What the heck are varicoceles?

A varicocele (VAR-ih-koe-seel) is a dilation of the veins that drain the testis, known as the pampiniform plexus. A varicocele is similar to a varicose vein that can occur in your leg.

As it turns out, varicoceles are present in approximately 15% of the general male population. They account for up to 40% of male factor infertility, yet nearly two-thirds of men with varicoceles are fertile... so could varicoceles be causing mine & B's infertility?

The answer I've been able to come with so far is "maybe."

Causes

Varicoceles are typically not noticed until after puberty because testicular blood flow remains low prior to that and so these veins do not become apparent until adolescence when blood flow increases.  However many are not detected until a man is evaluated for fertility problems later in life. 

It's not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the spermatic cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate). 

Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles. 

Our doctor, Dr. Jay Sandlow (I like to refer to him as "Dr. J"), published an article called, "Do varicoceles really affect male fertility?" in Sexuality, Reproduction & Menopause, arguing that it is not the valve that is the issue, so much as the anatomy of the entire drainage system that plays a major role in the the development of varicoceles.

"Because the left side drains into a system with higher resistance (the renal vein), small venules may persist or open during embryogenesis." - Jay Sandlow

Don't ask me what that means... after looking up definitions for venules and embryogenesis, I think it means the way a man's anatomy is formed while still a fetus determines whether he'll have varicoceles, though they aren't detected until after puberty when things really start flowing down there.  Maybe I should ask Dr. J if I understand that correctly though :)

How can they affect fertility?

In cases of where men who have varicoceles happen to be experiencing infertility, varicoceles are thought to cause spermatogenic defects by raising the intratesticular temperature in both the affected and the adjacent testes. However, not all varicoceles affect sperm production, which explains why not all men with varicoceles (in fact, most of them), are fertile.

Diagnosis


When varicoceles are suspected of causing infertility, abnormalities in all of the seminal parameters are usually present.  However, they can also cause isolated defects in sperm count, motility, morphology, or function.  Therefore, according to the article written by Dr. J mentioned above, the results of semen analysis are not a good predictor of the presence or absence of varicoceles.  And so, they are typically diagnosed by physical examination.  Most experts agree that the only varicoceles to worry about are the ones that can be detected by physical examination, though ultrasound can be used to identify them as well.


In our case...


B's were visible right away upon physical examination, and he has them on both sides.  We discovered this back in April 2011, but because the results of his seminal parameters testing were all coming back within the range of normal fairly consistently, Dr. J instructed us to first continue trying naturally for 4-6 months, with timed intercourse (only every other day during the fertile period of my cycle).  


That brought us to September, when we did our first IUI, which failed.  That's also when we learned how low B's "good sperm" counts were post-washing.  It was at that time that Dr. J recommended doing one more IUI, and if the numbers came back that low again post-wash, then he would recommend varicocele repair surgery as our next course of action.


We attempted an IUI earlier this month (February 2012) and his count came back lower than last time, so in effort to save money, we didn't even go through with it.  I was on clomid that cycle for the IUI, so there could have been a chance of increased fertility for us naturally... but I got my period Wednesday night so [sigh] that's disappointing.


So we scheduled the surgery for early April.  I'll post more soon about what that entails and what the success rates are.

Nothing Like Peeing on a Stick in the Bathroom at Work

What a roller coaster the last two weeks have been... again.


First off, let me clarify that the stick pictured above and the kind that I was peeing on in the bathroom at work yesterday are ovulation predictor kits, not pregnancy tests.


B and I had scheduled another IUI for this month.  On day one of my period, I had to call my RE back here in WI and let them know I was menstruating.  His nurse sent my Clomid prescription to my pharmacy and told me to take a pregnancy test before taking the medication on days 3-7 of my cycle.  


I had met with my RE right after returning from Dallas last month to ask about using my two Gonal-F pens left over from our cancelled IVF cycle, but that would cost us around $3500 per cycle and B and I only set aside $1300 for a regular Clomid cycle with ultrasound monitoring.  So, not only would using injectables be much more expensive for us, it has huge risks of high-order multiples.  I mean, we're talking like Octomom here.  Those pregnancies are very high risk for the mother and babies, and if you choose to reduce (terminate) the number of fetuses, you risk miscarrying all of them.  So that's not the best option for us at this time.


On day 3 of my cycle I took a pregnancy test (knowing the answer since my period was getting heavier, not lighter), and that night I started taking 50mg a day of Clomid for 5 days.


I'm wondering, what dosage of Clomid my readers have taken?  I know 50mg is the lightest dosage you can get.  But during our last IUI it got me two good sized follicles, so that's exactly where the doctor wants me.  Also, at that dosage, it didn't effect the lining of my uterine wall, which Clomid can do, so this is a good amount for my body.


I felt very bloated all week while taking the Clomid, and actually did gain a few pounds, I wonder if any of my readers noticed weight gain while taking Clomid?


On cycle day 10 I began testing with my OPK.  My RE said to test once a day, preferably mid to late morning after having not peed for four hours.  The kit's instructions will tell you to pee with your first morning's urine, but the doctor feels that the concentration hasn't had enough time to build up by then, so later in the day is better.  I told him that I usually test at least twice a day anyway.  He told me I don't need to do that, but I told him I always do it so I don't miss the LH surge.  He said that's my choice, but if I get a positive surge in the morning, we'd schedule the IUI the next day, and if I get it in the evening, we'd do it the day after the next day.  Whatever you say doc.


Cycle day 10 was Monday, so I was testing with my first morning's urine (just in case) as soon as I woke up all week.  Then I would hold my bladder all morning along and at around lunch time, sneak into the most private bathroom I could find at work and test again (that's where the title of this post comes in).  Then, I'd  test again when I got home from work or before bed, depending on how often I'd relieved my bladder in the 3-4 hours prior.


Yesterday was Wednesday, and I got a negative result in the morning.  I had back to back meetings all day from 9am-4pm, to the extent that I hardly had  time to pee in-between meetings, let alone sit around waiting for OPK test results.  So, I did pee on a stick, but then shoved the tester in my drawer in my office with the stick still in it.  An hour later, when I had a chance to sneak into my office before another meeting started, I looked at it.  It was blank, which is usual with the digital tests, after a while the results disappear because the tester kind of "turns off."  I pressed the eject button to release the tester and, as has happened for me in past experiences, the last test result displayed on the screen.  It was a smiley face!  I had a positive result!


I kind of didn't trust that because I hadn't seen it in real time, so I didn't pee all afternoon and at 4pm snuck back into the bathroom at work to test again. Unfortunately, the tester was malfunctioning and the smiley face wouldn't go away.  I couldn't test with it and didn't have a spare, but had to pee REALLY bad, so I just went to the bathroom and figured I would hold my pee all evening and test again with my other tester when I got home, at around 7pm.


In the meantime I scheduled our IUI appointments for today.  B had to go in as early as possible because he had important meetings later in the morning at work that he couldn't miss, so the scheduled him to give his "sample" at 8:30am.  But they couldn't get me in until 2:15!  I was kind of freaking out that his swimmers wouldn't be as good if they had to wait around all day, but the receptionist assured me it would be fine.


When I tested last night after work with my other tester, there was no smiley face...


That made me question the validity of the test I'd taken at noon and not looked at the results of for an hour, so I thought I'd better say something at our appointment in the morning.


The results of that conversation and the appointment in general are complicated enough to warrant a separate post, so stay tuned for the rest of the story coming soon!


To be continued...