Possible malpractice lawsuit? (bad protocol and surgery)

Chris84

Member
Hey, guys. Firstly, I’m not the kind of person whose first instinct is to sue a doctor if the results aren’t satisfactory because they are human after all, and I also don’t need the money. However, I’ll provide you a timeline of doctor visits, semen analysis results, medications, surgery, etc. and please tell me what you would do in my situation. Sorry about the poor format. I wrote all of this up first in my notes app and it didn’t copy and paste that great.

I’m 37 years old and trying to have children with my wife for the past year. Prior to the April 7, 2020, I was on a TRT protocol of test cyp 70-80mg/twice a week and HCG 500iu/2 times a week for 2.5 years with no breaks or missed doses. I’m 6’1 and 200 pounds and have been actively weight training bodybuilding style since high school and my nutrition is always dialed-in very well.

During all of the dates below, labs were drawn along with the semen analysis. My testosterone remained from 800-1000+, my FSH always below the range and my LH remained below the detectable range.

Cliff Notes (because I wrote way more than I expected)

  • March: Best count semen analysis w/bad morphology and this was while on T and HCG
  • April: Urologist has me stop the T and increase HCG (1000iu/3 a week)
  • May: Bad semen analysis
  • July: Wants me to increase HCG (2000iu/3 a week) and declines my clomid request
  • July: Good semen analysis w/ bad morphology (3 months after quitting T)
  • July: Dr discovers severe left varicocele and pushes for surgery and says it will help with my poor DNA frag and morphology
  • September: surgery (Dr said everything went well)
  • October: Dr says everything looks fine
  • December: Poor semen analysis w/ slightly improved morphology
  • January: Dr wants no changes with HCG only and declines my clomid request again. Mentions COVID as a possible fertility factor. Says results can take up to a year for varicocele surgery
  • January: COVID antibody test shows up negative
  • February: Worst semen analysis so far
  • March: Wife’s doctor prescribes me clomid at 25mg/day
  • March: Dr confirms that I have a large epididymal cyst on my left side and schedules ultrasound
  • March: Ultrasound shows that not only do I have a 2 inch cyst on my left epididymis, but I still have a varicocele on my left side.


To conclude, my urologist continued to see poor semen analyses, didn’t make the necessary medication changes and performed an unsuccessful varicocele surgery where I also grew a large cyst in that same area where he was operating on and says it has nothing to do with the surgery. I am now worse off fertility wise for a natural conception as well as have a dull ache(3 out of 10 pain) in my scrotum that he says that I, “just have to deal with.”



March 30, 2020

  • my first and only semen analysis while on TRT. At this moment, I believe I was using 500iu of HCG 3 times a week at this point
  • Total count: 115 mil
  • Total motile count 92 mil
  • Surprisingly good counts but morphology was low and no fast swimmers




  • April 7, 2020
    • Televisit with urologist who told me to stop testosterone and bump up the HCG to 1000iu/3 times a week. He didn’t like my low morphology numbers (optimal sperm shape) at 2%. 4% is the minimum of the range.


  • May 4, 2020



    A more in-depth semen analysis and the first test after stopping T but continuing HCG only



    Total sperm count: 9.6 mil (Poor)

    Total motile count: 5.4 mil (Poor)

    Notes: DNA fragmentation of the sperm was way below the range which supposedly increases the chance of miscarriage.


    July 6, 2020
    • finally an in-person visit with urologist.
    • Checks for varicocele. Finds a severe left varicocele and insists on microsurgery. He believes it will improve my fertility as well as the morphology and dna fragmentation issues due to the added heat from the pooling blood in the scrotum.
    • Said that semen improvement for DNA fragmentation may take a year after surgery which was one of the main points he was driving to make me go under the knife since he knows that my wife and I are both 37 years old, so every month counts for the next couple of years.
    • I asked about adding clomid, but he said that it can make my sperm numbers worse and said that increasing the HCG dose would be a better route.
    • HCG dose increased to 2000ius/3 times a week

      July 13, 2020

      Semen analysis 3 months after stopping T

      Total count: 84.6 mil. (Good)

      Total motile count: 45.7 mil (Good)

      Morphology still low at 1% (Poor)



      September 11, 2020

    • Surgery day
    • Doctor called wife afterwards and said the surgery was successful.
    • I was pretty sore for 2 weeks and had some bruising but that’s expected.
    • I refrained from weight lifting or picking up heavy objects for 3 weeks.

      October 19, 2020

    • first urologist visit since surgery
    • I mentioned tenderness in my epididymis area on the left side where the surgery was performed. It was a little swollen looking and I mentioned to him how it looked like how the varicocele appeared.
    • He said everything felt normal after scrotal exam

      December 11, 2020



      Semen Analysis



      Total count: 10.2 mil (poor)

      Total motile: 5.2 mil (poor)

      Sperm morphology improved to 4%(minimum of the range)



      January 20, 2021



    • Televisit with urologist
    • Growing frustrated with another poor semen analysis, I asked about adding clomid again. He again declined saying the same negative things about clomid and wanted to stay the course with the same dose of HCG at 2000ius/3 times a week.
    • He said that he wanted to continue to wait for things to improve because it can take 6-12 months to see improvements after surgery.
    • Pulled the COVID card saying that they’ve been seeing it affecting fertility and that I could’ve gotten it without even knowing.
    • I took an anti-body test a week later and had none.

      February 23, 2021



      Semen analysis (Now 5.5 months after surgery)



      Total count: 9 mil (worst count to date)

      Total motile count: 3.9 mil (worst count to date)



      March 10, 2021



    • Following the recommendations of my wife’s IVF doctor who said, “Uh, why isn’t he taking clomid?”, I was prescribed clomid by him and began taking 25mg/day

      March 18, 2021

      In-person urologist visit after my worst semen analysis
    • My wife is an NP, so she finally came with me because she was getting just as frustrated.
    • I started having a dull pain on the left side of my scrotum and was afraid the varicocele had returned.
    • Urologist checks for varicocele and finds a large epididymal cyst on the left side and before we can even say anything, he insisted it isn’t from the surgery and how he stayed away from that area.
    • After scrotal exam, we both noticed that he would only look at me and not at my wife for the rest of the appointment (sign of guilt). My wife’s suspicions of a surgery gone wrong start to grow.
    • Doctor says that there are no options for an epididymal cyst and it’s something that we “have to deal with”
    • We also told him that I had start clomid (against his advice). He immediately was concerned and started asking how I’m feeling and about any side effects like headaches, etc.
    • An ultrasound was prescribed not only for the cyst but also whether I still had a varicocele.

      March 25, 2021


    • Ultrasound confirms that I both have a varicocele as well as a 4 cm(2 inch) long epididymal cyst.
    • Confirmation that not only was my surgery unsuccessful, but now I have a dull pain due to a cyst with no remedies and no idea for the long-term whether it will grow or remain there for a long time.

      April 20, 2021



    • In-person urologist visit with my wife is scheduled
What would you do in my situation? My semen results are terrible and I am left way worse off than I was before ever visiting this doctor.
What’s the cost of a wasted year regarding time lost, expensive testing, surgery and medication?
The proper treatment probably should’ve been HCG to Clomid and then add FSH if necessary, right? The urologist made a big deal about DNA fragmentation and morphology justifying surgery when in reality he should’ve realized I had undetectable FSH, a crucial hormone for spermatogenesis which could’ve improved my two weak points in my first semen analysis.
 
Last edited:

Systemlord

Member
It would seem this urologist is pushing for surgeries over everything else and may have gotten tunnel vision by overly focusing on your DNA fragmentation and morphology diagnosis, therefore not bothering to check all parameters (FSH) for sperm production.
 
Last edited:

ERO

Member
I can't believe he didn't prescribe FSH right away? Or if not right away, right after seeing how increasing HCG didn't help.

Guys that remained on TRT and used FSH have become fathers.
 

Chris84

Member
Thanks for the responses so far, guys. One theory of my wife and I is that since people were putting off surgeries at that time, he was looking to make some money while business was slowed down in the middle of COVID. All avenues weren’t exhausted, the varicocele wasn’t painful and surgery should always be the last option. Since we are in our late 30’s, he knows we don’t have a ton of time to conceive naturally and made it seem like surgery should be done soon since it could take up to a year to see improvement in the areas he was concerned about (fragmentation and morphology)
 

Chris84

Member
According to what I’ve researched on the board so far, HCG monotherapy can shut you down from producing FSH, a very important component to sperm production and quality like morphology which in the beginning was my only issue that this urology wanted to correct. I have been shut down since I started TRT until now (3.5 years) which is shown in my labs and yet no new medications were prescribed and instead a failed surgery was performed. If this was you, would you present this to a medical malpractice lawyer?
 

Weasel

Member
I can't believe he didn't prescribe FSH right away? Or if not right away, right after seeing how increasing HCG didn't help.

Guys that remained on TRT and used FSH have become fathers.
Guys that remained on TRT and used HCG have become fathers. I'm one of them.
 
Can you clarify - are your TT levels still 800+ off of TRT?
Let's assume your left testicle is dead, whether due to history of vericocele, result of surgery, or whatever. Can you explain why your right testicle is unable to produce healthy sperm?
The following link mentions Testosterone level being too high can cause the sperm count to go down rather than up. Also mentions sperm takes 90+ days to be produced, so you may need to wait 3+ months after starting Clomid to see results. Clomid for Male Infertility - Low-T - Fertility Treatment - Austin Fertility Docs.
 

Chris84

Member
Can you clarify - are your TT levels still 800+ off of TRT?
Let's assume your left testicle is dead, whether due to history of vericocele, result of surgery, or whatever. Can you explain why your right testicle is unable to produce healthy sperm?
The following link mentions Testosterone level being too high can cause the sperm count to go down rather than up. Also mentions sperm takes 90+ days to be produced, so you may need to wait 3+ months after starting Clomid to see results. Clomid for Male Infertility - Low-T - Fertility Treatment - Austin Fertility Docs.
Yes. My testosterone just came back this past Monday at 1090 ng/dl, so the HCG must be doing its job in that sense. It has never dropped below 800 on HCG only. I’ve currently been on 25mg of Clomid for the past 5 weeks and am waiting to speak to the nurse to hear what the next step should be after another low FSH reading. I’m thinking I should titrate off the hcg and just do Clomid only and see what happens after the next 2 months

I’ve read that link recently and it got me thinking that I should work on getting my testosterone lower. Prior to surgery and with the varicocele, I had my two of my best counts ever, so I’m assuming that it has something to do with being on the hcg monotherapy for so long and not making many adjustments. I wonder if the elevated testosterone plus the low FSH has anything to do with the recent low counts. Who knows what the failed surgery did to me as well. Can we desensitize at the same HCG dosage after a while? I’ve been on it for 3.5 years if I include the time on TRT
 
Last edited:

Chris84

Member
Updated protocol from wife’s IVF doctor (instead of urologist). Reduced HCG to 1500ius/3 times a week and increase Clomid to 50mg/day. I’m going to feel like shit
 
Yes. My testosterone just came back this past Monday at 1090 ng/dl, so the HCG must be doing its job in that sense. It has never dropped below 800 on HCG only. I’ve currently been on 25mg of Clomid for the past 5 weeks and am waiting to speak to the nurse to hear what the next step should be after another low FSH reading. I’m thinking I should titrate off the hcg and just do Clomid only and see what happens after the next 2 months

I’ve read that link recently and it got me thinking that I should work on getting my testosterone lower. Prior to surgery and with the varicocele, I had my two of my best counts ever, so I’m assuming that it has something to do with being on the hcg monotherapy for so long and not making many adjustments. I wonder if the elevated testosterone plus the low FSH has anything to do with the recent low counts. Who knows what the failed surgery did to me as well. Can we desensitize at the same HCG dosage after a while? I’ve been on it for 3.5 years if I include the time on TRT
I just read your post that you lowered hcg to 1500 3x per week from 2000 3x per week. As for your suggestion above to titrate off hcg completely, I have no idea if going off completely is fully warranted or not. Your testosterone on the 2000 dose was obviously in the high range, so lowering it to some degree seems like correct path. Follow the fertility expert's advice, and be patient as it may take a couple months to see the full impact of Clomid. Good luck & keep us posted.
 

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