Varicocele Case Studies
Sometimes it's helpful for a patient to know that they are not in a unique situation. Here are a couple of stories from my practice. One story is of a couple struggling with infertility. The other patient experienced a very low hanging scrotum. He was so happy with the result that he documented it in a magazine article.
Michael and Cheryl had been married for two years, and decided to start trying to have a child on a cruise to Bermuda. After six months without a pregnancy, they began to get worried, but they figured it might have something to do with the fact that they both were nearing 40.
“We both work incredible hours and have very high-stress jobs,” Cheryl says. “We were buying a house, and we thought those were all contributing factors. We just never slowed down.”
Several months later Michael went to a local urologist, who did a basic semen analysis and physical exam.
“He said my sperm count was on the low side of normal and that he saw a small varicocele but that it wasn’t anything to worry about,” Michael says.
Meanwhile, Cheryl had a complete fertility workup, including a surgical examination of her ovaries. No abnormality was found.
When Michael and Cheryl finally came to see Dr. Fisch, they were frustrated by the lack of answers and by the reluctance on the part of their doctors to consider seriously what Dr. Fisch felt were two important findings: He believed the varicocele was much more severe than Michael’s doctor did, and when Dr. Fisch did a semen culture he found signs of a urinary tract infection. He recommended a course of antibiotics and that the varicocele be repaired as quickly as possible.
When Dr. Fisch operated on Michael he found a set of very large veins — much larger than he had suspected. The surgery went smoothly. Because it takes three months for new sperm to form and mature, Dr. Fisch waited that long to do another sperm analysis.
According to Michael, “It was Halloween and we were walking around with our nephews and nieces, out on the sidewalk, and Dr. Fisch called me on my cellphone with my test results. It was kind of a funny place to be talking about my sperm count, you know? But he said everything looked great, the sperm looked good and the infection was gone. I turned to Cheryl and said, ‘Hon, we can go for it.’ I was elated.”
Michael and Cheryl believe they conceived that Christmas Eve. The following September, after a normal pregnancy, their son Colin was born, weighing 8.9 pounds.
A varicocele can result in the testicles hanging very low and away from the body. Since testicles need to stay cool, if blood pools in the testicles, the testicles get warm. Warm testicles try to move to cooler climates, and thus stretch low away from the body.
While some inexperienced surgeons are attempting to correct this problem through excising the scrotal skin or performing plastic surgery to tighten the skin, the real answer is a varicocelectomy. Once the blood is eliminated from the scrotum, the testicles will return to their normal place.
Esquire Magazine wrote up one man's experience with "low hanging fruit" in an article entitled "The Ball Tuck".