Hello XXXXXXX
Thanks for your query.
Firstly, regarding your husband's semen count.
The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce hormones that trigger sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production. Also, there are problems of abnormal sperm shape (morphology) or movement (motility). Often the cause of low sperm count isn't ever identified.

A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. It's a common cause of male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm.

Some infections can interfere with sperm production and sperm health or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, including chlamydia and gonorrhea; inflammation of the prostate (prostatitis); inflamed testicles due to mumps (mumps orchitis); and other infections of the urinary tract or reproductive organs.

Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra. Certain medications also may result in retrograde ejaculation, such as blood pressure medications known as alpha blockers. Some men with spinal cord injuries or certain diseases can't ejaculate semen at all, though they still can produce sperm.

Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them. This is especially common in men who've had a vasectomy.

Cancers and nonmalignant tumors can affect the male reproductive organs directly, or can affect the glands that release hormones related to reproduction (such as the pituitary gland). Surgery, radiation or chemotherapy to treat tumors can also affect male fertility.

Undescended testicles. During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.
Hormone imbalances. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal, may impair sperm production.
Sperm duct defects. The tubes that carry sperm can be damaged by illness or injury. Some men are born with a blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one of the tubes that carry sperm out of the testicles (vas deferens). Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether.

Chromosome defects. Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann's syndrome, Young's syndrome, and Kartagener syndrome.
Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer medications and some other medications can impair sperm production and decrease male fertility.

Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead may contribute to low sperm counts.Exposure to lead or other heavy metals also may cause infertility.Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced. Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or using a laptop on your lap for long periods of time also may increase the temperature in your scrotum and reduce sperm production. The type of underwear you choose to wear is unlikely to significantly impact your sperm count. Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles.

Drinking alcohol can lower testosterone levels and cause decreased sperm production.Certain occupations may increase your risk of infertility, including those associated with extended use of computers or video display monitors, shift work and work-related stress. Men who smoke may have a lower sperm count than do those who don't smoke.Severe or prolonged emotional stress, including stress about fertility itself, may interfere with certain hormones needed to produce sperm. Obesity can cause hormone changes that reduce male fertility.

Your husband should consult an expert XXXXXXX who would examine him completely, and do relevant tests before giving appropriate therapy. Ayurvedic medicines and CO Q are not permanent treatments.

Also, I would like to know his current counts and the counts at which IUI was done.
If the semen count is less than 10 million, IUI has very less chances of success.

Also, regarding your ( female ) factors.
Could you tell me if during the IUI, your ovulation was successful and whether endometrium ( uterine lining ) grew properly.
Your basic hormones like FSH, LH, TSH, prolactin, AMH should be tested.
Baseline ultrasound on day 2 of periods should be normal.

HSG is not confirmatory of tubal patency.
A laparoscopy alongwith hysteroscopy is the gold standard to evaluate status of the uterus, fallopian tubes and ovaries.
You have not mentioned your age, and your partner's age, which is an important factor.

Right now the steps for you to follow are :

1. Consult an Infertility specialist for complete evaluation.
2. Consult an XXXXXXX for your husband.
3. Go for a diagnostic hystero - laparoscopy, and only if tubes are patent and all other factors are normal ( ovulation and your husband's semen count ) then go for 2 - 3 cycles of IUI more with intensive stimulation.
4. If semen count is low, tubes are blocked , then consider going in for IVF ( in vitro fertilization ).

Meanwhile, maintain a healthy BMI, a positive attitude and take regular folic acid supplements.

Take care and feel free to ask further questions.

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Hello
I do not think it is unexplained infertility.
The last count of your husband is still low and motility is definitely on the lower side, even for an IUI.
As I said earlier and I repeat, HSG is not confirmatory of patent tubes.
Lubrication gel could be a reason, but not for the past 5 years.
Considering your ages, I urge you to consult a reputed Infertility specialist, proceed for laparoscopy and then plan IUI / IVF accordingly.
take care.

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