Low Sperm Count – Symptoms and Causes

        Reasons

• Symptoms
• What to do to improve the count

What is low sperm count?

According to WHO (World Health Organisation) sperm health is considered normal if :

1. Quantity (Count) : >15 million sperms per ml
2. Movement: 32% of sperms show good movement
3. Structure (Morphology) : 4% of all the sperms are structurally normal.

If the count of sperm is less than 15 million per ml it is called oligospermia (low sperm count) and if no sperms are seen in the semen sample it is called azoospermia.

Oligospermia is further divided into 3 categories, depending upon the severity:-
Mild: Sperm concentration is between 10 to 15 million/ml.
Moderate: Sperm count is between 5 to 10 million/ml.
Severe: Sperm concentration is less than 5 million/ml
Low sperm count is one of the important causes of male infertility.
One in every three cases of infertility is due to problems in a male partner.

Causes of low sperm count :

1. Medical / Surgical causes

● Infections: Various bacterial and viral infections can disrupt the process of sperm formation and thus affect the quality of sperms or cause scarring of the passages which carry the sperms from testes to the outside world. The infection can be of testes (orchitis) or epididymis (epididymitis). Many sexually transmitted diseases like gonorrhea and chlamydial infection can affect fertility. Mumps and tuberculosis can also be the infectious causes of low sperm count. Sometimes these infections can cause long-term problems that cannot be fixed, but quite often good quality sperms can be retrieved despite the infection.
● Varicocele: Dilation of veins around the testes is called varicocele, which causes local increase in temperature of testicles. Only severe degree like grade three or four varicocele needs to be treated surgically.
● Retrograde ejaculation : In this condition, instead of coming out of urethra, semen goes backward into the urinary bladder at the time of ejaculation. It can be due to diabetes, spinal injury, or the previous surgeries done on bladder, prostate or urethra.
● Antisperm antibodies : Antibodies are the defence mechanism of body against foreign invaders but sometimes these antibodies erroneously identify sperms as foreign bodies and destroy them leading to infertility.
● Cancer of testis for which chemotherapy or radiotherapy is given to the patient. These treatments destroy the sperm forming capabilities of the testes.
● Undescended testes : During foetal life testes are placed in flanks in the abdomen and they slowly descend down to the scrotal sac. If these are not able to descend down then it leads to increase in the temperature of testicles and impairs the sperm formation process.
● Hormonal imbalances in males : Hypothalamus and pituitary are those parts of the brain that regulate the production of hormones required for sperm formation. Alteration in this hormone as well as thyroid and adrenal gland hormone imbalances can be a cause of infertility.
● Genetic disorders: Many syndromes known to cause infertility are enumerated below: –
o Kleinfelter’s syndrome (XXY)
o Kartagener syndrome
o Cystic fibrosis
o Kallman syndrome
o Y chromosome microdeletion
● Celiac disease: It is due to gluten sensitivity which is found in wheat and wheat is consumed in a large part of India. This disorder can cause male infertility.
● Steroid abuse: Testosterone treatment and extensive anabolic steroid use to increase muscle mass by bodybuilders can lead to infertility.
● Surgical reasons: some surgeries like the following can cause make infertility
o Vasectomy
o Inguinal hernia repairs
o Testicular, scrotal surgeries
o Prostatic surgeries
o Abdominal surgeries for cancers, rectal cancers

2 .Environmental factors:

● Industrial chemicals like benzene, toluene, xylene, herbicides, pesticides, organic solvents, painting components, or lead may cause low sperm count.
● Heavy metals and radiation exposure
● Overheating of testicles: Though not confirmed the following can be the reasons for low sperm count:-
o Regular use of saunas, hot tubs.
o Sitting for long hours with a laptop on the thigh area.
o Tight-fitting clothes.

3.Lifestyle :

● Drug abuse like anabolic steroids, cocaine, marijuana.
● Heavy alcohol consumption.
● Cigarette smoking.
● Professions that cause an increase in scrotal region temperature like automobile driving, welding, mining works.
● Stress and anxiety.
● Excessive weight.

Symptoms of low sperm count

There may be NO evident symptom of low sperm count other than inability to conceive.
Sometimes low sperm count symptoms could possibly include: –
● Reduced sexual desire or problems sustaining erection.
● Pain in the testicular area, swelling, redness.
● Reduced facial and body hair and voice not having male character.

When to consult your doctor?

If a couple is planning pregnancy and not able to have a baby even after six months to one year of normal, unprotected intercourse then it’s time to consult your fertility specialist.
You may have to consult earlier in the following situations:-
● Reduced sexual desire or having other sexual dysfunctions.
● Pain, swelling, redness in the testicular area.
● Previous history of surgery or diseases in the testicular, prostatic, or rectal area.
● Surgery in the groin, testis, penis, scrotum, or rectal area.

How to evaluate low sperm count?

● Detailed history as well as physical examination of patient.
● Semen evaluation.
● Additional tests like
o Scrotal ultrasound, transrectal ultrasound
o Hormonal assessment
o Post ejaculation urine analysis
o Chromosomal tests to rule out hereditary causes
o Antisperm antibody check
o Testicular biopsy.

How to treat low sperm count?

Surgical treatment

1. If it’s a duct block like blocked vas deferens it is surgically resolved. Previous vasectomy surgery can also be reversed. Even after surgical correction if there are no sperms in the ejaculated semen then sperms can be retrieved from the testes or epididymis.
2. Treatment of infections can restore reproductive function.
3. Erectile dysfunction or premature ejaculation can be managed medically. Alternatively, guidance from a counsellor can be taken.
4. In cases of hormonal imbalances, proper diagnosis and treatment of the condition will help improve sperm production.
5. Treat underlying medical conditions like diabetes mellitus which can cause retrograde ejaculation. Almost 30 to 40% of diabetics don’t know that they have the problem of diabetes. They come to know about their diabetes only during an infertility evaluation.
6. An untreated infection of the reproductive system or urinary tract can be a cause of infertility
7. Other conditions that can lead to infertility are
   o Anaemia
   o Celiac disease
   o Crohn’s disease
   o Cushing’s syndrome
   o Thyroid disease.

8. ART (Assisted Reproductive Technologies)
   To treat low sperm count ART is of immense help for couples where sperm count is low or absent in semen. There is a full range of treatment options available right from getting normal mechanical ejaculation to surgical extraction from testes or epididymis to donor sperms available from semen banks.
   Various surgical techniques are available to retrieve sperms if they are formed in the testes but not able to come out in semen.
   ● Penile vibratory stimulation (PVS)
   ● Electro ejaculation (EEJ)
   ● Testicular sperm extraction (TESE)
   ● Testicular sperm aspiration (TESA)
   ● Microsurgical epididymal sperm aspiration (MESA)
   ● Percutaneous epididymal sperm aspiration (PESA)
   ● Microsurgical testicular sperm extraction(micro TESE).
   So male infertility should not be hidden from your doctors.
   It can be resolved very easily; all that is needed is just a step forward to discuss with your Best IVF Doctor.
   If the sperms are less than 5 million per ml then the best treatment would be IVF-ICSI. If they are between 5 to 10 million per ml then you might be a good candidate for IUI or IVF, but we must understand that it’s not the number only which is the deciding factor. Dr. Alka fertility specialist is your guide and after full discussion, jointly decide what can be the best treatment option most suitable for you.