Low Sperm Count

1 What is Low Sperm Count?

Low sperm count, also called oligospermia, is a condition in which the sperm count in the fluid called semen reduces to levels lower than normal. Semen is the male reproductive fluid released during ejaculation.

The sperm level less than 15 million sperms per milliliter of semen or less than 39 million total sperms per ejaculate is considered to be low. Having a low sperm count decreases the chances of egg fertilization, thus reducing the chances of pregnancy.

The condition of complete absence of sperms is called azoospermia. There could also be problems with abnormal sperm shape (morphology), movement (motility) or function. Nonetheless, many men who have a low sperm count are still able to father a child.

2 Symptoms

Generally, there is no particular sign and symptom of low sperm count. Activities like intercourse, erections, or ejaculation can usually happen without difficulty but in some patients the symptoms may involve:

  • Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
  • Pain, swelling or a lump in the testicle area
  • Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
  • Discomfort during sex

3 Causes

The causes of low sperm count depend on various factors such as health issues, medical treatment, lifestyle, hereditary background and environmental factors.

The production of sperm is a complex process and requires the normal functioning of the testicles (testes), the hypothalamus and the pituitary gland. Hypothalamus and pituitary gland are the organs in your brain that produce hormones that trigger sperm production. 

Medical factors which contribute to the incidence of low sperm count include:

  • Varicocele: Swelling of the veins that drain the testicle
  • Inflammation of the epididymis, known as Epididymitis
  • Orchitis: Inflammation in testicles
  • Sexually transmitted infections like gonorrhea or HIV
  • Health status: Various health conditions including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra can cause retrograde or lack of ejaculation.
  • Sperm production problems
  • Blockage in sperm transportation
  • Production of antibodies that attack sperms
  • Tumors
  • Undescended testicles
  • Hormone imbalance
  • Defects in tubules that transport sperm
  • Chromosomal defects
  • Certain medications and therapies like Testosterone replacement therapy, long-term anabolic steroid use, cancer medications, and certain antifungal and antibiotic medications

Environmental Factors:

  • Exposure to harmful industrial chemicals
  • Exposure to heavy metals
  • Exposure to radiation like X-rays

Poor Lifestyle:

  • Drug use
  • Alcohol consumption
  • Tobacco smoking
  • Stress
  • Obesity

4 Making a Diagnosis

Making a diagnosis of low sperm count is done by performing several tests.

It is recommended that if a couple is not able to conceive a child, even after a year of regular, unprotected intercourse, they should consult a doctor.

However, the doctor might refer the patient to an infertility specialist, if needed. The doctor will examine your genitals carefully and will inquire about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and your sexual development.

Other questions which your doctor can ask may include:

  • At what age did you start puberty?
  • Have you had a vasectomy or a vasectomy reversal?
  • Do you use illicit drugs, such as marijuana, cocaine or anabolic steroids?
  • Have you been exposed to toxins such as chemicals, pesticides, radiation or lead, especially on a regular basis?
  • Are you currently taking any medications, including dietary supplements?
  • Do you have a history of undescended testicles?

After physical examination, the doctor will suggest semen analysis, which will include a microscopic examination of the semen to measure the number of sperms present though, in some cases, a computer might be used.

To collect a semen sample, the doctor asks the patient to masturbate and ejaculate into a special container. It is also possible to collect sperm for examination during intercourse by using a special condom.

The doctor will ask the patient to:

  1. Make sure that all of the semen while collecting the sample for analysis, should be collected properly in the container.
  2. Abstain from ejaculating for at least once, but no longer than 11 days before collecting a sample.
  3. Collect a second sample at least one to two weeks after the first analysis.
  4. Avoid the use of lubricants because these products can affect sperm motility.

Development of new sperms in the testicles is a continuous process and the sperm take about 42 to 76 days to mature. Thus, a semen analysis reflects the health status of the patient during the past three months. Several semen samples are analyzed over a period of time as the number of sperms per ejaculate varies usually. Normal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semen. Sperm count less than 15 million sperm per milliliter or less than 39 million total sperms per ejaculate.

Other tests

Depending on the initial findings, the doctor may ask the patient for other tests to find out the cause of the condition, which may include:

  • Scrotal ultrasound: This test is used for ultrasound imaging of the testicles and the supporting structures. It employs the ability of high-frequency sound waves to obtain the images.
  • Hormonal testing: A blood test to analyze the hormonal profile of the patient could be recommended. It is very useful for determining the levels of the hormones which are produced by the pituitary gland and testicles to play crucial roles in the process of sexual development and sperm production.
  • Post-ejaculation urinalysis: Urine examination after ejaculation could also be suggested to confirm if the sperms are traveling backward into the bladder instead of moving out the penis during ejaculation. The condition is called retrograde ejaculation.
  • Genetic tests: The doctor could recommend genetic tests to check if a genetic cause is involved. 
  • Testicular biopsy: It involves removal of a tissue sample from the testicle, with the help of a needle, which is then examined under a microscope. The test allows the doctor to confirm if there is any abnormality in the sperm. If the sperms are produced normally, there could be some kind of blockage in the transport channel of the sperms. Although the test is useful, it is recommended only in certain situations. 
  • Anti-sperm antibody test: This test is used for the detection of antibodies produced by immune cells to attack the sperms. 
  • Specialized sperm function tests: Various tests which can be used to determine the specific function like to check how well the sperm survive after ejaculation or how well the sperm can penetrate an egg and whether there is any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change treatment recommendations.
  • Trans-rectal ultrasound: In this test, a probe (a finger sized blunt ended surgical instrument) is inserted into the rectum to look for blockages or other abnormalities in the prostate or surrounding tissues.

5 Treatment

Although the options are limited, the choice of treatment approach for low sperm count depends on the cause of the problem.

The doctor will choose one or a combination of the following options:

  • Treating infections: If the cause behind the reduced serm count is an infection in the reproductive tract, the doctor will prescribe antibiotics.
  • Sexual intercourse problems: In cases where conditions such as erectile dysfunction or premature ejaculation are involved the doctor will suggest counseling along with Medication.
  • Intra- cytoplasmic sperm injection (ICSI): Fertilization by injecting single sperm directly into the egg.
  • Hormone Drugs: Prescription of hormones like Gonadotrophin supplement (Gonadotrophin is a hormone which stimulates sperm production).
  • Donor insemination: If the patient’s sperm count is not sufficient enough to fertilize parter’s egg, sperms from a donor could be inseminated into the uterus of the female partner, so that fertilization of egg could take place.
  • In Vitro Fertilization: The egg and sperms are taken from the couple and fertilized in a laboratory. The fertilized egg is then transferred into the woman’s uterus, where it may implant and result in a successful pregnancy.

6 Prevention

Some measures, as discussed below are considered to prevent the risk of acquiring low sperm count condition:

  • Limit or abstain from alcohol intake.
  • Do not smoke.
  • Do not use illicit drugs.
  • Consult your doctor before taking any medication
  • Maintain a healthy weight.
  • Avoid long exposure to heat.
  • Manage stress.
  • Avoid exposure to pesticides, heavy metals, and other toxins.

7 Alternative and Homeopathic Remedies

In case the cause of low sperm count is a deficiency, some alternative rremedies could help.

Studies have shown that supplements like Alpha-lipoic acid, Anthocyanins, L-arginine, Astaxanthin, Beta-carotene, Biotin, L-acetyl carnitine, Co-enzyme Q10, Ethylcysteine, Glutathione, Inositol, Lycopene, Pentoxifylline, Phosphodiesterase-5 inhibitors, Polyunsaturated fatty acids, Selenium and some Vitamins, have potential benefits on improving sperm count or quality. But these supplements are not effective if the underlying cause of infertility is a sperm duct defect or a chromosomal disorder.

Always take any kind of supplement after consulting the doctor.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with low sperm count.

Some measures as described below could help couples in conceiving a child.

  • Increase the frequency of sex without protection, to increase the chances of pregnancy.
  • Have sex when the chances of fertilization are high. The chances of getting pregnant are very high in the middle of menstrual cycle (between two periods), when the woman is ovulating.
  • Avoid using lubricants. Lubricants for example Astroglide, K-Y jelly, lotions,or saliva may impede the function or movement of the sperm towards the eggs thus, reduces the chances of fertilization.

9 Risks and Complications

Some factors and habits increase the risk of suffering from low sperm count condition, which include:

  • Smoking
  • Excessive alcohol intake
  • Using certain illicit drugs
  • Obesity
  • Some infections
  • Exposure to toxic chemicals
  • Overheating of the testicles
  • Trauma to the testicles
  • Medical conditions, including tumors and chronic illnesses
  • Radiation exposure
  • Certain medications
  • Prior vasectomy, major abdominal or pelvic surgery
  • History of undescended testicles

Low sperm count conditions can lead to infertility.

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