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How to manage recurrence of varicocoele?

Q: My husband is 29 years old. He underwent a surgery for varicocoele at the age of 16-17 years. He had a normal sperm count after that and his sperms became thicker. Recently following an evaluation from a urologist his varicocoeles reccured. We are trying for a family for the past 5 months now. He has slight discomfort in his testes sometimes. His left testes is slightly bigger than the right one. How should we approach this problem? We prefer to have a non-surgical treatment and if that doesn't work out, then we can think about a repeat surgery. Is lap surgery or embolisation equally effective like a conventional surgery? How long should we wait before having sex so that sperms are enough? His sperm count is more than 20 million and the motility is 38%. Please advise.

A:Recurrence of varicocoele is not uncommon, and is highest after laparoscopic ligation. Best results with varicocoele surgery are obtained with microsurgical vericocelectomy. Varicocoele may only be one of the multifactorial etiology for poor sperm count, and thus, other causes like infection and antispermantibodies need to be ruled out. Although present count may not be sufficient for normal conception, the same may obtain with assisted fertilization methods like intrauterine insemination by your gynaecologist.

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