- As a man I have normal sexual performance? How can I be responsible for infertility?The sexual act and fertility are not directly related to each other. One could be impotent yet fertile. At the same time, a sexually potent man might not be fertile. Fact: In 50% of childless marriages, the male factor has been found to be the major cause of the couple’s inability to conceive.
- Does varicocele always cause male infertility?Usually varicocele is asymptomatic. It is usually detected when the patient is evaluating for possibility of male factor in an infertile marriage. The presence of abnormal semen parameters ( Oligo-astheno-terato-zoospermia ) and / or diminished testicular size points to varicocele as a cause of infertility.
- Does subclinical varicocele cause male infertility?Yes. Subclinical varicocele with abnormal semen analysis, usually contributes to male infertility. Varicocele causes progressive testicular damage over time. Surgical correction not only halts the damage, but can also reverse it.
- Does surgery cause pain or morbidity?There is a transient dull pull sensation when the spermatic cord is handled during surgery. It is mild and bearable. However, anxious patients may opt for General Anaesthesia where no unpleasant sensations will be tolerated.
- How quickly can I return to work after surgery?You can return home immediately after surgery. Routine travel can also be undertaken immediately. Routine office activity can be resumed after 24 hours.
- Are there any precautions during the post-operative phase?The patient has to take oral medications as prescribed. He should not wet the dressing, which will be removed after 72 hours. Long distance travelling may be undertaken after 7 to 10 days. Exercise and strenuous physical activity is recommended only after 4 weeks.
- How much time does surgery take?15 to 20 minutes
- How many stitches will be taken? When will they be removed?Absorbable stitches are put in below the skin (subcuticular) in a continuous manner. They need not be removed, but get absorbed in the body.
- How soon can I have sexual intercourse after surgery?After 15 to 20 days.
- How long after surgery does it take for sperm count to improve?Sperms live in your body 78 days from the beginning of their development until they are ejaculated. It therefore takes a minimum of four months after surgery, to see significant improvement in semen analysis. Improvement can be seen for up to two years.
- Is any medical therapy required after varicocele surgery?Surgery halts the damage to the spermatogenesis process caused by varicocele. Nature tries to correct and improve upon the existing damage. Some drugs may be prescribed for 6 months to one year to augment the recovery of spermatogenesis.
- My doctor says that results of varicocele surgery are poor and I should opt for a test tube baby. What should I do?Before the technique of cremasteric disruption as advocated by Dr. Parag Shah was used, the results of varicocele surgery were poor with the associated morbidity of surgery. However the technique of cremasteric disruption with venous ligation has high success rates and almost nil morbidity.
A ‘cost per delivery’ analysis in the USA revealed that varicocelectomy is three times more effective than Intra Cytoplasmic Sperm Injection (ICSI). The European experience estimated it to be seven times more cost effective. In India varicocelectomy may be ten to twenty times more cost-effective than ICSI.
Besides infertile men can expand their reproductive option after surgery and no further treatment is required for subsequent pregnancy.
Assisted Reproductive Treatment (ART) does not permit natural selection of genetic material. There are stray reports of increased congenital abnormalities in babies born by ART. Besides long term effects of ART are still unknown.
In conclusion, our results are our best advocates for suggesting the further course of treatment.
- What is the usual investigation for male infertility?Semen Analysis is the usual investigation for infertility.
- What is the usual examination for infertility?Taking down the pants of the male partner and clinical examination of the male genitalia (and not necessarily laparoscopy of the female partner).
- What life-style changes could improve sperm quality?i) Quit smoking. Smoking causes 23% decrease in sperm density and 13% decrease in sperm motility. It also increases abnormal sperms.
ii) Reduce alcohol.
iii) Excessive exercise / gymnasium / long distance running and cycling reduces sperm quality and should be avoided.
iv) Avoid high temperature saunas, hot tubs, hot baths, multi-layer underwear, tight underwear.
v) Avoid hot spicy food.
vi) Avoid constipation: Straining at stools. Avoid refined food. Increase dietary fiber, raw salads, fruit and whole grain.
- Will surgery affect sexual performance ?No!!.
- What are the complications of surgery?We have performed over 500 surgeries. Transient discomfort was reported by 6% patients. Hydrocele was recorded in just one patient.
- Will my insurance company pay for my surgery?Your insurance company will usually pay if the indication for surgery was pain. It might not pay for infertility treatment.
- What are the costs involved ?Being an ambulatory technique, our technique is cheaper than most other modalities of treatment for varicocele