Low Sperm Count or Abnormal Semen Analysis? Now What?

So your partner has been diagnosed with low sperm count or an abnormal semen analysis. Now what? First of all, according to Dr. Don Aptekar, M.D., FACOG, who has been delivering babies since 1977, "having a low sperm count is not necessarily a 'kiss of death’. There is no need to panic." This is not an uncommon problem, and in fact, male-factor infertility represent about 50% of all fertility problems (source). In Dr. Aptekar’s 40 plus years of practice, he has seen plenty of men with a low sperm count, even as low as 10 million sperm per milliliter, who are still able to achieve a natural pregnancy.  Each individual case, however, presents its own unique issues and potential solutions.

If your doctor has confirmed that you are ovulating and are physically normal, but your partner’s semen analysis came back abnormal, you may be wondering 1) what do these numbers mean? 2) how will we solve this? And 3) if needed, what are the treatments?
 

What These Numbers Mean: The Semen Analysis

The semen analysis evaluates the quantity and the quality of the sperm, as well as the semen.  Some research indicates that your partner should do two or three samples to obtain baseline data (source). In addition to sperm count, the doctor will also look at sperm motility (how the sperm move) and sperm morphology (how the sperm is shaped), and other characteristics.


Low sperm, called oligospermia, can lead to either reduced fertility (subfertility) or infertility, but it is not the only characteristic that is responsible for determining fertility. Dr. Aptekar explains that the key is healthy sperm. In other words, the way sperm are shaped, how they move and how active they are, plus the composition of the seminal fluid are also important for sperm function. For example, a man with low sperm count, but with healthy motility and shape, may have a higher chance of conception than a man with high sperm count but poor motility.
 

If your partner falls below the normal parameters, you may have a more difficult time becoming pregnant. Here are the World Health Organization’s (W.HO.) and Resolve parameters for a semen analysis:

Volume: 1.5 to 5 milliliters is a normal volume. Low volumes can indicate a blockage, dysfunction in the seminal vesicles or prostate, or hypospermia.

Sperm count: 15 million sperm per milliliter of semen is considered lower than normal.  You may see 20 million per mL in some papers, however, the lower reference limit for sperm concentration decreased from 20 million/mL to 15 million/mL (95th CI 12-16 million). W.H.O defines normal count values to be 15 million per ml ejaculated or 39 million per complete semen sample. The technical term for low sperm count is oligospermia.

Motility: There are two parts of motility that are evaluated: 1) the activity of the sperm (rated on a scale from 0-100%) and at least 50% of the sperm should be active and 2) the quality of the movement (rated on a scale from 0-4) of which a score of 2 or more is considered normal.

Morphology: Examines the shape and size of the sperm head. At least 30% of cells should be of normal shape according to the W.H.O.

Liquefaction: The fertility specialist will look to see if the fluid part of the semen coagulates and then liquefies. In normal semen, the fluid part of the ejaculate, will immediately coagulates into a pearly gel that liquefies within 20 minutes. Failure to coagulate and then liquefy may indicate a problem with the seminal vesicles. Other issues include increased thickness or the presence of white blood cells.

Seminal Fructose: Fertility specialist test for seminal fructose if no sperm are present. Seminal fructose is normally produced by the seminal vesicles. If fructose is absent, it may indicate a congenital absence of the vas deferens or seminal vesicles, or that an obstruction of the ejaculatory duct may be present.

Cultures: In addition, the physician/urologist may test the semen and/or the urethra for the presence of any STD's or other bacteria.

 

Check out the sources here for more information: W.H.O,  Resolve , OMICS International, and the Mayo Clinic

 

How do We Solve This:  

 

“The call that came from the doctor a few days later shifted the trajectory of our lives. “The lab called and asked if this was a post-vasectomy sample,” noted our doctor. It’s a sentence that is etched into the fibers of my memory.” Brandi Koski
 

You don't have to be in the top top 25% to be fertile, but if your partner’s sperm count falls below normal levels it may be harder to achieve pregnancy. Unless there is zero sperm (azoospermia), however, it’s not possible to say exactly how low a sperm count can be to have a successful pregnancy.  Getting abnormal results back can be one of the most stressful times in one's life, especially if finances are tight. Dr. Aptekar encourages his patients to not go down the dark path of despair that can fall upon couples struggling with infertility. He recommends talking to other couples who have suffered from infertility and joining support groups if needed.

 

Depending on the nature of the problem, a number of treatments are available: it could simply be a lifestyle change such as losing weight or antibiotics for an infection that has been detected to something more complex such as in vitro fertilization (IVF).  With the variety of treatments and costs, if available where you live,  it would be wise to research multiple fertility clinics. Ask about their success rates for your age and issue.


 

Lifestyle Factors:

The following factors can have a negative impact on otherwise normal healthy sperm cells:

  • Smoking cigarettes
  • Smoking marijuana
  • Riding a bike, horse, motorcycle for prolonged periods of time
  • Uses or is often in contact with certain chemicals (such as pesticides)
  • Being overweight or obese

 

For more details on lifestyle factors and their impact, please click here.


 

Frequency of intercourse:
 

You may have received advice to 'save up' sperm. Turns out frequent ejaculation has a significant benefit, improving sperm motility and sperm morphology, while reducing levels of DNA fragmentation (source), (source). Dr. Aptekar recommends that if you have low sperm count, to have intercourse every other day. That way it gives your partner’s  body enough to replenish, but not long enough to reduce quality.

If you and your partner don’t get too fatigued or stressed about the process, you may want to try having intercourse twice in one hour during your most fertile days, which are two days before you ovulate. The rationale behind this technique is simple-  there is more sperm making it’s way to the egg (source). 


 

Treatments: 

Here are some examples of the most often used reproductive treatments for couples with abnormal semen test results.


Artificial Insemination (also known as Intrauterine insemination or IUI)

This method is relatively simple and may be able to be performed at your doctor’s office. It involves preparing the sperm and then a doctor inserting the sperm into your uterus using a catheter.

Best for: Cases in which men have slow-moving or lower quality sperm or a low-sperm count. May work for counts of 1-3 million sperm per mL and higher.

Costs: On average, $865.
 

In Vitro Fertilization (IVF)

This method can be quite costly if your health insurance doesn’t cover this procedure, however, it has helped many couples have a baby that would otherwise not be able to achieve pregnancy. A cycle first involves fertility drugs so that your doctor can extract your eggs. They will fertilize your eggs with your partner’s sperm or a sperm donor if you are using one in a lab. If the fertilized eggs develop into viable embryos, it will be up to you if one or two are implanted in your uterus. If there are any remaining, they will be stored.

Costs: $8,000, on average, per cycle, not including medications.


Intracytoplasmic Sperm Injection (ICSI)

ICSI is used for more severe cases of male-factor infertility. After you do an egg retrieval,  your fertility specialist will select a single healthy-looking sperm and inject  it directly into the egg with a microscopic needle. Once an embryo develops it's transferred into the uterus through IVF.

Costs: $9,000 to $10,000 per cycle (including cost of IVF)


 

What if my partner has zero sperm (aka azoospermia):

There are basically 4 causes behind having no sperm for otherwise healthy men (source):

  1. The testis are making sperm, but there is a blockage.
  2. The brain is not stimulating the testis to make sperm.
  3. The testis are not producing any sperm
  4. The testis may be producing a tiny amount of sperm, but it is not coming out in the ejaculate
     

Your partner will need for his doctor (whether a urologist or fertility specialist) to figure out what is behind the problem. If your partner is making sperm, sperm retrieval rates may be effective in 30-70% of cases.  Unless your doctor is able to fix the blockage or other issue leading to azoospermia, you most likely will have to use IVF. Pregnancy rates of 20-50% may be obtained at different centers with IVF and intracytoplasmic sperm injection (source).

Click here for an online IVF calculator to get a ballpark estimate of cost. 



Does Insurance Cover Infertility Care:
 

Only 15 states require insurance companies to provide coverage with infertility treatments, but there are certain conditions for which insurance coverage may be available even if you don't live in those states. Learn more here . Even if you do not reside in one of those 15 states, you may wish to call your current insurance company to learn whether they provide coverage or not.


 

While the news of abnormal semen results may be overwhelming, the good news is that you live in a time where there are treatment options for male-factor infertility. Should you need treatment, it’s recommended to ask 1) if your condition can be treated in other ways 2) know why a test or procedure is recommended 3) what the results could mean and 4) the statistical success rate.

 

Whether trying to conceive or a Healthcare Professional, join our blog community to receive weekly fertility education based on scientific evidence by signing up below:

 

 

Resources and References

  • http://www.nhs.uk/conditions/low-sperm-count/Pages/Introduction.aspx
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854088/
  • http://www.nytimes.com/health/guides/disease/infertility-in-men/print.html
  • http://apps.who.int/iris/bitstream/10665/44261/1/9789241547789_eng.pdf?ua=1