My husband had a varicocele operation a year ago. His sperm count before the operation was 5 million. After the operation he began taking Clomid. About four months ago, his sperm count had risen to 10 million. We just went back for another semen analysis last week, and his sperm count now is less than 1 million. The doctor now says our chance of getting pregnant is slim to none. We do not understand what happened to make the sperm count go so low. What could have caused the sperm to die? Do we still have a chance to get pregnant? Please help us find some answers.

Mandy

I can't be sure why the sperm count has dropped without more information, such as the size of the varicocele and hormone levels before and after clomiphene. So let me give you some general information that may or may not be relevant to your situation.

Surgery to correct a moderate- to large-size varicocele improve sperm count in up to 60 percent of men. Only about half of these couples will achieve conception as a result of the surgery. If any benefit is seen after surgery, continued improvement can be noted for up to two years after the surgery.

Clomiphene is overprescribed for male fertility. It is likely to benefit only those men with soft, small testicles who also have low testosterone and low levels of the hormones LH and FSH. If the FSH is high and/or the testosterone and testicular exam is normal, there will be little benefit from clomiphene therapy. Clomiphene causes LH and FSH to rise. In those men with an underactive pituitary gland (low FSH, LH and testosterone), clomiphene may be beneficial. However, clomiphene can also elevate testosterone levels, which can actually suppress sperm production. (Testosterone injections are currently undergoing research as a male contraceptive.)

As for fertility, if the sperm levels are low, I recommend that my patients test for chromosomal anomalies and DNA microdeletions, which can interfere with sperm production and may indicate a problem that can be passed on to a male offspring. Otherwise, IVF with sperm injection (ICSI) should be able to offer a good chance for you to conceive your miracle baby.