Saturday, March 27, 2010

Husband Has Severe Varicocele: Surgery or IVF?


My husband has a severe varicocele on the left. The sperm count is 0.8 million in total and has 5% motility after 1 hour. What should be our first option: should we do varicocele repair first or should we go for IVF/ICSI?

Thank you for your help in advance. S. from Illinois.


Hello S. from Illinois,

The severely decreased sperm count is probably not from the varicocele but other factors. Several studies have shown that removing the varicocele make little difference, and so nowadays it is not recommended. Many Urologists will recommend it and do the procedure because that is the only treatment they can offer. I think most infertility centers will recommend proceeding directly to IVF/ICSI. That is what I recommend. Besides, if your husband goes through this surgery and the semen analysis is still abnormal, you will still have to go to IVF with ICSI.

Why not go to your infertility clinic directly and get pregnant? :)

Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.


  1. My husband has MFI. What are some other things that can causes MFI besides tight clothes and heat? Does anyone really know?

  2. I presume MFI stands for "male factor infertility" which is not a standard medical acronym but I am learning more and more new acronyms as I read through blogs, twitter and facebook. If I'm wrong, please let me know.

    There are many factors for abnormalities in the semen analysis and male factor problems. In fact, heat and tight clothes are contributing factors but not significant ones, and rarely the problem.

    Sperm abnormalities can be caused by various testicular abnormalities due to anatomical causes such as undeveloped testis, undescended testes, genetic disorders, scar tissue formation, damage due to infectious diseases, nutritional problems, hormonal problems, substance abuse, exposure to chemicals/toxins/ radiation. Without a thorough urological evaluation, by a urological male infertility subspecialist, one cannot know.

    Unfortunately, treatments are limited with male disorders. Sometimes corrective surgery can be done, or the noxious agent such as hormones, drugs, alchohol, chemicals or radiation can be removed and it will return to normal, but in most cases either IUI or IVF/ICSI will be required. In some cases, donor sperm is the only option.

  3. Thank you for your response! My husband has a low sperm count of about 2-3 million. His morphology and motility are ok though. He went to a urologist and all was ok...He even did Clomid for 3 months, but it didnt work. He does drink about 12 beers once a week. We have been doing IVF tx with no success so far.
    Thanks again for your response, and thank you for having this blog. :)

  4. hi also had tha same problem but i had variocele.and now am takin clomid ope it wil work.

  5. Hello March 25th,

    Clomid will sometimes help to increase Sperm count if it is lower than normal. It is taken at 25-50 mg per day and you will need to use it for 3 months to see if it works. It does not work with severely abnormal counts (<10 million count), but between 10-20 million it can increase it enough to make IUI a possible treatment option.

    Clomid works by increasing testosterone output.

    Good Luck



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