Low Sperm Count

Infertility is the inability of a person to reproduce by natural process. It is a growing problem which affects many couples in the world. Either the male or the female or both can be responsible for this condition. Male infertility can be due to structural and functional defects in sperms due to some genetic or environmental causes. These can either be correctable or permanent. When couples fail to conceive even after unprotected intercourse for at least a year, the doctor diagnoses them with infertility. Investigations are carried out to try and find out if the problem is with the male or female partner or both. The cause of low sperm counts in men is found due to sperm defects in 20-30% of people. To find out underlying problem, a detailed history about lifestyle, habits, and occupation is carried out by the doctor. Once a person is diagnosed with low sperm counts, the problem can be treated with appropriate guidance from the doctor regarding healthy habits, some precautions, nutritional supplements, and medications if needed.

Low sperm count is defined as a decrease in a total number of sperms in the testing fluid (semen) than the average number of sperms required in the sample. This is an important parameter to determine the fertility of men (the ability of men to conceive). Normal average sperm count is 15-39 million per sample. Low sperm count means sperm count less than 15 million per sample.

There are primarily two types of low sperm count- oligospermia and azoospermia.

• Oligospermia
  In this problem,  semen contains sperms lesser than what is the standard.

• Azoospermia
  It is the problem, semen contains no sperm.

There are usually no symptoms but some people may have the following symptoms:

• Not being able to conceive even after having unprotected intercourse for at least a year.
• A person may experience a low sex drive.
• There may be swelling in genital organs.

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Causes

There are various causes which can be related to low sperm counts:

• Problems with ejaculation
  This can be due to trauma or injury after undergoing a surgery.

• Varicocele
  It is a disease in which there is are problems with temperature regulation causing a rise in temperature and abnormal sperm quality.

• Infection of the adjoining glands
  Infectious diseases or sexually transmitted diseases which lead to inflammation and abnormal functioning of parts of the reproductive system.

• Systemic causes:

  • Exposure to high temperatures especially for men who take frequent steam baths, and in workers exposed to high heat.
  • Effect of radiation absorbed by electric welders, by radiologists.
  • People who work with, or are exposed to heavy metals like lead, cadmium or pesticides.
     
• Genetic disorders
  These are diseases which occur due to mutation of genes.
   
• Unexplained infertility
  Wherein the cause of infertility remains unidentified.
   
• Drug-induced
  Certain drugs like anabolic steroids, anticancer drugs can also affect sperm count temporarily or permanently.  
   
• Stress-induced
  A stressful lifestyle can be responsible for low sperm count. (Read more - Stress)

Risk Factors

There are many factors that can increase the risk of low sperm count. These include: 

• Alcohol intake.
• Smoking.
• Obesity.
• Exposure to high temperature.
• Certain medications.
• Genetic disorders.
• Exposure to Radiation.
• Exposure to toxic heavy metals.
• Exposure to pesticides.
• Stress.

There are ways by which the problem of low sperm count can be prevented. These include :

• Avoid exposure to radiation
  People who work in places with exposure to radiation such as nuclear power plants, uranium mines or diagnostic centres with imaging machines should use radiation protecting gear like bodysuits, eye gear, and mask to prevent excessive exposure.  
   
• Avoid high temperature
  Avoid very hot baths and use lukewarm water for bathing. People who work in metal industries, mines, welding workshops, and road surface making are at a risk of high-temperature exposure which can be avoided by using special protective jackets, caps, glasses and increasing ventilation of the venue.
   
• Keep your weight in check
  Keep your weight in the healthy range to reduce the risk of low sperm count. Opt for a healthy diet, regular exercise, and a healthy lifestyle to keep your weight in check.
   
• Avoid direct exposure to heavy metals
  If you are working in heavy metal industries like lead, cadmium, direct exposure should be avoided by using appropriate protection like insulated jackets and masks.
   
• Avoid direct exposure to pesticides
  Farmers should take extra precautions by using mask and gloves and follow protective measure while sprinkling pesticides.
   
• Seek prompt treatment of any infection
  Infection to a local genital area can lead to spread of disease and damage to genitals which often lead to low sperm counts. This can be avoided by visiting the doctor and taking proper medication. Consultation with the doctor at the earliest without hesitation is essential to stop sexually transmitted diseases which can lead to many complications if not treated on time.
   
• Adopt a healthy lifestyle
  Along with diet and exercise, healthy habits like taking adequate sleep, giving up smoking, avoiding tobacco chewing and limiting alcohol consumption are important in preventing low sperm counts.

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Diagnosis is established by getting a semen study done. Semen is the fluid in which sperms are present. Penis releases semen during ejaculation at the time of intercourse. Semen study or analysis can be carried out in the laboratory by giving your semen sample in a bottle to the lab person. Further, this sample is processed, and results are assessed for quantity and quality of semen in which one of the parameters is sperm count. This means sperm count in a given semen sample can be calculated using special techniques.

This test, when advised by the doctor, should be carried out in the laboratory for which private rooms are made available adjacent to the laboratories. This is important to avoid the temperature fluctuation and save time to process the sample. It is generally not advisable to collect a sample at home. The sample is collected in clean (sterile) containers, and it is ensured that a complete semen sample is collected at one time. It is also advisable to keep abstinence (no ejaculation) for minimum 2-7 days before giving a sample for the test. This sample is then processed and sperm count is evaluated by microscopic examination.

Normal average sperm count is 15-39 million per sample. Hence low sperm count means sperm count less than 15 million per sample.

Treatment of low sperm count depends on the underlying cause. If the underlying cause is treatable, then low sperm count can be treated. Treatment involves:

• A detailed history
  ​This can be helpful to know about
  • Systemic medical illnesses (e.g., diabetes mellitus and upper respiratory diseases).
  • Any surgeries in past.
  • Sexual history including sexually transmitted infections.
  • Exposure to heat, any toxins or pesticide.
  • The occupational history which includes any exposure at the time of work.
     
• Counselling
  Your doctor can explain you better about your condition. You should not hesitate to share your problems and personal history as it may help in identifying and treating the cause. Most importantly your doctor can help you in dealing with stress which could be a reason for low sperm count.
   
• Avoiding exposure to high temperature, radiations, and toxic substances can increase the sperm count.
   
• Taking proper care and protection while working in heavy metal industries and while using pesticides.
   
• Avoiding smoking or tobacco chewing can be helpful.
   
• Avoiding alcohol as it is proven that alcohol interferes with sperm maturation.
   
• Proper healthy diet and exercise along with nutritional supplements will control obesity and can help to deal with low sperm count.
   
• If low sperm count results due to varicocele, surgery can cure it.
   
• In the case of genetic disorders, proper evaluation and alternative methods to extract semen depending upon the disease can be helpful.
   
• If the low sperm count is due to certain medicines that you are taking, your doctor may ask you to reduce the dose or discontinue use of the drug.

Lifestyle management

Lifestyle modifications can help in case of low sperm count. These include:

• Having a healthy and nutritious diet along with the use of nutrition supplements if advised by the doctor.
   
• Avoiding stress by opting for stress-busting activities such as meditation, deep breathing exercises, and yoga.
   
• Including 30-45 minutes of daily exercise in your daily routine.
   
• Giving up smoking and limiting the intake of alcohol.
   
• Avoiding tobacco use.
   
• Avoiding taking extremely hot water baths.

Prognosis

Prognosis depends upon the underlying cause. Correctable causes like exposure to heat and radiations have good prognosis than permanent causes like genetic disorders.

Complications

Low sperm counts can lead to failure of conception by the natural process of reproduction. Other complications may not be related to low sperm count but the conditions or disorders causing it.