LOW SPERM COUNT
One of the reasons for male infertility is oligospermia, which is the low sperm count in semen. Oligospermia treatment depends on its cause and may involve both, conservative and surgical procedures, such as IVF. Let us review this condition, its causes and treatment options in more detail below.
Low sperm count means that the fluid (semen) you ejaculate during an orgasm contains less sperm than usual. A low sperm count is also referred to as oligospermia (ol-ih-go-SPUR-me-uh) and a complete absence of sperm is called azoospermia. Your sperm count is considered lower than normal if you have fewer than 15 million sperm per millilitre of semen. When you have a low sperm count, it is less likely that one of your sperm will fertilize your partner’s egg, resulting in pregnancy. Nonetheless, many men who have a low sperm count are still able to father a child.
WHAT CAUSES A LOW SPERM COUNT?
Often, no cause can be found for a low sperm count. However, it has been associated with several genetic and non-genetic conditions, including:
- Hypogonadism, a hormone imbalance where the testes produce few or no hormones (often has an identifiable cause such as Klinefelter syndrome)
- Klinefelter syndrome (an inherited genetic problem)
- Undescended testicles
- A structural problem with the male genital tract (for example, the tubes that carry sperm can be blocked or damaged by illness or injury)
- A genital infection such as chlamydia, gonorrhea or prostatitis(infection of the prostate gland)
- Previous surgery to the scrotum or surrounding area
- varicoceles (dilated veins within the testicles)
- Certain medication, including testosterone replacement therapy, long-term anabolic steroid use, chemotherapy, some antibiotics and some ulcer medications
- Exposure to harsh chemicals such as pesticides
- Using drugs, such as marijuana
SYMPTOMS OF LOW SPERM COUNT
There might be no other obvious signs or symptoms other than the inability to conceive a child. In some cases, an underlying problem such as an inherited chromosomal defect, a hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause more noticeable signs and symptoms. Low sperm count symptoms might include:
- 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 chromosome or hormone abnormality
OLIGOSPERMIA TREATMENT OPTIONS
For example, a varicocele can often be corrected using surgery as well as an obstructed vas deferens. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
Antibiotics can cure infections of the reproductive tract; however, this doesn’t always restore fertility.
TREATMENTS FOR SEXUAL INTERCOURSE PROBLEMS
Medication or counselling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
HORMONE TREATMENTS AND MEDICATIONS
Your doctor might recommend hormone replacement therapy or medications in cases where infertility is caused by low or high levels of certain hormones or problems with the way your body uses hormones.
IVF (In Vitro Fertilization)
IVF (In Vitro Fertilization) is a one assisted reproductive technology (ART). IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
THERE ARE FIVE STEPS IN THE IVF AND EMBRYO TRANSFER PROCESS:
- Observe and stimulate the development of healthy egg(s) in the ovaries.
- Collect the eggs.
- Collect the sperm.
- Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth to take place.
- Transfer the embryos into the uterus.
Step 1: Fertility medications are first prescribed to stimulate egg production. Having multiple eggs is preferred, as some eggs will not develop or fertilize after retrieval. A transvaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.
Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity in order to remove the eggs. Medication is then provided to reduce and remove any potential discomfort the patient might experience.
Step 3: The male is then asked to produce a sample of sperm, which is prepared for combining with the eggs.
Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory to encourage fertilization. In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. During this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are closely monitored to confirm that th fertilization and cell division is successful. Once this occurs, the fertilized eggs are considered embryos.
Step 5: The embryos are usually transferred into the woman’s uterus three to five days following the egg retrieval and fertilization. A catheter (small tube) is inserted into the uterus to transfer the embryos. This procedure is usually painless, although some women may experience some mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following the egg retrieval.
DIAGNOSING LOW SPERM COUNT
- History taking and physical examination: This includes examining your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could potentially affect fertility. Your doctor might also ask about your sexual development and sexual habits.
- Semen analysis: A low sperm count is diagnosed as part of a semen analysis test. Sperm count is generally determined by examining semen under a microscope to see how many sperm appear within squares on a grid pattern. In some cases, a computer is used to measure sperm count.To collect a semen sample, you will be asked by your doctor to masturbate and ejaculate into a special container. It’s also possible to collect sperm for examination during intercourse, using a special condom. Because sperm counts often fluctuate, typically several semen analysis tests are done over a period of time to ensure accurate results.
- Scrotal ultrasound: This test uses high-frequency sound waves to look at the testicles and their supportive structures.
- Hormone testing: Your doctor may recommend you have a blood test to determine the level of hormones produced by your pituitary gland and testicles, which play a key part in sexual development and sperm production.
- Post-ejaculation urinalysis: Sperm in your urine can also indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation. This is known as retrograde ejaculation.
- Genetic tests: When your sperm concentration is very low, genetic causes could be involved. A blood test can reveal whether there are any subtle changes in the Y chromosome or signs of a genetic abnormality. Genetic testing may also be ordered to diagnose various congenital or inherited syndromes.
- Testicular biopsy: This test involves removing small samples from your testicle with a needle. The results of the testicular biopsy can tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem related to sperm transportation. However, this test is typically only used in certain situations and is not commonly used to diagnose the cause of infertility.
- Anti-sperm antibody tests: These tests are quite uncommon and are used to check for immune cells (antibodies) that attack sperm and affect their ability to function.
- Specialized sperm function tests: A number of tests can be used to check how long and how well your sperm survive after ejaculation as well as how well they can penetrate an egg and whether they have any problems attaching themselves to the egg. These tests are rarely performed and often do not significantly change treatment recommendations.
- Transrectal ultrasound: A small lubricated wand is inserted into your rectum to check your prostate, and for anything that may be blocking the tubes that carry semen (ejaculatory ducts and seminal vesicles).
Depending on the initial findings, your doctor might recommend having additional tests to look for the potential cause of your low sperm count and other possible causes of male infertility. These tests include: