Low Sperm Count

Overview

Low sperm count, also known as oligospermia, refers to a condition where the fluid (semen) ejaculated during an orgasm contains fewer sperm than the typical amount. It is considered lower than normal if the sperm count is fewer than 15 million sperm per milliliter of semen. A complete absence of sperm is called azoospermia. A low sperm count reduces the likelihood of fertilizing a partner's egg, which can lead to difficulty in conceiving a child.

Understanding the disease

Symptoms

The main symptom of low sperm count is the inability to conceive a child, but there might be no other obvious signs or symptoms. Some men with low sperm count may experience erection or ejaculation problems, low sex drive, or other problems with sexual function. Other potential symptoms can include pain, discomfort, a lump, or swelling in the testicle area. However, often the cause of low sperm count isn't identified.

Risk Factors

Risk factors for developing low sperm count include smoking tobacco, drinking alcohol, using certain illicit drugs, being overweight, being severely depressed or stressed, having certain past or present infections, being exposed to toxins, overheating the testicles, having experienced trauma to the testicles, being born with a fertility disorder or having a blood relative with a fertility disorder, having certain medical conditions, undergoing cancer treatments, taking certain medications, and having a prior vasectomy or major abdominal or pelvic surgery. However, often the cause of low sperm count isn't identified.

Development

Low sperm count can develop due to a variety of health issues, medical treatments, and lifestyle factors. Some of the common causes include:

1. Varicocele: A swelling of the veins that drain the testicle can reduce the quality of sperm.
2. Infection: Certain infections can interfere with sperm production or sperm health, leading to a low sperm count.
3. Hormonal imbalances: Abnormal levels of hormones, such as testosterone, can impact sperm production.
4. Chromosomal abnormalities: Inherited genetic disorders can cause low sperm count.
5. Testicular injury or trauma: Previous injuries to the testicles can result in reduced sperm production.
6. Cancer treatments: Radiation therapy and certain medications used in cancer treatment can cause a decrease in sperm production.
7. Environmental factors: Exposure to toxins, radiation, or excessive heat can contribute to low sperm count.
8. Lifestyle factors: Smoking, alcohol consumption, drug use, obesity, severe depression, or stress can negatively affect sperm production. It's essential to consult a healthcare professional for a proper evaluation and diagnosis, as the underlying cause of low sperm count varies from person to person.

Assessment and Diagnosis

Triage

You should see a doctor if you have been unable to conceive a child after a year of regular, unprotected intercourse or if you experience any of the following: erection or ejaculation problems, low sex drive, or other problems with sexual function; pain, discomfort, a lump, or swelling in the testicle area; a history of testicle, prostate, or sexual problems; or if you have undergone groin, testicle, penis, or scrotum surgery. Additionally, consult a doctor if you suspect low sperm count or any other fertility issues.

Diagnosis

A low sperm count is diagnosed as part of a semen analysis test. The 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 might be used to measure sperm count. To ensure accuracy in a collection, your doctor will ask you to make sure all of your semen makes it into the collection cup or collection condom when you ejaculate, have you abstain from ejaculating for two to seven days before collecting a sample, collect a second sample at least two weeks after the first, and avoid the use of lubricants because these products can affect sperm motility. Normal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semen. A low sperm count is considered to be fewer than 15 million sperm per milliliter or less than 39 million sperm total per ejaculate.

Management and Treatment

Complications

Complications of low sperm count may include infertility, stress related to the inability to have a child, and the need for surgery or other treatments for an underlying cause of low sperm count. Depending on the severity of the low sperm count, couples may require expensive and involved assisted reproductive techniques, such as in vitro fertilization (IVF). Low sperm count can also lead to stress for both partners, impacting their emotional and mental well-being.

Prevention

There are measures you can take to potentially prevent low sperm count. Some of these include:

1. Avoiding known factors that can affect sperm count and quality, such as smoking, excessive alcohol consumption, illicit drug use, and exposure to toxins.
2. Maintaining a healthy weight and lifestyle, including regular exercise and a balanced diet.
3. Keeping your testicles cool by wearing looser clothing and avoiding activities that may cause overheating, such as frequent hot tubs or saunas.
4. Managing stress through relaxation techniques, such as meditation or yoga, as stress can negatively impact sperm production.
5. Avoiding activities that may cause testicular injury or trauma, and seeking medical attention if you experience pain or discomfort in the testicular area. Remember, it's important to consult with a healthcare professional if you have concerns about your sperm count or fertility. They can provide personalized advice and recommendations based on your individual circumstances.

Treatment

Treatments for low sperm count can include lifestyle changes and medical interventions. If a reversible cause is identified, such as an infection, hormonal imbalance, or environmental factors, treating the underlying issue can often improve sperm count. Some lifestyle modifications that may help include:

1. Quitting smoking and limiting alcohol consumption.
2. Maintaining a healthy weight.
3. Avoiding illicit drugs and certain medications that can impact sperm count.
4. Managing stress through relaxation techniques or therapy.
5. Wearing loose clothing and avoiding overheating the testicles. In cases where no reversible cause is found, or when medical intervention is necessary, the following treatments might be considered:
6. Medications: Hormone replacement therapy or medications to treat underlying hormonal imbalances can be prescribed.
7. Surgery: Surgical procedures may be performed to correct blockages, remove varicoceles (enlarged veins in the scrotum), or correct other structural issues that may be contributing to the low sperm count.
8. Assisted Reproductive Techniques (ART): In vitro fertilization (IVF) and other ART methods can be considered when natural conception is not possible. These techniques involve fertilizing an egg with sperm in a laboratory and then transferring the embryo to the uterus. It's important to consult with a healthcare professional to determine the most appropriate course of treatment, as the effectiveness of treatments can vary depending on the underlying cause of low sperm count.

Preparing for medical consultation

To prepare for an appointment for low sperm count, you should:

1. Make a list of any symptoms you're experiencing, including those that may seem unrelated to the reason for your appointment.
2. Gather key personal information, including any major stresses or recent life changes.
3. Find out if you have a family history of fertility problems or if you had any issues at birth or in early childhood.
4. Create a list of all medications, vitamins, and supplements you are taking.
5. Bring your partner along to the appointment, as both of you may need tests to determine the cause of infertility.
6. Write down a list of questions to ask your doctor, including queries about potential causes, recommended tests, available treatments, and any restrictions you should follow.
7. Expect your doctor to perform a general physical examination, ask about your sexual habits, and inquire about any inherited conditions, chronic health problems, or surgeries that could impact fertility. Remember to chart menstrual cycles and associated symptoms, bring previous medical records, and bring a notebook or electronic device to help you keep track of information during the appointment.