal so i wouldn't give much thought about it. liquefaction is where in the enzymes in the semen causes the fluid to be less viscous. you may have healthy enzymes that's why your liquefaction is much faster than the normal range but like i said this is commonly seen and more than be a problem .
in terms of alcohol binging everything is ok as long as it is done in moderation and not done very often. you have a healthy semen based on your semen analysis and i would advise you to just continue what you're doing in the past because you have a healthy sperm at this point in time and i don't expect you to have an abnormal sperm anytime in the future based on all available data that we have but of course only time will tell.

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