Male infertility: Varicocele embolization consultation, with CT scan

This is an ongoing series about my journey with infertility. I was diagnosed with a varicocele, which is likely responsible for poor sperm quality. It's something present in around 15% of all men, but in upwards of 40% of all infertility cases. Start here for the background and what we've done so far.

Varicoceles don't only affect fertility (and don't always lead to infertility). Apparently, they can be very painful; mine doesn't hurt at all. I have, over the past few weeks, noticed occasional soreness in my left testicle, but that's really only been since the urologist told me varicoceles are often painful, so it may be primarily in my head. Who knows how long I've had this issue, with no pain?

When a physician's assistant asked, "On a scale of 1-10 (10 being excruciating), what's the pain like?"

"Two to three," I said.

"What do you do when you feel the pain?"

"Nothing. When you get older your knee just hurts a little bit sometimes? It's kinda like that."


I had a consultation with the physician's assistant for an interventional radiologist who would perform a varicocele embolization.

This is a non-surgical, outpatient procedure. They're so confident in the procedure not producing issues that they don't even follow up with patients to see how they're doing a few days later.

I have a CT scan scheduled. This will show a map of my arteries and veins, give the doctor an idea of whether he'd go in through my neck or my leg (more in a minute) and whether for some reason I might not be a candidate for the procedure.

The alternative is a surgical fix, called a varicocelectomy, performed by a urologist, which comes with as much as six weeks of recovery time.

Now, some of this is recap from the first installment, but here's the skinny. We don't know why varicoceles occur (we know how they occur, but not the underlying cause). After being corrected, they can return. Once detected, we have no idea how long they've been there (we might assume mine's been there at least 19 months, since that's how long we've been trying to have a child). The urologist told me both the varicocelectomy and the embolization have a success rate of around 90% (that's success in eliminating the varicocele), and in case that the varicocele is eliminated for fertility purposes, about half of couples conceive naturally.

Sperm take about three to four months to develop; sperm I might ejaculate today started forming sometime between Thanksgiving and Christmas 2017. That means we won't find out if my sperm quality improves until four months or so after the procedure. We do that by a seed test, which is essentially me masturbating in a cup in someone else's bathroom (again, see the first installation for a deeper description).

Back to my consultation.

The procedure goes like this. You get an IV with an anesthetic (a name I wouldn't know) and a pain killer (fentanyl). In theory, just enough to keep you sedated, but a lot of people fall asleep. Then they take a catheter, put it into a vein in either your neck or your leg (you're facing away from the procedure, with a nurse monitoring vitals in your field of vision, if you're awake). Once the catheter is in, you get either some tiny metal balls or some tiny metal coils to break up the varicocele and hopefully prevent from happening again.

They pull the catheter out, remove the IV, monitor you for a couple of hours, put you in a car (preferably one driven by someone you know), and send you a bill at some point.

My next step is the CT scan. Results from that usually take about two days, so unless something comes up, that'll be the next installation.


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