Low Sperm Counts and Abnormal Sperm Findings

As abnormalities in sperm production or function account for 35%-50% of all cases of infertility, male fertility testing is a key factor in determining a couple’s most effective fertility treatment.

A man’s low sperm count or abnormal sperm shape is first detected through a semen analysis. This test evaluates a single ejaculate sample for the total number of sperm (count), the concentration of sperm, percentage of moving sperm (motility), and the shape of the sperm (morphology). For most accurate results, the semen specimen should be collected following a two- to four-day period of abstinence. A shorter window of abstinence may artificially increase the concentration of sperm and the volume of semen, while a longer window may reduce sperm motility.

Fertility treatment should be sought when a semen analysis shows that a man has fewer than 39 million sperm per sample (oligospermia), less than 40% moving sperm (asthenospermia), or less than 4% normally shaped sperm (teratospermia).

Some men experience no indications of infertility while others only have slight signs. Because male infertility can easily go unnoticed, it is important to be evaluated by an expert to diagnose any issues requiring fertility treatment as soon as possible. The sooner an issue is diagnosed, the sooner we can begin a treatment plan.

Causes of low sperm count:

  • Reproductive history, including previous pregnancies with other partners
  • Sexual frequency & timing
  • Past surgeries (e.g. vasectomy, hernias)
  • STDs
  • Testicular trauma
  • Medications, drugs, or toxins
  • Temperature extremes in leisure and/or occupational activities (past or present)

Sperm motility and conception

In addition to sperm count, motility, or movement of sperm is one of the most important factors for conception. In order to achieve fertilization, the sperm must travel a great distance and penetrate both layers of the egg (coronal cells and the zona pellucida) before fusing with the egg’s cell membrane. A semen analysis will evaluate both the sperm’s quantitative movement as a percentage (motility) and the sperm’s qualitative movement on a subjective scale (progressive motility). Both factors are key, as it is possible that sperm are moving but not in a forward motion.

If semen analysis results show a very low percentage of motility, it may be beneficial to perform a vitality stain. This method distinguishes whether non-moving sperm are alive or dead. This is important to know in determining the viability of using the sperm for fertility treatments.

Sperm motility factors include:

  • Age & health
  • Amount of time since last ejaculation
  • Exposure to excessive heat or toxins
  • Semen collection method
  • Time & handling of specimen from collection to analysis

Sperm morphology or shape

A normal semen analysis should include at least 4% normal-shaped sperm when evaluating strict morphology. A sperm’s shape is considered normal if it has a smooth, oval head with a straight mid-piece that is thicker than the tail and a single, straight tail. Any sperm that deviate from this normal shape are considered to be abnormal sperm.

Fertilization potential is directly related to sperm morphology. A sperm’s shape affects its motility, or ability to move, effectively, and it may also hinder its ability to deliver genetic material to the egg. Women whose partners have a strict morphology less than 4% will have a decreased rate of fertilization with intercourse or insemination.

Treatment options for low sperm count & abnormal sperm

Based on our experience diagnosing many of cases of male infertility, we are confident there is hope! If you are experiencing a low sperm count, low motility or abnormal sperm shape, treatments are available that can provide successful outcomes.

Medication or surgery can often increase sperm counts, depending on the cause. If medication or surgery is not effective, In Vitro Fertilization (IVF) with Intracytopasmic Sperm Injection (ICSI) is an option that can achieve pregnancy.

Typically, 10-20 million sperm are required for intrauterine insemination or intercourse to be successful in achieving pregnancy. In men with counts lower than 10 million, IVF with ICSI significantly increases the chance of success in men with normal or abnormal sperm, allowing a woman to achieve pregnancy with as few as 5-10 normal sperm.

If a semen analysis shows no or very few visible sperm, urologic procedures such as Testicular Sperm Aspiration (TESA), Testicular Sperm Extraction (TESE), and Microsurgical Epididymal Sperm Aspiration (MESA) can be used to locate and extract sperm for IVF.

Azoospermia

A small number of infertile men (10%-15%) will experience azoospermia, or a complete lack of sperm. This diagnosis is made when no sperm are found in two separate semen samples. If this is the case, additional tests will be conducted to determine if there is retrograde ejaculation (sperm going into the bladder), an obstructed ejaculatory duct or if the cause is testicular failure (low or no sperm production).

 

See Related:

Anatomic Causes

 

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