Infertility? Check Out the Guy First!

One of the best parts of my job is helping couples have kids. Last week, for example, I heard some good news from a couple I first saw about 3 years ago. I want to tell you their story, because it contains some important lessons that any couple trying to get pregnant needs to know.

Bruce and Donna came to my office dispirited. They had failed to conceive naturally after a year of trying. They then tried in vitro fertilization (IVF), but 5 attempts and $150,000 later…nothing. Like many, many couples, Bruce and Donna assumed that when they couldn't get pregnant the problem was (a) with the woman, and (b) their only option was IVF. Both assumptions are wrong.

Here's a little-known fact: In any instance of infertility, the problem is on the guy's side about 40% of the time. The problem is on the woman's side about the same - 40%. The other 20%? Those are the mystery cases where no specific cause can be found. IVF is a way of getting around a problem on the women's side. It's great (if expensive) technology, but it may be the wrong tool for the job if the problem is with the guy.

When I examined Bruce, I found that he had a varicocele (vari-ko-seal), which is a bundle of enlarged veins in the scrotum that feels like a bag of worms. The veins are swollen because of defects in the tiny valves that normally keep blood moving forward in the veins and prevent pooling. In a varicocele, the valves don't work well, so the blood collects and swells the veins. That extra blood down there warms the testes unnaturally. This interferes with the cells that manufacture sperm, which are extremely temperature-sensitive.

Like most men, Bruce didn't realize anything was wrong. A varicocele typically doesn't hurt and it doesn't interfere with orgasm or ejaculation. Varicoceles are pretty common: roughly 1 out of every 5 guys will have one, with the incidence rising with increasing age. Think of a varicocele if one testicle hangs much lower than the other and if there's a bundle of veins (may feel like a bag of worms).

Here's the good news though: varicoceles are one of the simplest things to fix. The main surgical techniques used to correct a varicocele involve tying off, or blocking, the distended veins in the scrotum. The results of microsurgical varicocele repairs in thousands of men show an overall improvement in semen quality of about 60-70% and an overall pregnancy rate of about 40% without the need for assisted reproductive technology.

And that's the punch line here: 3 months after the varicocele surgery, Donna was pregnant. They conceived naturally, without IVF. Their baby boy, Henry was born last year. And the call I got last week? It was Bruce - Donna's 4 months pregnant with their second child. Now that's the kind of thing that makes my day!


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