Monique Rainford - HER HEALTH

Dear Dr Rainford,

I really need some serious advice and your expert opinion. I have been married for almost four years; my husband and I are both 24 years old. The problem is we have been trying to conceive for about two and a half years but with no success.

I have done the necessary tests and I am fine. My husband has done a semen analysis and it shows that his sperm count and motility rate are low. The urologist put him on 25mg of clomid per day for three months and said that if this doesn't work, we would have to move on to another treatment. I should also mention that an ultrasound showed that my husband had a small varicocele but the doctor said if it wasn't causing pain there was no need to operate.

Doc, what I want to find out is, can the varicocele be the cause of his low sperm count? I have read that it could be a contributing factor. I am thinking about in-vitro fertilisation but I don't know where it is done in Jamaica. I guess it is expensive but from the look of things that procedure could be our only hope.

Dear Reader,

I am sorry that you and your spouse are having difficulty conceiving. Nevertheless, your husband's problem is more common than many people realise. An article published in The Gleaner on January 2, 2008, reported that a male factor is the cause in about 50 per cent of cases of infertility in Jamaica. Your husband's sperm count is unfortunately very low as you recognise, since normal sperm count is at least 20 million/ml.

Clomiphene citrate (clomid) which is used to help women to ovulate has also been used for many years to treat men with low sperm count. Although clomid use in men has been shown to be effective in increasing the levels of certain hormones including testosterone, some research suggest that treating the male with this medication may not improve the pregnancy rates in their spouses.

Although there may still be a role for this medication in your husband's treatment, it may be more effective for men who have low levels of these specific hormones or if their sperm count is only slightly low.

Varicocele scrotum

A varicocele occurs when there is swelling and widening of the veins in the scrotum. It has been identified as the most common cause of male infertility in the world. The longer a man has one, the worse his sperm count. Repairing a varicocele can improve the overall sperm production but the repair of larger varicoceles appears to lead to more improvement than repair of smaller ones.

However, some research has shown that repair of even small varicoceles which are only detected by ultrasound can improve a man's sperm count. Therefore, it is certainly possible that your husband's varicocele may have contributed to his low sperm count but I would not be able to determine with any certainty whether treating it would help him.

Finally, in-vitro fertilisation is performed at the Hugh Wynter Fertility Management Unit of the University of the West Indies and the cost per cycle is about US$7,000.

I certainly hope that you and your husband will have children one day.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.