Hi Jayan , Male factor is the commonest cause for infertility . Varicocele alone is not a cause for infertility. Only when all other possible causes have been ruled out, varicocele should be blamed. I assume that repeated semen analysis showed a poor count & quality. Before going for higher management try to remove the cause for the poor sperm quality. Only healthy sperm can give a healthy baby. Kindly confirm if 1.your blood sugars/ Serum Thyroid & Prolactin are normal 2. Reduce body weight , if your on to overweight 3. Avoid smoking( even passive smoking ) / alcohol/ any other substance abuse 4. Have cold water bath 2-3 time / day if possible 5. Try methods to reduce mental stress( I know it s easy to say , but tough to practice)- by meditation , Yoga 6. Kindly repeat semen analysis from an infertility centre- with abstinence not less than 3 days & not more than 6 days. If they report any infection / WBC/ Pus cells above normal , you will need a course of antibiotics for 2 weeks. Expecting your wife s tubal factor & ovulation factors have been ruled out. Since you are married for 7 yrs, after this basic evaluation & treatment you can try IUI with good hormonal induction & support. In IUI they wash the semen & separate the healthy sperms & keep it close to the waiting egg. Pregnancy chances are 4 times. Even after 3 IUI if you don t get a positive result you can go for IVF, where only the healthy sperm is selected . Don t worry , The lowest count for which I could get a pregnancy was 5 million. All the best Dr.Balakrishnan