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Have Bilateral Varicocele, Semen Analysis Showed Oligoasthenoteratozoospermia, Abnormal Blood Test. What Is Going On?
Question: Dear Doctor,
I'm a male age 32. 6' high and weighing 80 kilograms.
After 4 years of trying I am still unable to get my wife pregnant for a second time. My wife thought I may have varicocele. I went to my house doctor and he told me to get an echo of my testicles. The results came back that I have bilateral varicocele. My doctor then told me to go the urologist. He examined me and said he does not see any varicole (he only did phisical examination) and asked me to get a blood test and semen test.
The semen test came with the result severe oligoasthenoteratozoospermia.
The blood test came with the following abnormalities:
Hct 42 Low (in %)
ESR 11 High (mm/hr)
FSH 20 High (mIU/mL)
Prolactin 30 High (ng/mL)
Testosterone 208 (ng/dL)
I am a bit corcerned and wondering what is going on and what should I ask/tell my doctor? I would like to be a bit more prepared when talking to him.
Please advice me what kind of tests or treatments should I consult with my family doctor.
Regards,
XXXXXXX
I'm a male age 32. 6' high and weighing 80 kilograms.
After 4 years of trying I am still unable to get my wife pregnant for a second time. My wife thought I may have varicocele. I went to my house doctor and he told me to get an echo of my testicles. The results came back that I have bilateral varicocele. My doctor then told me to go the urologist. He examined me and said he does not see any varicole (he only did phisical examination) and asked me to get a blood test and semen test.
The semen test came with the result severe oligoasthenoteratozoospermia.
The blood test came with the following abnormalities:
Hct 42 Low (in %)
ESR 11 High (mm/hr)
FSH 20 High (mIU/mL)
Prolactin 30 High (ng/mL)
Testosterone 208 (ng/dL)
I am a bit corcerned and wondering what is going on and what should I ask/tell my doctor? I would like to be a bit more prepared when talking to him.
Please advice me what kind of tests or treatments should I consult with my family doctor.
Regards,
XXXXXXX
Dear XXXXXXX,
Thanks for your query.
I understand your concerns. Following are my observations & comments:
1) Your varicocele is detectable only on doppler ultrasound but not palpable clinically on physical examination. Your varicocele is “Subclinical" according to Dubin grading system which is most widely used classification. It means you absolutely don’t have to worry about varicocele. It does not need any treatment. Let me reassure you that you have nothing to worry about this.
2) Your hematocrit is borderline low and Erythrocyte Sedimentation Rate (ESR) is marginally high. This is not related to your condition & hence don’t worry.
3) The Follicle Stimulation Hormone (FSH) is marginally elevated which shows there is problem in sperm production. That is the reason your semen analysis shows oligoasthenospermia. The real reason you are suffering from infertility is because of low sperm count.
4) When you see your urologist tomorrow, ask for prescription for antioxidant tablets. I am afraid there is nothing much of treatment available in current medical literature to reverse the FSH value from oligoasthenospermia to normal levels.
5) You must be worried about how your wife can get pregnant with such low count?
There are 2 options for you:
First to undergo Intrauterine insemination (IUI) which can be done if your sperm count is little higher range (more than 10 million /ml).
Secondly, if count is less than this, best advice would be to go ahead with In Vitro Fertilization (IVF) & ICSI (Intra Cytoplasmic Sperm Injection).
For detailed demonstration of these procedures, it is advisable to see an infertility specialist who will explain more about IVF in person.
I hope I answered your questions. I would be glad to answer if you have any more queries.
Regards,
Dr.Mahesh Koregol
Infertility Specialist
Thanks for your query.
I understand your concerns. Following are my observations & comments:
1) Your varicocele is detectable only on doppler ultrasound but not palpable clinically on physical examination. Your varicocele is “Subclinical" according to Dubin grading system which is most widely used classification. It means you absolutely don’t have to worry about varicocele. It does not need any treatment. Let me reassure you that you have nothing to worry about this.
2) Your hematocrit is borderline low and Erythrocyte Sedimentation Rate (ESR) is marginally high. This is not related to your condition & hence don’t worry.
3) The Follicle Stimulation Hormone (FSH) is marginally elevated which shows there is problem in sperm production. That is the reason your semen analysis shows oligoasthenospermia. The real reason you are suffering from infertility is because of low sperm count.
4) When you see your urologist tomorrow, ask for prescription for antioxidant tablets. I am afraid there is nothing much of treatment available in current medical literature to reverse the FSH value from oligoasthenospermia to normal levels.
5) You must be worried about how your wife can get pregnant with such low count?
There are 2 options for you:
First to undergo Intrauterine insemination (IUI) which can be done if your sperm count is little higher range (more than 10 million /ml).
Secondly, if count is less than this, best advice would be to go ahead with In Vitro Fertilization (IVF) & ICSI (Intra Cytoplasmic Sperm Injection).
For detailed demonstration of these procedures, it is advisable to see an infertility specialist who will explain more about IVF in person.
I hope I answered your questions. I would be glad to answer if you have any more queries.
Regards,
Dr.Mahesh Koregol
Infertility Specialist
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. Manesh Koregol,
Thank you for taking the time to answer my question.
Do you have any comments as to why the Prolactin is high and my testosterone is so low? Will fixing the FSH level also increase my testosterone level? Does having such a low level of testosterone be bad for my health? If so should I check with another specialist ont this part?
My wife and I already done the ICSI procedure twice and failed. Right now I am trying to solve my problem which might be a bit cheaper then doing the ICSI procedure again since it takes a big toll on my wife every time.
Looking forward to your next reply.
Regards,
XXXXXXX
Thank you for taking the time to answer my question.
Do you have any comments as to why the Prolactin is high and my testosterone is so low? Will fixing the FSH level also increase my testosterone level? Does having such a low level of testosterone be bad for my health? If so should I check with another specialist ont this part?
My wife and I already done the ICSI procedure twice and failed. Right now I am trying to solve my problem which might be a bit cheaper then doing the ICSI procedure again since it takes a big toll on my wife every time.
Looking forward to your next reply.
Regards,
XXXXXXX
Dear XXXXXXX,
Thanks for reverting back.
I understand It is physical and mental agony for a lady to undergo IVF & ICSI. I am sorry for the emotional trauma you both are undergoing.
Your high FSH and low testesterone suggest low testicular activity. The leydig cell function in testis is low. The production of sperms and testesterone occur in testis.
Since you seem to have primary testicular dysfunction (not total failure), the testis is not responding to FSH stimulation, hence high FSH & low sperms with low testesterone. Hence this imbalance has lead to disrupted hypothalamo-pituitary axis & hence abnormal prolactin values.
Please get MRI of pituitary gland also for possible prolactinoma (chances are less though). Unfortunately there is nothing much which can be done to reverse your condition as you are expecting. I am sorry about that.
Another worry in oligoasthenospermia is high DNA fragmentation of sperms leading to low sperm quality. That might be reason for failed ICSI cycles.
I would like to recommend another ICSI cycle using donor sperms. This might result in better embryo quality & successful treatment.
I hope I answered your questions. I would be glad to answer if you have any more queries.
Regards,
Dr.Mahesh Koregol
Infertility Specialist
Thanks for reverting back.
I understand It is physical and mental agony for a lady to undergo IVF & ICSI. I am sorry for the emotional trauma you both are undergoing.
Your high FSH and low testesterone suggest low testicular activity. The leydig cell function in testis is low. The production of sperms and testesterone occur in testis.
Since you seem to have primary testicular dysfunction (not total failure), the testis is not responding to FSH stimulation, hence high FSH & low sperms with low testesterone. Hence this imbalance has lead to disrupted hypothalamo-pituitary axis & hence abnormal prolactin values.
Please get MRI of pituitary gland also for possible prolactinoma (chances are less though). Unfortunately there is nothing much which can be done to reverse your condition as you are expecting. I am sorry about that.
Another worry in oligoasthenospermia is high DNA fragmentation of sperms leading to low sperm quality. That might be reason for failed ICSI cycles.
I would like to recommend another ICSI cycle using donor sperms. This might result in better embryo quality & successful treatment.
I hope I answered your questions. I would be glad to answer if you have any more queries.
Regards,
Dr.Mahesh Koregol
Infertility Specialist
Above answer was peer-reviewed by :
Dr. Yogesh D
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