Looking for conceive but with Varicocele

Hello,

I am 37 years old and my wife and I have been trying to conceive for the past five months. I have bilateral varicocele and underwent two previous surgeries (spermatic vein ligation), both followed by recurrence. I decided not to pursue further surgery.

Since September 2025, we have been actively trying to conceive, and I have been taking supplements. Below is a brief summary of my latest semen analysis and hormonal tests. Although I am already under medical care, I would appreciate your opinion.

***Latest semen analysis (Nov 2025):

- Abstinence: 5 days

- Volume: 4.0 ml (WHO 2021 ≥ 1.4 ml)

- pH: 7.6

- Liquefaction: incomplete

- Sperm concentration: 27.7 million/ml (WHO 2021 ≥ 16 million/ml)

- Total sperm count: 110.8 million (WHO 2021 ≥ 39 million)

- Motility:

- Progressive (a+b): 54% (WHO 2021 ≥ 30% progressive)

- Total motility (a+b+c): 66% (WHO 2021 ≥ 42% total)

- Immotile (d): 34%

- Normal morphology: 8% (WHO 2021 ≥ 4%)

- Leukocytes: absent

***Hormonal profile (Jan 8, 2026):

- FSH: 1.4 mIU/ml (ref. 1.4–18.1)

- LH: 2.56 mIU/ml (ref. 1.5–9.3)

- Total testosterone: 20.75 nmol/L (ref. 6.85–23.23)

- Prolactin: 5.1 ng/ml (ref. 2.1–17.7)

***Hormonal profile (Feb 8, 2026):

- Morning Cortisol: 17.3 μg/dL (Ref.: 4.8 – 22.4)

- 17 Beta Estradiol (E2): 29.7 pg/mL (Ref.: < 39.8)

- FSH: 2.0 mIU/mL (Ref.: 1.4 – 18.1)

- LH: 2.12 mIU/mL (Ref.: 1.5 - 9.3)

- Prolactin (PRL): 4.4 ng/mL (Ref: 2.1 – 17.7)

- Free Testosterone: 23.6 (Ref. 12.3 - 46.6)

- SHBG: 46.7 nmol/L (Ref.: 20.6 – 76.7)

- Dihydrotestosterone (DHT): 331 ng/L (Ref.: 143 – 842)

As I said, since September 2025 I have been taking Arginine and Ashwagandha, and starting in November I added CoQ10, Zinc, Selenium, and Folic Acid.

Since January 2026, I have also increased the Arginine up to 3000 mg, added Horse Chestnut (60 mg Aescin), Vitamin D 2000 IU, and Magnesium.

I am being followed by doctors at a fertility center, but they do not currently recommend assisted reproductive technology ("A.R.T." and about it, my wife is in favor of not pursuing it; she does not want to force things.). Instead, I am looking for a doctor who can perform sclerotherapy embolization.

My wife is in wealth, she's 35 yo and with no clinical issue.

Every time she tells to me: "I'm sick, I think my things are coming", i feel sad.

Kind regards.