Infertility/Fertility/male infertility


hello ! ,iam 37 i was recently diagnosed with severe oligoastenospermia, my sperm count was 0,4 million/ml , and percentage of progressivly motile spermatozoa 25%. i did a hormonal check which came back normal, my testicular ultrasound result was bilateral varicocela (2,5 mm dext and 3,3 mm sinister)what chances do we have for a pregnancy  after varicocelectomi is done or should we directly try ivf if we want to have a baby, my wife is 33, and we would really appreciate your advise for us on what to do next at this point?
thank you

Hello Brandon from Albania,

I think that you can go either way, although there is a higher chance of failure with varicocelectomy (surgery) than IVF.  My recommendation would be to do IVF with ICSI.  The semen analysis is an indirect measure of what we actually want to know, which is whether or not the sperm can fertilize an egg.  It only takes ONE sperm.  Since we can't do that test, we examine for everything else.  What we have found is that when the semen analysis is abnormal, there is often a fertilization defect when IVF is done.  So that is a functional problem.  Doing the surgery might be able to get your numbers up a little, probably not significantly, but it doesn't solve the functional problem.  The only way to assist with that is through injecting the sperm into the egg, called ICSI.  That can only be done with IVF.  Therefore, that is the treatment of choice.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at if you are interested in continuous access to me.


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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