Q: I underwent varicocoelectomy a year back. My sperm count increased from 25 million per cc to 220 million per cc. Active motile - 20%, sluggish motile - 20%; non motile - 60 %. I took Clofert 50 for 4 months. After that my sperm count decreased drastically to 25 million per cc and active motile - 3%, sluggish motile - 22%, non motile - 75%. Do I have to stop the medicine or not?

A:Outcome after varicocoele surgery is variable. These can be measured in terms of pregnancy rates as well as improvement in seminal parameters. 33 to 50% couples may be expected to have a successful pregnancy after surgery, while seminal parameters may improve by more than 100%. Unfortunately, what needs to be understood is that varicocoele surgery outcome depends on many preoperative characteristics. Most important of these are 1. Palpable varicocoele, when treated, have better outcome than sub-clinical varicocoele (detected on Doppler examination) 2. Improvement is likely to be more after bilateral correction of varicocoele, 3. Men with smaller testes may have poorer outcome, and need evaluation with LH and FSH estimation too. 4. Men with sperm count of less than 5 million/ml, and motility less than 30% may never have enough improvement to have a successful pregnancy, and should, rather, be referred for assisted fertilisation (IVF- in vitro fertilisation). Medication you were having is a nonspecific treatment for infertility, and changes in your seminal parameters are unlikely to be related to the medical treatment. Both, the improvement as well as deterioration after varicocoele surgery in your case, are too dramatic to explain, and may have been present in one isolated report only. You need a complete evaluation, and a fresh look at all the events so far to put things in proper perspective, and right advice.