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Urology (Expert Forum)
Time for Hydrocelectomy? and Question on Fertility
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
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Time for Hydrocelectomy? and Question on Fertility
by LRT10, May 20, 2003 12:00AM
6 years ago I had a bilateral vericocelectomy, which resulted in a left-side hydrocele and unfortunately no noticeable change in sperm production (the vericocelectomy was performed due to pain and also infertility). The vericocelectomy did relieve the pain for a while, but a few years ago the pain started again and I have had the recurring pain ("chronic epidimitis" according to one urologist) in the right testicle ever since. The pain is mostly felt after vigorous activity or sex, and it often radiates to my right hip making it feel achy. Three different urologists have told me that there is sometimes simply unexplained pain after vericocelectomies, and I can accept that.
There are two other concerns, though... The first is that the hydrocele I mentioned has gotten steadily bigger particularly in the past few months, so that the left testicle is MUCH larger than the right and has resulted in frequent pain on the left side as well as the usual on the right. I am actually scheduled for a hydrocelectomy this Thursday (5/22).
However, my second concern is that it has recently occurred to me that some kind of blockage or damage (scar tissue? blood clot?) may have resulted from the original vericocelectomy on the right side, which is the cause of the "unexplained pain" and possibly the infertility at the same time. The urologist who is scheduled to perform the hydrocelectomy referred me to another local urologist specializing in vasectomy reversals and procedures to identify blockage in the sperm pathways. My (slim) hope is that there may still be a surgically correctable problem causing my continued infertility. In other words the vericocelectomy would have increased my sperm production but...
To tie these two things together, would it be adviseable to hold off on the hydrocelectomy until after I have had a chance to see the "specialist" urologist regarding my infertility? Is it possible that a hydrocele could have any impact on pain or fertility by causing pressure or stress on the other, smaller, testicle? Are there any questions I should be asking the urologists that I have not been asking, or does anything seem striking to you about this that may not have been caught by other doctors?
My final question is regarding my semen itself. Assuming there is no surgical solution to my infertility, is there anything else that might help boost my output? Drugs, vitamins? Also, my understanding is that I have about 5 million healthy, viable sperm per mL, and another 5 million that are deformed or otherwise not viable. Is it possible to collect multiple ejaculates from me over time as you would from a fertile sperm donor, and then combine them in some way to retrieve a single sample of just the healthy ones, to use for artificial insemination in my wife? Has this been tried before, and if not is there a compelling reason why not?
Thank you for your consideration of all these questions.
There are two other concerns, though... The first is that the hydrocele I mentioned has gotten steadily bigger particularly in the past few months, so that the left testicle is MUCH larger than the right and has resulted in frequent pain on the left side as well as the usual on the right. I am actually scheduled for a hydrocelectomy this Thursday (5/22).
However, my second concern is that it has recently occurred to me that some kind of blockage or damage (scar tissue? blood clot?) may have resulted from the original vericocelectomy on the right side, which is the cause of the "unexplained pain" and possibly the infertility at the same time. The urologist who is scheduled to perform the hydrocelectomy referred me to another local urologist specializing in vasectomy reversals and procedures to identify blockage in the sperm pathways. My (slim) hope is that there may still be a surgically correctable problem causing my continued infertility. In other words the vericocelectomy would have increased my sperm production but...
To tie these two things together, would it be adviseable to hold off on the hydrocelectomy until after I have had a chance to see the "specialist" urologist regarding my infertility? Is it possible that a hydrocele could have any impact on pain or fertility by causing pressure or stress on the other, smaller, testicle? Are there any questions I should be asking the urologists that I have not been asking, or does anything seem striking to you about this that may not have been caught by other doctors?
My final question is regarding my semen itself. Assuming there is no surgical solution to my infertility, is there anything else that might help boost my output? Drugs, vitamins? Also, my understanding is that I have about 5 million healthy, viable sperm per mL, and another 5 million that are deformed or otherwise not viable. Is it possible to collect multiple ejaculates from me over time as you would from a fertile sperm donor, and then combine them in some way to retrieve a single sample of just the healthy ones, to use for artificial insemination in my wife? Has this been tried before, and if not is there a compelling reason why not?
Thank you for your consideration of all these questions.
Doctor's Answer
by Kevin Pho, MD, May 20, 2003 12:00AM
, May 20, 2003 12:00AM
Hello - thanks for asking your question.
As for as I can tell, the hydrocele itself should be be associated with infertility (I can find no evidence of the larger testicle "inhibiting" the smaller one).
However, it is possible that hydrocele or varicocele repair may have damaged the sperm-carrying ducts, resulting in infertility. It seems that your urologist may be thinking along the same lines by referring you to someone who can identify blockages along the sperm pathways.
Without knowing your case further (i.e. examining you and your records myself), I cannot make any recommendations about delaying the hydrocele repair. That is a decision that you should ask your personal urologist.
As for treatment for the infertility, it would depend on the cause. Sperm concentration is normally above 20 million/mL. However, men with sperm counts under 20 million/mL can be fertile and, for the purposes of fertilization in vitro, 10 million/mL or even less can be satisfactory. With your sperm count of 5 million/mL, artificial insemination may be a possibility.
Your semen test should be repeated. If the viable sperm is again around 5 million/mL, then tests for serum FSH, LH, and testosterone should be measured - this will evaluate for any hormonal abnormalities. Specialized tests such as sperm motility, testicular biopsy and genetic testing may be considered with coordination by your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
As for as I can tell, the hydrocele itself should be be associated with infertility (I can find no evidence of the larger testicle "inhibiting" the smaller one).
However, it is possible that hydrocele or varicocele repair may have damaged the sperm-carrying ducts, resulting in infertility. It seems that your urologist may be thinking along the same lines by referring you to someone who can identify blockages along the sperm pathways.
Without knowing your case further (i.e. examining you and your records myself), I cannot make any recommendations about delaying the hydrocele repair. That is a decision that you should ask your personal urologist.
As for treatment for the infertility, it would depend on the cause. Sperm concentration is normally above 20 million/mL. However, men with sperm counts under 20 million/mL can be fertile and, for the purposes of fertilization in vitro, 10 million/mL or even less can be satisfactory. With your sperm count of 5 million/mL, artificial insemination may be a possibility.
Your semen test should be repeated. If the viable sperm is again around 5 million/mL, then tests for serum FSH, LH, and testosterone should be measured - this will evaluate for any hormonal abnormalities. Specialized tests such as sperm motility, testicular biopsy and genetic testing may be considered with coordination by your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
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