Introduction
Up to a fifth of young men find themselves with a low sperm count, defined as fewer than 15 million sperm per milliliter of semen. The biggest cause of infertility around 20% of couples is low sperm count or poor sperm quality, and a contributory factor in a further 25% of couples.
Getting diagnosed
If you have not managed to conceive after one year of trying for a baby, you should consult medically. They will carry out fertility investigations including semen test to check the quality and quantity of the partner’s sperm.
Around 1 in 10 men will have an abnormal result on the first semen test but this does not always mean they have a ‘true’ abnormality. So, if the results of the first semen test are abnormal, then repeat the tests. Between the tests keep a gap of atleast three months, but if it looks like sperm count is very low or no sperm at all, repeat the test as soon as possible.
What causes a low sperm count?
Often, no cause can be found for a low sperm count. However, it has been associated with several genetic and non-genetic conditions, including:
- A hormone imbalance such as hypogonadism, where the testes produce few or no hormones – this often has an identifiable reason, such as Klinefelter syndrome
- An inherited genetic problem such as Klinefelter syndrome
- undescended testicles
- A structural issue with the male genital tract – for example, the tubes that carry sperm can be damaged and blocked by illness or injury
- A genital infection such as chlamydia, gonorrhea or prostatitis(infection of the prostate gland)
- Previous surgery to the scrotum or surrounding area
- Varicoceles (dilated veins within the testicles)
- Certain medication, including testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some antibiotics and some ulcer medications
- Exposure to chemicals such as pesticides
- using drugs, such as marijuana
Treatment options
If you or your partner has been detected with a low sperm count, there are a few treatment options available.
Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection (ICSI) involves injecting a single sperm directly into an egg to fertilize it. The fertilized egg or embryo is then transferred to the woman’s womb.
You should be offered ICSI if you have been trying to conceive naturally with your partner for at least two years and you have either:
- Few or no sperm in your semen
- Poor quality sperm
Before you consider ICSI, your healthcare team should offer both of you an appropriate test and discuss the results and their implications with you. They should also consider whether a genetic problem is involved in your fertility issues.
Some men have a fertility problem due to gene abnormality on their Y chromosome (the male sex chromosome). However, unless this is suspected, you do not normally need tests for this before having ICSI.
If you or your healthcare team know or suspect that you have a specific gene defect they should offer you appropriate genetic counselling and tests.
Gonadotrophin drugs
If you have very low levels of gonadotrophin hormones, which stimulates the creation of sperm you should be offered treatment with gonadotrophin drugs to improve your fertility.
However, if no cause has been found for your abnormal sperm count, you will not be offered hormone-based drugs as they are not known to improve fertility.
Donor insemination
Donor insemination means using sperm donated anonymously by another man. As a couple, you may wish to consider using donor insemination as an alternative to ICSI.
Donor insemination may also be considered if the man has a genetic disorder that could be passed on to any children.
It can be used as part of IVF if necessary. The clinic where you are treated should follow a specific selecting and screening sperm donors.
If you are considering donor insemination, you should be offered independent counselling as a couple about the implications for you and any potential children.
