Wait out varicocele surgery or move to IVF?

[Anonymous]

I could use some input. We've been trying to conceive for 12 months. Our only known issue is male factor - my husband's motility is around 20% and morphology is 1%. We met with an RE after 6 months, as I am 36. My numbers are all great. We've done 2 IUIs without success, and 90% of his sperm died in the prep (washing) process.

Last week my DH finally saw a urologist, got an ultrasound, and was diagnosed with 2 varicoceles - one on each side. He feels somewhat reassured that there is a reason for his sperm issues - not knowing really bothered him. He went ahead and booked the earliest available surgery slot, which is 4 weeks away.

We're faced with making a decision whether to do IVF with ICSI, or wait it out to see if the surgery improves his sperm quality sufficiently. It takes 3 months to regenerate new sperm, however, I have read that for men who get a positive change from the surgery, those improvements can sometimes take longer. I'm not going crazy with grief yet or anything, but am starting to get nervous about my age and how long this is taking. We've saved with the possible need for IVF in mind, so financially it is a stretch but doable.

In our shoes, would you wait to see if surgery helps, or move to IVF?

[Anonymous]

Have you told your RE about the surgery? My RE said that surgery went the way of the dinosaurs. I would discuss it with your RE first.

[Anonymous]

Anonymous wrote:Have you told your RE about the surgery? My RE said that surgery went the way of the dinosaurs. I would discuss it with your RE first.

OP here. We're going to discuss it with the RE this week.

My understanding is that studies on varicocele surgery show improvement in around 2/3 of men and that those men showed a significant improvement in semen parameters. I will say that the RE of course has an interest in moving couples toward IVF, and the fact that ICSI is available makes varicocele surgery unnecessary if you're willing to do IVF/ICSI (hence my question). But all that said, we'll discuss with the RE soon. Thanks for your response.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Have you told your RE about the surgery? My RE said that surgery went the way of the dinosaurs. I would discuss it with your RE first.

OP here. We're going to discuss it with the RE this week.

My understanding is that studies on varicocele surgery show improvement in around 2/3 of men and that those men showed a significant improvement in semen parameters. I will say that the RE of course has an interest in moving couples toward IVF, and the fact that ICSI is available makes varicocele surgery unnecessary if you're willing to do IVF/ICSI (hence my question). But all that said, we'll discuss with the RE soon. Thanks for your response.

It's a tough call, but at age 36, I would proceed directly to IVF with ICSI, particularly if I wanted more than 1 child. I would ask the RE if your husband has the surgery and you don't get pregnant, how quickly can you do IVF? For example, have surgery in 1 month, then 3 months to generate new sperm, then 6 months TTC, then repeat some of the infertility workup (I know some tests are only good for a year), then get on birth control before the cycle if the RE requires it, etc. Maybe there's a way to shorten the timeline, but it looks to me that doing the surgery sets you back almost a year if you don't conceive naturally.

[Anonymous]

I would do IVF and ICSI.

[Anonymous]

Anonymous wrote:I would do IVF and ICSI.

+1
At your age it's pretty likely that you end up with enough blasts to test and be sure you have enough and some extra if you want more than 1 kid. My DH had worse #s (but OK DNA frag) and with ICSI it was like the MF didn't exist. But if you wait you're headed into that age range where quality gets dodgy. You'd still probably have success, but you may need more than 1 round, esp if you want more than 1 kid. The added stress isn't worth it, in my opinion (from experience).

[Anonymous]

My kids are 20 and 22. My husband had varicocele surgery and it did not help. At your age your should proceed directly to ivf and icsi to have children sooner. Do not waste precious time on this surgery. I was 38 and 40 when I had my children and consider myself extremely fortunate. Maternal age is the biggest hurdle in infertility treatment.

[Anonymous]

We went straight to IVF with ICSI at age 30 (and only one varicocele). Had success with our second cycle.

[Anonymous]

Did varicocele surgery and vast improvement of sperm but it took a long time. More than 3 months. 2 children.

[Anonymous]

we were in a very similar situation - low morphology and I was 35. We did two rounds of IVF with no success. He finally had the surgery and we waited 6 months. The timing is not ideal but there was a slight improvement and we are now pregnant. Although expensive, if possible, I would get on the train to do IVF ASAP. If you don't have success, consider the surgery.

[Anonymous]

I honestly would do the surgery. My husband just had hydrocele surgery and he was told he only had to wait a month to use his sperm. Isci is not a guarantee.

[Anonymous]

We did surgery, was success but still needed icsi.
I would recommend both. The 90% sperm dying during wash sounds very strange to me.
What is his actual count?