We are seeing a growing level of awareness that problems with infertility, far from being exclusively ‘women’s problems’ are in reality often attributable to male factors. In fact, current estimates are that between one third and 40% of all infertility cases arise from this cause. And within that group, the vast majority, 90% of cases, are because of a low sperm count. In recent times this subject has gone from being somehow unmentionable to something that can be discussed more openly, but is still beset by myths, anecdote and urban legends.
In this article we unpack some of those myths. We examine the causes of the condition and the question of whether there is a cure for low sperm count. We also consider recent developments in how to test for low sperm count. Finally, our optimistic message is that there are a range of low sperm count treatment options available.
What are the causes of low sperm count?
Male infertility is complex, and there are a number of causes which encompass physical, genetic, hormonal and environmental factors. In addition to a low sperm count, there are two further common causes: slow sperm motility, which makes it harder for sperm to swim to the egg, and abnormal morphology. Any one or a combination of these can be identified in many cases, although there is not always a specific reason which can be pinpointed.
- Physical causes can include varicocele: swelling of the veins that drain the testicles. This results in reduced quality of sperm, and is the most common reversible cause of male infertility. Some infections can also interfere with sperm production or health, or can cause scarring that blocks the passage of sperm. Other physical causes include undescended testicles, and defects affecting the tubules that transport sperm. Some types of medication such as steroids, antibiotics and cancer therapies can also cause a low sperm count.
- Genetic chromosome disorders such as Klinefelter’s syndrome can cause abnormal development of the male reproductive organs. Other genetic syndromes associated with male infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
- The hypothalamus, pituitary gland and testicles produce hormones that are necessary to create sperm. Imbalances or alterations in these hormones, as well as disorders affecting the thyroid or adrenal gland, may impair sperm production.
- Environmental factors such as exposure to heavy metals or industrial chemicals, X-ray or radiation exposure can damage sperm quantity and quality. Overheating due to sitting for long periods, for example driving or working on a laptop, can also have a detrimental effect on sperm. Even the urban wisdom that wearing overly tight underwear can have negative effects is probably true, since the optimum temperature for sperm development is 4 degrees Fahrenheit lower than the rest of the body.
Symptoms and how to test for low sperm count
Usually anyone with a low sperm count is completely unaware of any symptoms until they experience infertility or low fertility as a result. Of course, once you and / or your partner suspect that this may be the case, your first question will be how to test for a low sperm count.
The general advice is that although there are many home testing kits available, their reliability has not been conclusively demonstrated and frequently they are designed to give an indication of sperm quantity but do not help with identifying any other factor such as low sperm motility. As a result, most authorities recommend that you get your sperm count checked by an accredited laboratory, where the test often needs to be repeated to double-check the results.
However, there has been significant recent progress in the effectiveness of home testing. In 2017 IVI, the global leader in fertility treatment, took part in a multi-centre clinical trial that proved the effectiveness of SwimCount, a home test that assesses male fertility. The trial found that the test delivers results with 95% accuracy. The reason why it works so well is that SwimCount is the first home test that measures the variable of sperm progressive motility, making a comprehensive diagnosis possible that much earlier. If this test confirms the high likelihood of a reduced sperm count, you will still need to see a doctor for further testing and investigation. If you would like to know more about the trials and results, you can read the full article on our website.
The clinical testing itself involves the microscopic examination of a sperm sample to assess quantity as well as certain sperm parameters such as abnormalities in morphology which, to date, home tests are not able to detect.
Low sperm count: the fertility treatment options
There is no specific medical low sperm count treatment designed to bring a low sperm count up to normal, except in the case of some hormonal abnormalities which can respond to medication. In most cases however, although natural conception can eventually take place, some form of assisted reproduction is required. How low sperm count is treated in your individual circumstances is a matter to decide in consultation with your medical practitioner, but one of the possibilities is IUI (Intrauterine insemination). This is a specialised type of artificial insemination whereby the highest quality sperm are selected, prepared and injected into the uterus where they are left to fertilise the eggs naturally. Compared to IVF, whereby eggs are removed from the body and fertilised in the lab, it is a less invasive procedure which involves fewer drugs.
Although IUI cannot be described as a cure for a low sperm count, it can certainly help increase the chances of conception in a simpler way than IVF. It is also suitable for people who need donated sperm but have no female fertility problems, including lesbian couples and single women. It can also be recommended for couples with unexplained infertility and those who are unable to have vaginal intercourse or who have a condition that requires sperm washing to remove the risk of disease, especially in the case of men who are HIV positive.
IUI success with a low sperm count is significant but below that of IVF, and you should discuss with your clinical advisor whether this is the best way forward in your case. How low sperm count is treated and the likelihood of IUI success with a low sperm count depends on many factors, so individual consultation is essential.
Treatment with IVF for a low sperm count
In Vitro Fertilisation involves uniting the ovum with the spermatozoon in the laboratory, in vitro, in order to obtain fertilised embryos for transfer to the patient’s uterus. The fertilisation of the ova can be carried out either by means of the conventional IVF technique or by Intracytoplasmic Sperm Injection (ICSI). ICSI using the male partner’s semen is recommended for cases of severe male factor infertility as well as for women with fallopian tube lesions, advanced endometriosis or limited oocyte numbers. It is also often recommended for patients for whom previous simpler treatments, such as artificial insemination, have failed.
ICSI can be included as part of IVF treatment, and has enabled pregnancy to be achieved successfully in couples diagnosed with severe male factor infertility. The man needs to provide a semen sample or undergo a testicular biopsy if necessary in order to extract and select the best spermatozoa which will be used to fertilise the oocytes. This is the form of procedure which carries the highest chance of success for IVF low sperm count treatment. If you would like to know more about IVI or ICSI, do have a look at the video about IVF on our YouTube channel for more information.
IVI and its record in IVF low sperm count treatment
Even though there may be no specific cure for low sperm count, IVI’s success rate per patient is among the highest. Nine out of ten couples that consult IVI due to problems with infertility and put their trust in us achieve their goal of becoming parents. Furthermore, from the outset IVI has pioneered many different techniques. Proof of this can be seen in the more than 160,000 babies born to date with the help of IVI.
Getting in touch with IVI
If you would like to find out more about how low sperm count is treated, or in particular the rates of IVF, ICSI and IUI success with low sperm count as a factor, do get in touch with us without any obligation. Before making your first appointment, we hope you will find it interesting and useful to have a look at our video about what you can expect from your first consultation. And then simply pick up the phone, or fill in our contact form, and our Patient Care team will schedule in your appointment with you. We’re always here to help.