Low Sperm Count – Diagnosis and Treatment
Diagnosis
A doctor starts with a physical exam and asks about the person’s health background. They check the genitals for swelling, masses, or missing parts that could signal issues like varicocele or past injuries.
The doctor asks about family history and past illnesses that might affect fertility, such as cystic fibrosis or Klinefelter syndrome. They also discuss lifestyle, previous infections, surgeries in the reproductive tract, and any medications taken.
Other topics include sexual development, testicular injuries, and past surgeries like vasectomy or hernia repairs. Information about sexual activity and habits helps the doctor understand possible causes of infertility.
These questions and checks help identify hormone problems, testicle injuries, or blockages in the reproductive system.
Evaluating Semen and Sperm
Doctors use a semen evaluation as the main test to check male fertility. This test examines a semen sample to count sperm, check movement, and assess shape.
You usually collect semen in a special cup at the clinic or with a special condom during sex. Following instructions closely helps ensure accurate results.
Here are the key points about collecting a semen sample:
- Avoid sexual activity for 2 to 7 days before collection.
- Collect the entire ejaculate in the provided container or condom.
- Do not use lubricants, as they can affect sperm movement.
- Bring the sample to the clinic quickly so it can be tested soon after collection.
Staff look at the sample under a microscope, and sometimes use a computer to help count the sperm. Because sperm levels can change, doctors often ask for two or more samples over several weeks.
This approach gives a clearer picture of sperm production and quality.
Understanding Semen Test Outcomes
The semen analysis provides several important results:
| Measure | Normal Range | Low Sperm Count |
|---|---|---|
| Sperm concentration | 15 million or more/mL | Less than 15 million/mL |
| Total sperm per sample | 39 million or more | Less than 39 million |
A low sperm count means fewer than 15 million sperm per milliliter or under 39 million total sperm. This can make pregnancy harder to achieve, but it does not always rule out fertility.
Some men with low counts can still father children. Others with normal counts may have trouble because other sperm features, like movement and shape, also matter.
If there is no sperm in the sample, doctors call this azoospermia. Blockages, problems with sperm production, or hormone issues can cause azoospermia.
Oligospermia means the sperm count is below the typical range but not zero. Sperm numbers can change over time. Doctors use results from two or more tests on different days to make a diagnosis.
Additional Diagnostics
If initial tests show fertility problems, doctors may order other investigations.
1. Ultrasound of the Scrotum
A scrotal ultrasound uses sound waves to create images of the testicles and surrounding tissues. This helps find blockages, swelling, varicocele, or injuries.
2. Blood Hormone Testing
Hormone tests check levels of testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Imbalances can reveal problems with the pituitary gland, testicles, or other glands that control sperm production.
3. Post-Ejaculation Urine Test
This test checks if sperm enter the bladder instead of leaving the body, which is called retrograde ejaculation.
4. Genetic Testing
Doctors use a blood test to look for missing or extra genes that may cause low sperm numbers or prevent sperm production. This can help explain nonobstructive azoospermia.
5. Testicular Biopsy
Doctors remove a small sample from the testicle using a needle. This test shows if sperm are being made inside the testicle. If sperm are present in the testicle but not in the semen, a blockage may exist. Sometimes, the biopsy reveals issues with sperm production.
6. Transrectal Ultrasound
A lubricated device goes into the rectum to view the prostate and check for blockages in ducts like the vas deferens or seminal vesicle.
Other Possible Tests:
- MRI scans for detailed imaging of the reproductive system.
- Tests for sperm antibodies, which can reduce sperm movement.
- Checking white blood cell levels in semen, as high levels may indicate infection.
Doctors use these tests to find out if infertility comes from sperm production problems, blockages, hormone levels, or other medical conditions. This information helps guide fertility treatment.
Treatment
Doctors can manage low sperm count with several options, depending on the cause. They may recommend one or more of the following approaches.
Medical and Surgical Choices
- Surgical Procedures: Doctors perform surgery to fix problems like varicocele or blockages. They can also reverse old vasectomies. If sperm are not found in the semen, doctors may retrieve sperm from the testicles or epididymis using special methods.
- Treating Infections: Doctors prescribe antibiotics for infections. This can clear the infection, but it may not always restore fertility.
- Addressing Sexual and Hormonal Issues: Medicines or therapy may help with sexual concerns like erectile dysfunction or premature ejaculation. Hormone-based drugs can help if hormone levels are the issue.
Assisted Reproductive Techniques
Assisted reproductive technology (ART) offers several options to help couples have a child:
| Technique | Description |
|---|---|
| Intrauterine insemination (IUI) | Staff collect sperm and place it inside the uterus with a thin tube, usually during ovulation. |
| In vitro fertilization (IVF) | Eggs and sperm meet in a laboratory. If fertilization happens, doctors place embryos in the uterus. |
| Intracytoplasmic sperm injection (ICSI) | Doctors inject one healthy sperm directly into each mature egg. The embryo is then transferred to the uterus. |
Other options, such as using donor sperm, may be considered based on individual needs. The method of collecting sperm depends on the situation and the couple’s preferences.
Options if Treatments are Not Successful
If fertility problems cannot be corrected, couples may consider alternatives. Options include using donor sperm or adoption.
Daily Habits and Tips for Better Sperm Health
Simple changes at home can support healthy sperm. Having intercourse every day or every other day, especially before and just after ovulation, can improve the chance of conception.
Avoid lubricants , regular lotions, or saliva, as these may lower sperm movement. Choose lubricants labeled as sperm-friendly or ask a healthcare provider for advice.
A balanced diet and regular exercise are helpful. Managing stress and getting at least seven hours of sleep each night can also benefit reproductive health.
Important lifestyle changes:
| Behavior | Recommendation |
|---|---|
| Smoking/Tobacco | Stop smoking or using tobacco products |
| Alcohol | Reduce or avoid alcohol |
| Obesity | Reach a healthy weight |
| Drugs | Avoid recreational drug use |
Try to prevent overheating your body, as high temperatures may lower sperm count.
Alternative Medicine
Some people try multivitamins or herbal supplements to support sperm health. Talk to a healthcare professional before starting any supplement. Not all supplements help male fertility, and some may interact with other medicines or health problems.
Getting Ready for Your Visit
Steps You Can Take Ahead of Time
Being prepared helps both you and your healthcare provider. Use this checklist:
- Check for special instructions. Contact the clinic to see if you should avoid certain activities, such as sex, for a few days before the visit.
- Write down current symptoms. Note any health changes, even if they donโt seem related to fertility.
- Note major life events. Stress or recent changes in routine can affect health and fertility, so share this information.
- Ask about family health history. Find out if close male relatives have had fertility issues.
- Gather childhood health details. Ask your parents about early health conditions, like undescended testicles.
- List all medicines and supplements. Include prescription and over-the-counter drugs, vitamins, and dosages.
- Bring your partner if possible. Both partners often need to be involved in testing. Having your partner there can help remember questions and answers.
- Prepare questions for the healthcare provider. Make a list so you donโt forget anything during the visit.
Sample Questions to Ask During Your Visit
| Question | Purpose |
|---|---|
| What do you think is causing the low sperm count? | Understand likely reasons |
| Are there other possible explanations? | Get a fuller picture |
| What tests will be needed? | Know what to expect |
| Does my partner need any checks as well? | Find out if both should be evaluated |
| Which treatments are options, and which do you recommend? | Learn about next steps |
| Are there activities I should avoid? | Stay aware of lifestyle changes |
| At what point should other options like a sperm donor or adoption be considered? | Plan for future decisions |
| Where can I get more information? | Collect helpful resources |
Write down any new questions that come up during the conversation.
How the Healthcare Provider Will Guide You
During the visit, the healthcare professional will likely ask questions to gather more information. These might include:
- When puberty started, since this detail can help identify underlying conditions.
- Whether you have had procedures like a vasectomy, or if you have attempted a reversal.
The provider will ask about current or past use of substances such as anabolic steroids, marijuana, or cocaine. They will also ask if you have been exposed to hazards at work or home, including chemicals, pesticides, or radiation.
You should mention all medicines and dietary supplements you currently use. The provider may ask about any history of childhood testicular conditions, such as undescended testicles.
You will discuss these topics with the provider and may need to complete some paperwork. The provider may also ask about your emotional well-being, mental health, and relationships, as these factors can affect fertility.
