How to treat, manage low sperm count
How to treat, manage low sperm count.
The words, ‘low sperm count’ and ‘no
sperm’, are very frightening terms for
many men and couples alike, especially
when there is a history of infertility. But
what do they mean?
Oligozoospermia or ‘low sperm count’
refers to semen with low concentration
of sperm cells. It is commonly
associated with male infertility.
Based on a recent World Health
Organisation criteria, an ejaculate with
a concentration of less than 15 million
sperm/ml of semen is termed
oilgozoospermia.
There are also different classes of
oligozoospermia (mild to severe). Mild
refers to a concentration of 10 million to
15million sperm/ml while moderate is
between five million and 10 million
sperm/ml and severe is 15 million
sperm/ml.
Azoospermia (no sperm) refers to
complete absence of sperm in an
ejaculate. It is a well-known cause of
male-factor infertility.
Cryptozoospermia applies to a situation
in which sperm cannot be seen in a
fresh semen sample but later found
after an extensive centrifugation and
microscopic search.
In our society, the burden is placed
more on the female partner when it
comes to conception. When a couple
can’t conceive after a year, the society
automatically blames the woman. This
assumption is often false. As a matter
of fact, male infertility accounts for
about 40 per cent of infertile couples.
About seven per cent of men are said to
be infertile. But a lot of men with fertility
problems are reluctant to come for
further testing and treatment.
The good news is that a diagnosis of
oligozoospermia or azoospermia is not
the ‘end of the road’. These conditions
can be treated and a lot of men have
benefitted from various treatment
options. Furthermore, it has been
observed that the success rate for the
treatment of infertility is higher when
both spouses face the issue and attend
the clinic together like in the developed
countries.
But before listing the treatment options
it would be important to discuss
preventive measures which would
include lifestyle adjustments such as
not smoking, avoidance of recreational
drugs and environmental toxins, cutting
down alcohol and caffeine intake.
It is important men avoid exposing their
testicles to high temperatures such as
hot tubs, long-distance driving and
tight underpants and seeking prompt
and regular medical care as a number
of medical conditions are associated
with infertility such as mumps,
tuberculosis, sexually transmitted
diseases, like gonorrhoea and syphilis.
Management
A detailed history and physical
examination is done by a clinician to
check for possible causes like
varicocoele, testicular atrophy,
undescended testis and other
abnormalities. A seminal fluid analysis
is done to properly assess the sperm
parameters. Usually, patients are
advised to abstain from intercourse for
between two and seven days before
doing this test for optimal results.
Further testing, including hormone
profile and scrotal ultrasound may be
done, especially to check for other
underlying causes.
In our centre we also recommend
bioenergetic testing to determine food
allergies, environmental toxins or the
presences of pathogens.
Medical treatment
Depending on the underlying cause,
patients can benefit from various drugs.
The following are commonly used:
Gonadotrophin: Gonadotrophins, especially human chorionic
gonadotrophin, have been used
successfully in treating some patients
with azoospermia, especially those with
underlying hormonal imbalance.
Anti-estrogens: Drugs like clomiphene
citrate and tamoxifen have also been
used in patients with oligospermia/
azoospermia. These drugs have been
used in patients with idiopathic
oligozoospermia, as well as patients
with low levels of the male hormone –
testosterone.
Dietary supplements and anti-oxidants:
The use of antioxidant therapy in
treatment of patients with male
infertility has been associated with
statistically significant improvements in
sperm parameters. This is because
many of these anti-oxidants are
required at different stages of sperm
production. Co-enzyme Q10, for
example, has been shown to
significantly improve sperm
concentration, motility and strict
morphology in patients undergoing
treatment.
Other drugs used include aromatase
inhibitors like Anastrazole and cyclic
steroids (for immunosuppresion). It is
important to note that these drugs can
be combined to get better results. It is
the duty of the clinician to identify the
underlying causes and appropriate
medication to use.
What we find most successful is to use
all these medication in a sequence but
not together. For instance, many
people use a testosterone medication
like proviron on a daily basis for
several months. Unfortunately in men,
the physiological levels of testosterone
is not constant; hence, the need to
prescribe them in a pulsatile fashion for
good results.
Lifestyle modification: Patients should
be encouraged to stop smoking
cigarettes and other psychoactive
substances. Stress relief and weight
loss, dietary modification, avoidance of
toxins have all been shown to be
beneficial in treating male infertility.
Body detox: A lot of people are exposed
to toxins from the environment,
preservatives in food, drugs, cosmetics
and stress. These toxins may
accumulate in vital organs, leading to
organ damage and infertility. Total body
medical detoxification in a medical spa
helps to remove these toxins, thereby
improving fertility
Assisted Reproductive Technology
These refer to the use of advanced
techniques to achieve conception. The following are commonly used:
Artificial Insemination and Fallopian Tube Sperm Perfusion: Patients with
mild and even moderate
oligozoospermia can benefit from this
non-invasive treatment. It involves
direct intrauterine injection of ‘sperm
suspension’ usually after adequate
sperm processing (washing). The aim is to achieve higher concentrations of sperm in the ‘fallopian tubes’ to facilitate conception.
Pregnancy rates are about 20 per cent per trial and multiple births are
common when combined with
superovulation.
Intra-cytoplasmic Sperm Injection
This is used for patients with severe
oligozoospermia. It involves direct
injection of sperm into the oocyte
(eggs). For this to be done, the oocytes
have to be retrieved from the female
partner while semen is collected from
the male and processed. This method
has been extremely beneficial for
patients with very low sperm
concentrations. Globally, pregnancy
rates are around 35 per cent to 45 per
cent and can go up to 60 per cent with
multiple trials.
Advanced sperm retrieval techniques
A number of procedures can be used to
collect sperm in patients with
azoospermia using local anaesthesia.
Many patients with absence of sperm in
their ejaculate (semen), still have some
sperm in their testis (organ where
sperm is produced) and epididymis,
which stores mature sperm. Certain
procedures can be used to collect this
sperm directly from these organs with
the help of special needles.
We have reported a number of
pregnancies and babies have been born
through these techniques.
In summary, there are various
treatments available for
oligozoospermia and azoospermia. The
type and extent of treatment can only
be determined after proper evaluation
and testing by a skilled fertility
physician using appropriate techniques
and procedures.
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