Low sperm count

Diagnosis

When you see a doctor because you're having trouble getting your partner pregnant, he or she will try to determine the underlying cause. Even if your doctor thinks low sperm count is the problem, it is recommended that your partner be evaluated to rule out potential contributing factors and determine if assisted reproductive techniques may be required.

General physical examination and medical history

This includes examination of your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and your sexual development.

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 might be used to measure sperm count.

Semen samples can be obtained in a couple of different ways. You can provide a sample by masturbating and ejaculating into a special container at the doctor's office. Because of religious or cultural beliefs, some men prefer an alternative method of semen collection. In such cases, semen can be collected by using a special condom during intercourse.

New sperm are produced continually in the testicles and take about 42 to 76 days to mature. So, a current semen analysis reflects your environment over the past three months. Any positive changes you've made won't show up for several months.

One of the most common causes of low sperm count is incomplete or improper collection of a sperm sample. Sperm counts also often fluctuate. Because of these factors, most doctors will check two or more semen samples over time to ensure consistency between samples.

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
• Have you avoid the use of lubricants because these products can affect sperm motility

Semen analysis results

Normal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semen. You are considered to have a low sperm count if you have fewer than 15 million sperm per milliliter or less than 39 million sperm total per ejaculate.

Your chance of getting your partner pregnant decreases with decreasing sperm counts. Some men have no sperm in their semen at all. This is known as azoospermia (ay-zoh-uh-SPUR-me-uh).

There are many factors involved in reproduction, and the number of sperm in your semen is only one. Some men with low sperm counts successfully father children. Likewise, some men with normal sperm counts are unable to father children. Even if you have enough sperm, other factors are important to achieve a pregnancy, including normal sperm movement (motility).

Other tests

Depending on initial findings, your doctor might recommend additional tests to look for the cause of your low sperm count and other possible causes of male infertility. These can include:

• Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.
• Hormone testing. Your doctor might recommend a blood test to determine the level of hormones produced by the pituitary gland and testicles, which play a key role in sexual development and sperm production.
• Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
• Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might also be ordered to diagnose various congenital or inherited syndromes.
• Testicular biopsy. This test involves removing samples from the 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 with sperm transport. 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, which are used to check for immune cells (antibodies) that attack sperm and affect their ability to function, are not common.
• Specialized sperm function tests. A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there's any problem attaching 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 check for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).

Treatment

Treatments for low sperm count include:

• Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens can be repaired. 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.
• Treating infections. Antibiotics can cure an infection of the reproductive tract, but this doesn't always restore fertility.
• Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
• Hormone treatments and medications. Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
• Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific situation and wishes. The sperm are then inserted into the female genital tract, or used for IVF or intracytoplasmic sperm injection.

When treatment doesn't work

In rare cases, male fertility problems can't be treated, and it's impossible for a man to father a child. If this is the case, you and your partner can consider either using sperm from a donor or adopting a child.

Lifestyle and home remedies

There are steps you can take at home to increase your chances of getting your partner pregnant, including:

• Increasing the frequency of sex. Having sexual intercourse every day or every other day beginning at least four days before ovulation increases your chances of getting your partner pregnant.
• Having sex when fertilization is possible. A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. This will ensure that sperm, which can live several days, are present when conception is possible.
• Avoiding lubricants. Some products such as Astroglide or K-Y jelly, lotions, and saliva might impair sperm movement and function. Ask your doctor about sperm-safe lubricants.

Alternative medicine

Supplements with studies showing potential benefits on improving sperm count or quality include:

• Black seed (nigella sativa)
• Coenzyme Q10
• Folic acid
• Horse chestnut (aescin)
• L-carnitine
• Panax ginseng
• Zinc

Talk with your doctor before taking dietary supplements to review the risks and benefits of this therapy, as some supplements taken in high doses (megadoses) or for extended periods of time might be harmful.

Preparing for your appointment

You should start with your family doctor or a different provider. However, he or she might refer you to an infertility specialist.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as refraining from ejaculating for a certain period of time or stopping certain medications.
• Write down any symptoms you're experiencing, including any that might seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Find out whether you have a family history of fertility problems. Having a male blood relative, such as your brother or father, with fertility problems or other reproductive issues might give clues to the cause of low sperm count.
• Find out from your parents if you had undescended testes or other issues at birth or in early childhood.
• Make a list of all medications, vitamins and supplements that you're taking.
• Take your partner along. Even if you have a low sperm count, your partner also might need tests to see whether she has any problems that could be preventing pregnancy. It's also good to have your partner along to help keep track of any instructions your doctor gives you or to ask questions you may not think of.
• Write down questions to ask your doctor.

Some basic questions to ask your doctor include:

• What do you suspect might be causing my low sperm count?
• Other than the most likely cause, what are other possible reasons my partner and I haven't been able to conceive a child?
• What kinds of tests do I need?
• Will my partner also need tests?
• What treatments are available to increase my sperm count? Which do you recommend?
• Are there any restrictions that I need to follow?
• At what point should we consider other alternatives, such as a sperm donor or adoption?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Some questions your doctor may ask you include:

• At what age did you start puberty?
• Have you had a vasectomy or a vasectomy reversal?
• Do you use illicit drugs, such as marijuana, cocaine or anabolic steroids?
• Have you been exposed to toxins such as chemicals, pesticides, radiation or lead, especially on a regular basis?
• Are you currently taking any medications, including dietary supplements?
• Do you have a history of undescended testicles?