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Male Fertility: Non-Surgical Answer to Varicoceles

After going through more than a decade of fertility problems, no couple may be more surprised or happy than Mahomet parents Danelle and Louis “Buddy” Bartels to learn they’re expecting a baby this summer.

Their first two children were conceived through in vitro fertilization procedures, but with additional procedures failing and fertility experts shaking their heads, their chances for a much-wanted third child were looking bleak.

That was until they tried one more thing.

Back in 2001, Buddy Bartels had undergone an unsuccessful surgery for a varicocele, a common cause of male infertility. But last July he underwent a second procedure — a nonsurgical varicocele repair — his wife discovered after doing some research online.

And it worked, the couple says. Their third child, conceived the natural way, is due in June.

To think this had seemed impossible for them, Danelle Bartels says.

“We could have given up at any moment,” she says.

A varicocele (pronounced “VAR-ih-koe-seel”) is a varicose vein of the scrotum and testicle, often found on the left side. It doesn’t always require treatment, but for some men it can lead to infertility, pain and testicular atrophy, says Dr. Michael Neuwirth, head of vascular and interventional radiology at Carle Physician Group and the doctor who performed the procedure last summer on Buddy Bartels.

Varicoceles affect about 15 percent of men, and the condition is linked to about 40 percent of primary male infertility and 80 percent of secondary male infertility, according to the American Urological Association.

A man who isn’t in pain or who is otherwise without symptoms often won’t be diagnosed unless he becomes part of a couple having trouble trying to conceive, Neuwirth says.

Then, surgery to tie off the swollen veins to redirect blood flow to normal veins is the most common form of treatment. But many men don’t know there’s a nonsurgical option, Neuwirth says.

The nonsurgical procedure, called varicocele embolization, involves inserting a tiny catheter into a vein through the neck or groin (Neuwirth says he prefers the neck) and using tiny coils to block the abnormal veins so blood can be diverted to healthy veins and relieve swelling.

Both embolization and surgery work about equally well for pain relief and fertility purposes, Neuwirth says.

Treatment achieves pain relief for about 96 percent of men and improves semen quality for about 60 percent to 80 percent of men, he says.

In one study, embolization improved semen quality in three months compared with a six-month improvement after one of the newest forms of surgery, microsurgery, Neuwirth says.

That few months can mean a lot to couples involved in fertility treatments, he says.

“This is important, because people who have been trying in vitro fertilization are on a timetable, and they’re trying to get pregnant as quickly as possible,” Neuwirth says. “And if you can offer them something with a quick, positive result, that makes a big difference to them.”

Neuwirth says embolization is also an excellent option for patients who have had prior surgery, but get recurrent varicoceles. Repeat surgery also remains an option when prior surgeries have failed, according to the American Urological Association.

A varicocele can recur after either surgery or embolization, Neuwirth says.

The recurrence rate after embolization ranges from 3.6 percent to 9 percent, he says. Surgery is done three different ways, so surgical recurrence rates vary from 0 to 28 percent, with the lowest recurrence rates for the newer forms of surgery: 0 to 3 percent for microsurgery and 7 to 9 percent for laparoscopy, he says.

A similar varicose-like vein condition can develop in women in the pelvic area and become the source of perplexing, chronic, intermittent pain, Neuwirth says.

Embolization can also treat that condition, called pelvic venous insufficiency, though many women are unaware of the source of the pain and never realize they can be helped, he says.

“Women have a very high pain tolerance, so they end up just dealing with it,” he adds.

The embolization procedure can be done on teenage boys with a varicocele, if they are suffering pain or have other symptoms, Neuwirth says.

“If your adolescent has a varicocele, don’t just ignore this,” he advises. “If your adolescent has pain or if the doctor finds one testicle is smaller than the other, they could consider treating it. If they treat it while they’re younger, they have more success for fertility later in life.”

Buddy Bartels, 35, says he never suffered pain from his varicocele, but he does remember a doctor mentioning to him while he was in junior high school that he would likely one day need surgery.

After the procedure with Neuwirth at the end of July, he was back on his feet the first day, he says, but he had to refrain from major physical activity for a week.

Danelle Bartels, 33, says the couple’s quest to have children hasn’t been easy.

“Twelve years ago, we were told we basically were not going to be able to have children due to male issues,” she says. “There was no way it was going to work on its own.”

She recalls in vitro fertilization — IVF — procedures for their first two children as expensive and painful. And with three failed procedures in their attempt to have a third child, there were disappointments.

IVF procedures can range from $15,000 to $20,000, with a lot of the costs not covered by insurance, Danelle Bartels says. The couple saved money for the procedures but is still in debt for part of the cost, she says.

Already the parents of two children, why go through so much to have a third?

Danelle Bartels says her husband was ready to stop after two children because of what the IVF procedures were putting her through. But both she and her husband had grown up in families of three children. She had also lost a sibling and her grandmother 11 years ago in a car accident, and she felt a deep conviction that she and her husband should have a third child, she says.

“I could feel that I wasn’t done,” she says. “Something was pushing me to keep going.”

Danelle Bartels says she found Neuwirth and the embolization procedure when she kept looking for options, and her husband was willing to talk to the doctor and then give it a try.

After the procedure, Neuwirth told them he saw no blockages but would need to confirm results with a semen analysis, she says. They were scheduled for an analysis at the end of October, but just before they went back to see the doctor, they had happy news of Danelle’s pregnancy to share with him.

She was so excited the day she found out she was pregnant, she did about seven home pregnancy tests to confirm it, she says.

Danelle Bartels says she believes persistence and her Christian faith and prayers helped lead her and her husband out of infertility, and she hopes sharing their story will help others.

“The biggest thing I have learned from this is don’t give up on your dream,” she says. “Don’t let somebody else tell you it’s not going to work.”

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