We have been married for four years, and my husband has a very low sperm count (10,000) with very little motility, dead sperm and deformed ones. The doctor said we should do intrauterine insemination. Is this painful for the woman? Does it work in a situation like ours? Can we use my husband's sperm?

-- Melissa

Intrauterine insemination (IUI) should not be painful. If the semen specimen is properly prepared before insemination and the procedure is performed by a skilled physician, your discomfort should be limited to mild cramping.

In your case, IUI will work only if you choose to use donor sperm. Pregnancy is unlikely using your husband's sperm for insemination. With sperm counts that low, the only successful approach is to perform in vitro fertilization with intracytoplasmic sperm injection (ICSI). With that procedure, results depend in large part on your age and not his sperm count, as long as a few hundred motile sperm are available.

If his urologist has ruled out obstruction as the cause of the abnormal semen analysis, you may wish to consider genetic testing. In about 10 percent of cases, a genetic abnormality or an abnormality in a small section of his DNA (called a microdeletion) may be responsible for the problem. If this is the case, you will need to be aware that the particular defect could be inherited by a male offspring, who may subsequently have fertility problems.