39M with Grade II Varicocele, TMSC ~3.2M on recent SA after 6 months TTC. Looking for advice on natural conception odds, next steps, and whether repair makes sense.

[u/eartheater007]

Hi everyone,

I'm looking for advice from others who have dealt with male-factor infertility, especially varicoceles.

I'm 39M and my wife is 31F. We've been trying to conceive for approximately 6 months without success. I have a known Grade II varicocele (diagnosed by physical exam by my urologist).

I recently completed two semen analyses with fairly different results:

Fellow.com mail-in test on 5/4:

- Volume: 2.2 mL

- Concentration: 13 million/mL

- Motility: 56%

- Morphology: 3%

- Estimated TMSC: ~16 million

Clinic semen analysis on 5/28:

- Volume: 2.0 mL

- Concentration: 10 million/mL

- Motility: 16%

- Morphology: 3%

- Liquefaction: >60 minutes

- pH: 8.0

- WBC positive

- Estimated TMSC: ~3.2 million

One thing I'm unsure about: I delivered the clinic sample within about 20 minutes of ejaculation, but the lab didn't analyze it until roughly 2 hours after collection. I'm wondering whether that delay could have significantly affected the motility result.

Additional context:

- Grade II varicocele diagnosed on physical exam

- My wife and I are both healthy weight, exercise regularly, and do not smoke or drink

- I've been trying to reduce heat exposure due to the varicocele

- Currently taking (for ~3 months):

- Omega-3

- CoQ10

- L-carnitine

- Zinc

- Selenium

- No known fertility issues on my wife's side at this point, but she is planning to begin fertility testing next month

My current urologist is skeptical that varicocele repair will meaningfully improve our odds, which surprised me based on what I've read. I'm planning to seek a second opinion from a reproductive urologist.

My questions:

- What type of specialist would you see next: reproductive urologist, fertility clinic, both? I'm in the Bay Area, and looking to visit Dr Turek's clinic (https://www.theturekclinic.com)

- At what point would varicocele repair start to make sense in a case like mine?

- Has anyone here had a Grade II varicocele with similar semen parameters and seen improvement after repair?

- Based on these numbers, what would you estimate my chances of natural conception are?

- What additional testing would you pursue next (hormones, DNA fragmentation, ultrasound, etc.)?

- Given that my wife is 31 and we're only 6 months into TTC, would you focus on further diagnostic workup first, or start seriously considering varicocele repair now?

I'd especially appreciate hearing from anyone who had similar semen parameters and a clinically significant varicocele, whether you pursued repair, and what your outcomes were.

Thanks in advance!

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[u/eartheater007 → u/[deleted]]

Thanks for the feedback! What does "RE" mean?

I'm hoping my situation may be a good candidate for varicocele repair before moving on to IUI or IVF. Is there any way to predict whether repair is likely to significantly improve sperm count or motility?

My current urologist is pushing IVF and feels that varicocele repair would likely provide only modest improvement. I'm planning to get a second opinion from a reproductive urologist. I expect the next steps will be an ultrasound, hormone panel, and another semen analysis, followed by a reassessment of my options.

[u/Prestigious_Day8553]

Test dna fragmentation. If that is elevated (I suspect it will be), I would prioritise varicocele repair over ivf.

[u/IntroductionOk4595]

I would do the varicocele repair now as it can take anywhere from 3-9 months to see improvements. I also would try to investigate the white blood cell count in your semen.

Also yes, the lab analyzing 2 hours later could make a difference in motility.