A low sperm count can make it more difficult to conceive naturally, although depending on the degree the sperm is effected, it may still be possible to conceive. Male factor infertility is very common and is the cause of difficulty in conceiving in 1 in 3 couples.
Sperm Analysis
Couples who have been trying to conceive for one year should see their doctor and request a sperm test.
The doctor can arrange a semen analysis to check the quality and quantity of the sperm. The results are usually available within a week.
Reference values
All laboratories have slightly different reference ranges however NICE (2014) recommended that all results of a semen analysis should be compared with the following World Health Organization reference values:
• semen volume: 1.5 ml or more
• pH: 7.2 or more
• sperm concentration: 15 million spermatozoa per ml or more
• total sperm number: 39 million spermatozoa per ejaculate or more
• total motility (percentage of progressive motility and non‑progressive motility): 40% or more motile or 32% or more with progressive motility
• vitality: 58% or more live spermatozoa
sperm morphology (percentage of normal forms): 4% or more.
Don’t be scared to ask the doctor for the results. It’s useful to keep a record of any tests either of you have done and you can then refer to these if they are repeated.
If the results are abnormal, the test should be repeated to ensure it was accurate. This will normally be performed after three months as sperm regenerates after 3 months and a second sample may be normal. If the second sample is low then you will be referred to a specialist for further investigations.
Home sperm analysis testing kits
There are several male fertility home-testing kits available to purchase. These tests claim to indicate whether a sperm count is low. However….
• although research by the manufacturers suggests these tests can give an accurate indication of sperm count, they haven’t been extensively studied
• some home-testing kits classify a low sperm count as under 20 million sperm per millilitre of semen, but more recent international guidelines state that anything above 15 million sperm per millilitre of semen is normal
• home-testing kits only check the number of sperm, not other aspects, such as motility.
It is advisable to get a medical opinion and have a proper analysis rather than relying on the home tests.
Causes of a low sperm count
In many cases, it’s not obvious what causes a low sperm count.
Sometimes problems with sperm count and quality are associated with:
• a hormone imbalance, such as hypogonadism (reduced hormone production)
• a genetic problem
• having had undescended testicles as a baby
• a structural problem – previous trauma or illness, or the tubes carrying sperm being absent from birth
• a genital infection such as chlamydia, gonorrhoea or prostatitis (infection of the prostate gland)
• varicocele (enlarged veins in the testicles)
• previous surgery to the testicles or hernia repairs
• Overheating of the testicles – sometimes due to occupation or lifestyle
• excessive alcohol consumption, smoking and using drugs such as marijuana or cocaine
• certain medications, including testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some antibiotics and some antidepressants
Treatment for low sperm count
Many couples conceive within the second year of trying and therefore you may be advised to try for a little longer naturally. You can help maximise your chances of conceiving by:
• having sex every two or three days – current research into whether you should conserve sperm for around the fertile window is conflicting and therefore the guidelines are to continue to have sex every 2-3 days throughout the cycle.
• moderating your alcohol consumption and stopping smoking
• staying in good shape, exercising regularly and having a healthy, balanced diet
• Taking selenium and Zinc supplements.
Assisted Conception
Intracytoplasmic sperm injection (ICSI)
ICSI is a type of IVF technique, in which a single sperm is injected directly into an egg to fertilise it. The fertilised egg is then transferred to the uterus.
ICSI may be offered if you’ve been trying to conceive naturally for at least two years and your partner has either:
• few or no sperm
• poor quality sperm
Donor insemination
If you’re considering donor insemination, you should be offered counselling as a couple about the implications for you and your children.
Gonadotrophin medication
If you have very low levels of gonadotrophin hormones (which stimulate the production of sperm), you should be offered treatment with gonadotrophin medication to improve your fertility.
But if no cause has been found for your abnormal sperm count, you will not be offered hormone-based medicines as they are not known to improve fertility in these cases.
References:
NICE (2014) Fertility problems. Available at: https://www.nice.org.uk/guidance/qs73/chapter/quality-statement-4-semen-analysis (Accessed: 24 January 2015)
