<s>[INST] i am male 28,on my infertility work up diagnosed with bilateral grade 2 vericocele, i had semen analysis 4 to 5 times. at first 40 million motility normal after sperm count deceasing to 25, 15, 20, 05 in further tests with all normal motility. i have no stress and psychological problems, all my harmonal reports lh,fsh,TT,TF, prolactin are normal but having elevated E2 is 92.29 pg/ml, having good erections but suffering low libido and no that much plesure in intercouse and while ejaculating. what to i do now doctor suggested surgery for vericocele is it required for bi lateral grade 2? [/INST] Hello and welcome to HCM. As an Urologist,i can understand your anxiety.Surgery for varicocele,isn't guaranteed to reverse your low sperm counts.Your semen analysis,showed decreasing counts of 25 to 5 million/ml.With normal hormonal levels,you should consider ART.ART is assisted reproductive techniques,like IUI (intra uterine insemination),or ICSI,which's a type of IVF (in-vitro fertilisation),or test tube baby.Medical treatment with clomiphene citrate,Co-Q and lycophene's needed.If you've any doubt's,send all reeports to me,as a direct question. Dr.Matthew J. Mangat. </s>