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Low sperm counts and other causes of male infertility


Last week we looked at the evaluation of male infertility and the semen-analysis. We said that a sperm count less than 20 million/ml is called oligospermia. Oligospermia is associated with most cases of male infertility. Oligospermia is considered severe if the count is less than 10 million/ml, moderate if between 10 and 15 million/ml and mild if between 15 and 20million/ml.{{more}} About 1/4 of men with mild oligospermia are still able to impregnate their partners, if the partners have no infertility problems themselves. It is more likely for the mildly oligospermia man to impregnate a younger fertile woman than an older woman (older than 35).

Men with no sperms seen on their analysis are called azoospermic. These men cannot impregnate their partners naturally. Oligo and azoospermic men are further investigated using hormone profile to find a cause for their problem.

Hormone profile

Hormones are chemical substances produced in our bodies to control how our organs work. They turn our organs on or off, up or down, depending on our requirements. If we look at the process of sperm formation as a factory producing a product where the factory is the testicle, the raw materials come from the blood and the end product is either sperms or testosterone. Hormones from the brain can increase or reduce the production of sperms or testosterone by controlling the activity of the testes. Likewise, if too few sperms or too little testosterone is being produced, the body has its own internal control mechanisms to try to increase their production. If we look at the hormone levels in a man with low or no sperm count, we can have a fairly good idea as to what is causing this problem. The hormones we look at are follicle stimulating hormone (FSH), leutinising hormone (LH), prolactin (PL) and testosterone (T). The first two hormones stimulate or activate the testicle to produce sperms and testosterone; prolactin inhibits or reduces testicular production of sperms; and testosterone or the male hormone is a finished product of the factory along with the sperms. Therefore, looking at the sperm count and the hormone profile after a thorough history and physical exam gives us a fairly accurate idea of what caused the low sperm count in a male.

Other tests

There are a few tests that are sometimes used to diagnose male infertility with low or absent sperm counts. These include tests such as cystoscopy, transrectal ultrasound (TRUS), anti-sperm antibodies (ASA), vasography and testicular biopsy. These tests are not done on all men and are the second line test after the initial clinical examination, semen-analysis and hormone profile. These tests, apart from the anti-sperm antibodies, are done in men who have no sperms (azoospermia) to determine whether the absent sperms is due to a blockage in the vas deferens (vasogram) or ejaculatory ducts (cystoscopy and TRUS) or a non-production (testicular biopsy). The tissue from the testicular biopsy can also be used to retrieve sperms which can be used to effect fertilization in the infertile couple where the man has no sperms in the semen. Anti-sperm antibodies like the post-coital test is done when the couple has no obvious reasons for infertility because the sperm count is normal or near normal but the sperms are sluggish in the semen (anti-sperm antibodies). The post coital test determines if the sperms are sluggish in the woman’s cervical mucus indicating that the women has antisperm antibodies or the mucus, is too thick. This test is done when the semen analysis is normal, but the couple still cannot get pregnant, even though the female evaluation is normal. In other words, both partners are normal, but they still cannot achieve a pregnancy. This condition is not as unusual as it may seem.

Next week we will look at the treatment of male infertility, looking at simple natural methods first, then advancing to the more invasive and expensive methods used in severely adverse conditions, such as severe oligospermia or azoospermia. In all cases of azoospermia not due to a blockage, and in the severely oligospermics, the man should undergo genetic testing, as many of these men have genetic abnormalities that will be passed on to the unborn child. Many of these couples produce children who are severely deformed or lose the pregnancy, as spontaneous abortions or stillbirths.

For comments or question contact:

Dr. Rohan Deshong
Tel: (784) 456-2785