What would you do?

[Elisabeth3468]

We have been ttc our second baby for nearly a year. One chemical/early miscarriage in October.
Our first child conceived via ivf Icsi after 18 months trying first time.
I have PCOS but now have regular periods and ovulating (confirmed by blood tests).
Known severe low sperm count due to varicocele. Recent analysis just as bad as 3 years ago and showed 1 percent progressive sperm. Count very very low.
We don't know whether to get the varicocele fixed or go straight to IVF ICSI. My thinking is get the sperm in the best shape possible before attempting IVF?
What would you do?
I've just turned 28 , partner is 36.
I feel so down about it and is there any point even trying naturally?

Meant to go onto the infertility forum

@Elisabeth3468 How is your AMH level and have you had a pelvic ultrasound recently to see number of follicles? Did the doctor say how big the varicocele was? My husband has one thats 2mm and his urologist said its ok to leave it as they don't operate under 3mm usually, which means after doing a DNA fragmentation (which also came back good) - we have no medical explanation or solution to improving his sperm.

Based on what you've said above, you have one huge advantage on your side - age. As 28 your eggs are younger so if the timeline to sort out the varicocele isn't too long it could be worth waiting, and using this time to nourish yourself and your husband to make sure your eggs and future sperm are the best quality.

Everyone says it just takes one sperm to make a baby, but I understand the frustration and concerns because its balancing time, mental health and financial implications if going down the IVF/ICSI route. I'd say weigh up your best and worse case scenario and as a couple decide which outcome you can take more. My husband (35) and I (33) have been TTC 2 years, during this time I watched my AMH drop from 6 to 3.9 and saw the number of follicles reduce from 16 to 6-8. My husbands sperm has a morphology issue 0-1% at best of times although his volume, motility, concentration were all very good and ultimately decided to go down the ICSI route as our worse case scenario was trying another 2 years and still no baby. We may not have a baby after 2 years of trying with ICSI, but in our case we gave it our best shot.

Good luck whatever decision you choose to make xx

@Lavendermarshmallows I haven't had a recent AMH test but when I had it 3 years ago it was 72.8. I was 25 at the time. Very high because of the PCOS and I had a lot of follicles. I got 17 eggs from the ivf but only one good quality blast at the end which is my son! He's now 2.
Not sure what my amh would be now but can't imagine it's gone down significantly. Ultrasound was normal (well for PCOS) and showed lots of follicles. I had that about 6 months ago as I was getting pains.
In terms of the varicocele I'm not 100 percent sure on the size but I think he had 2. They only told us when I was already pregnant with my son as that was our follow up from the urologist. So we wasn't really interested in correcting it at that point so got discharged.
In terms of health we both eat really well and are not over weight. We both exercise and go to the gym 4 -5 times a week. I was really shocked about the sperm result knowing how healthy my partner is. He's just started proxeed a few weeks ago so hopefully that might have some improvement. But I'm naïve it probably won't be a quick fix.

It's a really hard decision because our chances of natural conception are so low.... his sperm count is severely low. Not just bit. But ivf is so expensive and we haven't really got any spare money so would have to take out a loan. It's such a gamble.
I really hope you get your baby soon, it's such a tough journey. Have you started ivf yet ? Xxx

Hi @Elisabeth3468 what did you decide to do regarding the varicocele ? X

Hello! Well I actually fell pregnant that same month I wrote this. 17 weeks tomorrow.
He never had the operation. But he did start taking Proxeed. He had also been having cold showers for about 8 weeks before I fell pregnant. Not sure if it has anything to do with it. He was only taking the proxeed for 2 weeks so not sure it was that either ! X

Amazing!! Congratulations!! X

Do you mind me asking what his count was? X

It was 4.5 million total. About 1.5 million per mls. 1 percent progressive motility. Couldn't measure morphology because count too low. X