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Hi Doctor, I Know Varicocele Is Common Among Men And

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Posted on Sun, 8 Sep 2019
Question: Hi Doctor,

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?
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Follow up: Dr. Manuel C See IV (0 minute later)
Hi Doctor,

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?
doctor
Answered by Dr. Manuel C See IV (12 minutes later)
Brief Answer:
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.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Manuel C See IV (0 minute later)
Brief Answer:
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.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Manuel C See IV (1 hour later)
Brief Answer:
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


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Manuel C See IV (0 minute later)
Brief Answer:
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


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Manuel C See IV (0 minute later)
So would varicocele surgery restore fertility?
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Follow up: Dr. Manuel C See IV (0 minute later)
So would varicocele surgery restore fertility?
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Follow up: Dr. Manuel C See IV (2 hours later)
I took a home sperm test and I saw a faint line show up which means I have normal sperm count but the home test doesn't test for other factors of semen analysis. Is this reliable or should I still get a formal analysis done at a lab?

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?
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Follow up: Dr. Manuel C See IV (0 minute later)
I took a home sperm test and I saw a faint line show up which means I have normal sperm count but the home test doesn't test for other factors of semen analysis. Is this reliable or should I still get a formal analysis done at a lab?

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?
doctor
Answered by Dr. Manuel C See IV (25 hours later)
Brief Answer:
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%.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Manuel C See IV (0 minute later)
Brief Answer:
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%.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Manuel C See IV (48 minutes later)
Brief Answer:
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.
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Manuel C See IV (0 minute later)
Brief Answer:
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.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Manuel C See IV (8 minutes later)
Oh okay, I have an appointment on Monday to do my sperm analysis.

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).
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Follow up: Dr. Manuel C See IV (0 minute later)
Oh okay, I have an appointment on Monday to do my sperm analysis.

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).
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Follow up: Dr. Manuel C See IV (10 days later)
Hi doctor,

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


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Follow up: Dr. Manuel C See IV (0 minute later)
Hi doctor,

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


doctor
Answered by Dr. Manuel C See IV (10 minutes later)
Brief Answer:
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
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Manuel C See IV (0 minute later)
Brief Answer:
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
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Manuel C See IV (51 minutes later)
yes, that was gonna be one of my questions. Excuse my ignorance but I think viscosity might change from time to time (which you just explained) so I am thinking maybe this one day my semen wasn't as thick as other times but I have no other signs of prostate infection which is basically what would cause abnormal viscosity I believe.

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?
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Follow up: Dr. Manuel C See IV (0 minute later)
yes, that was gonna be one of my questions. Excuse my ignorance but I think viscosity might change from time to time (which you just explained) so I am thinking maybe this one day my semen wasn't as thick as other times but I have no other signs of prostate infection which is basically what would cause abnormal viscosity I believe.

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?
doctor
Answered by Dr. Manuel C See IV (22 minutes later)
Brief Answer:
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.




Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Manuel C See IV (0 minute later)
Brief Answer:
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.




Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Manuel C See IV (27 minutes later)
is there a chance for motility to decrease in the near future? also, are there natural things i can do to improve motility? like anything i can eat? excersize? any vitamins or supplements i can take?
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Follow up: Dr. Manuel C See IV (0 minute later)
is there a chance for motility to decrease in the near future? also, are there natural things i can do to improve motility? like anything i can eat? excersize? any vitamins or supplements i can take?
doctor
Answered by Dr. Manuel C See IV (21 hours later)
Brief Answer:
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
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Manuel C See IV (0 minute later)
Brief Answer:
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
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Manuel C See IV (3 hours later)
thank you, i also drink a lot of alcohol and normally binge drink so I hope that won't effect fertility too much.

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?
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Follow up: Dr. Manuel C See IV (0 minute later)
thank you, i also drink a lot of alcohol and normally binge drink so I hope that won't effect fertility too much.

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?
doctor
Answered by Dr. Manuel C See IV (10 minutes later)
Brief Answer:
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.



Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Manuel C See IV (0 minute later)
Brief Answer:
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.


Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Manuel C See IV

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Practicing since :2005

Answered : 909 Questions

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Hi Doctor, I Know Varicocele Is Common Among Men And

Hi Doctor, 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?