When a man ejaculates the semen during an orgasm containing fewer sperm than normal, is termed as a condition “Oligospermia-Low sperm count”. On the other hand, if a man ejaculates the semen with zero sperm count, that condition is termed as” Azoospermia”. Both conditions contribute to “ Male Infertility”.
Normal sperm count on an average is around 75 million sperm per millilitre, sperm count fewer than 15 million sperm per millilitre of semen is classified as Low sperm count.
A man with Low sperm count has less chances that one of his sperm can fertilize his partner’s egg resulting in pregnancy. However, it only takes one sperm to fertilize an egg but chances are better with more sperm.
There are three main characteristics of healthy and quality sperm in a man’s semen.
- Number or Quantity: Minimum 15 million sperm per millilitre of semen is what a man’s semen should contain to have a “normal sperm count”.
- Motility or Movement: It defines how well a man’s sperm move to his partner’s egg. At least 50% of total sperm count needs to be moving.
- Shape or Structure: A normal sperm has a shape with heads and long tails.
HOW TO IDENTIFY THE SIGNS OF LOW SPERM COUNT OR MALE INFERTILITY?
A man experiences any signs or symptoms of low sperm count when he tries to make his female partner pregnant. However, there are no other obvious signs or symptoms.
- Inability to make his partner pregnant after trying for a long period
- Erectile Dysfunction or low sex drive
- Swelling or a lump associated with pain in the testicle area
- In some cases, due to chromosome or hormone abnormality a man may experience decreased facial or body hair
CAUSES FOR LOW SPERM COUNT OR MALE INFERTILITY
There are certain causing factors for low sperm count, here we will discuss by classifying in three main categories: Medical, Environmental, and Lifestyle.
A number of health issues and medical treatments can result in low sperm count. These include:
- Varicocele. It is one of the most common causes of male infertility. A varicocele is a swelling caused by dilated or enlarged veins within the testicle. This condition can interfere with the movement of sperm out of testicles by blocking the passage.
- Infection: Some infections including inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections can interfere with sperm production or can cause scarring, which block the passage of sperm.
- Ejaculation problems: Various conditions including diabetes, spinal injuries, and surgery of the bladder, prostate or Urethra can cause retrograde ejaculation or lack of ejaculation. In retrograde ejaculation, semen enters the bladder during orgasm instead of ejaculating out of the tip of the penis.
- Cancers and non-cancerous Tumours: Surgery, radiation or chemotherapy to treat tumours can affect the male reproductive organs directly, through the pituitary gland and other glands that release hormones related to reproduction leading to male infertility.
- Absent or Undescended testicles: A congenital condition in boys where one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles. Men with such condition gets affected with male infertility.
- Hormone imbalances: Abnormal production of hormones that are necessary to create sperm may affect sperm production.
- Certain medications: including testosterone replacement therapy, chemotherapy, certain antifungal and antibiotic medications, long-term anabolic steroid use can affect sperm production.
- Previous surgeries: Certain surgeries including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries may affect sperm production.
Overexposure to certain environmental elements can affect sperm production or function. Certain factors are as follows:
- Industrial chemicals: Overexposure to chemicals like benzenes, toluene, pesticides, organic solvents, painting materials and heavy metals like lead might lead to reduction in sperm counts.
- Radiation or X-rays: Exposure to high doses of radiation can reduce sperm production.
- Overheating the testicles: As per a few studies, highly elevated temperatures including frequent use of saunas or hot tubs impair sperm production and function. Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also might increase the temperature around the scrotum and might reduce sperm production to some extent.
HEALTH, LIFESTYLE AND OTHER CAUSES
- Drug use: Anabolic steroids taken to gain muscle strength such as testosterone boosters, vitamins, and pre-workout supplements can cause the testicles to shrink reducing the sperm production. Also, the use of cocaine or marijuana might reduce the number and quality of the sperm too.
- Alcohol use: Chronic alcohol consumption can lower testosterone levels causing decreased sperm production.
- Occupation: Certain occupations including welding or those associated with prolonged sitting, such as truck driving might be linked with a risk of infertility.
- Tobacco smoking: Smokers might have a lower sperm count when compared with those who do not smoke.
- Emotional stress: Prolonged emotional stress or stress due to routine life might interfere with hormones needed to produce sperm.
- Depression: Being depressed may affect sperm quality.
- Body weight: Obesity can affect fertility by causing hormone changes that reduce male fertility.
“If a couple is not able to experience the parenthood even after trying for a long time, they both need to consult the fertility doctor.” Fertility specialist diagnose the infertility in man by following tests and investigations:
- General physical examination followed by medical history
- Semen analysis. Sample of semen is examined under microscope to check for number, shape and motility of sperm in the semen.
Usually, two or more semen samples over time are examined to ensure the accuracy in results.
- As we have mentioned earlier that sperm count lower than 15 million sperm per millilitre of semen is considered as “Oligospermia-Low sperm count” and zero or nil sperm is termed as “Azoospermia”.
Once it is confirmed that sperm count is low or nil then a series of other tests are conducted to define other possible causes of male infertility. These are:
- Scrotal ultrasound
- Hormonal testing
- Post-ejaculation urinalysis: To check if sperm is traveling backward into the bladder instead of out the penis during ejaculation.
- Genetic tests: to diagnose various congenital or inherited syndromes.
- Testicular biopsy: Recommended by the Andrologist only in a few cases. In this a sample of testicles tissue is taken using needle and is examined in a laboratory.
TREATMENT OPTIONS FOR LOW SPERM COUNT
- Treating infections of the reproductive tract with help of certain antibiotics, but it does not always restore man’s fertility.
- Treatments for Erectile dysfunction: Various treatment options ranging from medicines to surgery are available to treat erectile dysfunction or premature ejaculation.
- Hormone treatments and medications
- Surgery / Microsurgical Varicocelectomy: Condition like varicocele can be managed with the help of surgery that can help in retrieving the obstructed sperm passage.
- Assisted reproductive technology: In ART treatments Sperm is obtained either through normal ejaculation or surgical extraction such as TESE, PESA, Micro TESE or from donor individuals and then inserted into the female genital tract.
- IVF: In vitro fertilisation, an egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory. The fertilised egg is then returned to the woman’s womb to grow and develop.
- Intracytoplasmic sperm injection: In ICSI, a single sperm is injected directly into an egg to fertilise it. The fertilised egg is then transferred to the woman’s womb.
- Donor insemination: Donor insemination means using sperm donated by another man which can be used as part of IVF.
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