We had a follow up appointment with our urologist and the good news is that our karyotype testing came back fine, no genetic issues, all chromosomes are in place - what a relief! I was so worried.
based on Dh's test results and particularly lower testosterone, the doc suggested the following treatment:
(i) increasing the count: FSH. There are three possible options for taking FSH: 1. tamoxifen, 20 mg/day for 30 days, which is what DH was prescribed; 2. some other anti-estrogen, forgot the name but basically it's only for overweight men; 3. Clomid, but the doc said this is too aggressive and may increase the testosterone too much and shut the system off completely;
(ii) improving the quality/morphology: antioxidants i.e. proxeed.
The doc was very clear that the above treatment may increase his count by 30-40% but it will not necessarily lead to pregnancy. We need to check DH's blood in 6 weeks to check that testosterone and FSH are rising and if everything is OK we will repeat SA in 3 months and then consider another IVF. Our urologist suggested stim IVF to improve the odds and did not recommend natural IVF. When I tried to explain that natural worked better for us because of my high FSH (at least we had a chemical pregnancy while with stim cycle we did not have any fertilasation), he kind of hinted that our clinic may not have been the best place for a stim IVF.
DH started the treatment last night but 3 months seems like ages.