Last attempt to find a cure for my DH's Azoospermia and Bilateral Varicocele Grade III

After hearing the same advice from Dr. Rupin Shah in Mumbai, we visited a few famous tourist spots, namely Siddhivinayak Temple, Mahalaxmi Temple, Haji Ali, Juhu Chowpati, Colaba Causeway, Gateway of India, Elephanta Caves etc in the rest two and a half days.

Upon our return to Bangalore, DH and I decided to visit one last specialist. We re-visited Dr. A Nagaraj Rao (Professor & Head of Urology Department, St. John Medical College and Hospital, Koramangala, Bangalore) in May'14. He briefly remembered our case history (told to him in Sep'12) and we also updated him about our latest Doctor-Hopping and their conclusions.

His advice was to get a Bilateral Testicular Fine Needle Aspiration Cytology (FNAC) done at Anand Diagnostics, Shivaji Nagar. I do not remember the cost of this test, shall update if I recall. Here's what FNAC procedure is :-

The result of this test would determine whether a Varicocelectomy could be of any help or not. We went ahead with the procedure in May'14 itself. The report was ready after 3 days and here's how it looked :-

 The report came with the studied slide too, for further reference or investigation. 

We went for the review of this report to Dr. Rao. He concluded that although Sertoli cells and Spermatids are seen but occasional; performing another procedure wouldn't change anything or undo the past. At that moment, it seemed to be a dead-lock situation for us; anger, depression, disappointment, fear, frustration, regret were just a few emotions to name which were portraying our state.                                                          

Meeting Dr. Rupin Shah in Lilavati Hospital - Mumbai

Our Delhi and Kolkata trips were informative but not pleasing. Our next destination was Mumbai and target specialist to meet was Dr. Rupin Shah. He was a visiting faculty/consultant in some clinic/hospital in Bangalore in 2014 but he wasn't visiting Bangalore in May or June that year; that forced us to make some travel plans. My DH likes to call such trips as "Medical Tourism", although it is within our country itself.

Anyway, we called and took next feasible appointment with Dr. Rupin Shah (Consultant Andrologist and Microsurgeon, Centre for Male Reproductive and Sexual Medicine, Lilavati Hospital and Research Centre, Bandra West, Mumbai). We flew to Mumbai 16 hours prior to our appointment and also emailed him our reports (we had briefly discussed our case with him over the phone, as they think out-station patients deserve to clarify few things before travelling to Mumbai).

Reaching the hospital an hour in advance is always a good idea. There's a One-time Registration done for Rs.100 and I fail to recall Dr. Shah's consultation fee. Everything is quite organized there; however the only tricky part was dropping one's prescription paper (which later gets attached to your file) in a letter-box type enclosure attached to the doctor's cabin door. That way, your turn may not come as per your sequence in queue, but randomly, by chance/luck/probability. Since there weren't many patients waiting at around 9:30AM on a weekday, we met up with him well within the "waiting time at a clinic" norm.

His advices were :-
1. Attempting a microsurgery (Varicocelectomy and Biopsy) to fix Bilateral Varicocele Grade - III
2. Using Artificial Donor Insemination (ADI)

We were so convinced with his confidence on fixing the Bilateral Varicocele that I almost got my DH admitted in the hospital on the spot, with no family or friends around to bank on for any help. Then we both took individual 10-minute time-off to virtually walk-through the whole thing. Fortunately, we agreed to "not taking hasty decisions" again and immediately went back to meet Dr. Shah to ask the Percentage of Success in such cases.

By his vast experience, he concluded that the TESE could have destroyed any plausible chances of natural sperm generation; his final advice was to take a chance with Varicocelectomy. We had already collected all possible details required for the microsurgery in those 10 minutes. After hearing the dreaded phrase “take a chance", we told Dr. Shah that we need to re-think and take advice of our parents too, and pushed off from there. Dr. Shah had patience; he quietly listened to all our concerns and fears and gave unbiased advice. He was quite affable too.

We faced disappointment in Mumbai as well. Since we had planned a 3-day trip, we continued with our plan after spending nearly 3 hours in Lilavati Hospital. In those two and half days, we explored Mumbai as much as possible and had good fun. It isn't just the disappointments which get hard-wired on your memory, good things too are a part of it; the key is to strike the balance to stay happy and positive. That's why we never miss an opportunity to enjoy life in spite of the tough situation we were facing.

Diagnosed with Severe Oligospermia and Bilateral Varicocele Grade III

Dr. Joshitha Naik suggested that we discuss our case with Dr. Mahendra Jain (Urologist, a consultant in Lady Hospital, Jayanagar, Bangalore). Unfortunately, visiting him was a complete waste of time, effort and money. We, being the only patient for him to consult on a Saturday afternoon, were made to wait for 1.5 hours, that too after making several enquires. Upon his arrival, he did some physical examination and prescribed few medicines to cure Severe Oligospermia. He didn’t suggest any tests or scans. We googled about the drugs and they were nothing but energy pills and some vitamin supplements. We discarded his diagnosis and discussed it with Dr. Naik. She then gave reference of Dr. Ravish I R (Urologist, a consultant in Lucid Diagnostics, Jayanagar, Bangalore), also attached with Vikram Hospital, Millers Road, Bangalore. 

We visited Dr. Ravish in Sep’ 12 itself. He had a fair idea of what it might be leading to. He asked my DH to get a Doppler Scrotal and Ultrasound Transrectal done. The report concluded that the Severe Oligospermia could be a result of Bilateral Varicocele Grade III (the worst case). He suggested that a Varicocelectomy “might” fix the problem but post the procedure, my DH would need at least 1 month to recover from the incisions and sutures, and the testis would require another 3 months to produce fresh sperms normally. For your information, Lucid Diagnostics conduct all sorts of tests and scans; their consultant doctors are very professional and they value your time.

We weren't sure if going for this procedure was the first thing to do, so we decided to consult another specialist. This time we googled and discovered that St. John’s Hospital has really good and talented doctors in their panel. St John's might not be the cleanest hospital in town but it is worth going there for their talented faculty. We met up with Dr. A Nagaraj Rao (Professor & Head of Urology Department, St. John Medical College and Hospital, Koramangala, Bangalore). He turned out to be a very knowledgeable and experienced professional. He took a lot of time to go through each and every report we were carrying with us, confirmed that the diagnosis of Dr. Ravish I R was in fact correct, and result of conducting Varicocelectomy might not be successful. We did few tests, namely FSH, LH and Free Testosterone. Reports highlighted the excessive work done by the brain, signalling the testis to produce sperms. He explained the science of testis and how varicoceles impede the production of sperms. Apart from the procedure, he gave us two more options, Artifical / Assisted Reproductive Technique (ART) and Ayurveda.