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Interpreting test results
– Assisted Reproductive Technology
Increasing your sperm count is a step-by-step process. The first step towards effective treatment is identifying potential cause/s of your low sperm count through a comprehensive analysis.
Low sperm count, also known as oligospermia or oligozoospermia, happens when a man has 15 million or less sperm per millilitre (mL) of semen.
There are 3 forms of oligospermia;
- Mild oligospermia: 10 to 15 million sperm/mL
- Moderate oligospermia: 5 to 10 million sperm/mL
- Severe oligospermia: < 5 million sperm/mL
According to the World Health Organization reference values for semen, only 5% of males with mild oligospermia achieve a ‘time to pregnancy’ of less than 12 months with their partner.Source: Cooper T G, et al. (2009)
In couples seeking treatment, where male factors is the sole cause of infertility, low sperm count accounts for 8 out of 10 cases. However, due to underreporting and a lack of high quality studies, the exact prevalence among the wider community is not known.
In the more general male population, semen volume and motility along with quantity and quality of sperm declines gradually with age, while oxidative stress increases.
Source: Nago M, et al. (2021); Collodel G, et al. (2021)
However the male body continues to produce sperm, well past the age of 80. At this point in life though testicular volume begins to decrease leading to a rapid decline in spermatogenesis and overall fertility.
Source: Handelsman D J and Staraj S, (1985)
In infertile males this rapid decline seems to occur much sooner.
With a significant drop in progressive sperm motility, morphology and vitality beginning around 35 years of age. This makes age a critical factor for men diagnosed with some form of infertility.
Source: Demirkol M K, et al. (2021)
HOW DO I KNOW IF MY HUSBAND IS INFERTILE
The first test for infertility in ones husband is semen analysis. Using the WHO reference values, a semen value in the 5th percentile (5% of males to conceive within 12 months of intercourse), is considered abnormal & also infertile after 12 months trying to conceive, where no female factors exist.
Initial semen analysis of low sperm count is then confirmed by repeating the test 3 months later. This allows spermatogenesis, the biological process where sperm develop from germ cells in the testis, to repeat one full cycle.
CAN LOW SPERM COUNT BE CURED
Low sperm count can be reversed in some acquired cases of the condition, such as those caused by obesity, smoking, recreational drugs & steroid use. However in cases of low sperm count caused by congenital disorders or cancer treatments (Chemotherapy, gonadotoxins) low sperm count cannot be cured.
The male reproductive system itself is regulated by a complex network of positive and negative feedback loops, beginning at the hypothalamus in the brain which releases gonadotrophin-releasing hormone (GnRH) in a pulsatile manner.
GnRH causes the secretion of gonadotrophins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), from the anterior pituitary gland which stimulate the (Leydig, Sertoli) cells in the testis, to produce sex steroids and inhibin, and in turn apply negative feedback to GnRH, LH and FSH secretion.
Any disruption to this network directly impairs the function of the testis, which is to synthesize testosterone and carry out spermatogenesis.
However the loss of one or both of these functions, known as male hypogonadism, is commonly found in 4 out of 10 men with oligospermia.
Source: Sussman E M, et al. (2008)
Hypogonadism itself may be diagnosed as primary hypogonadism or secondary hypogonadism.
Primary hypogonadism is when the testes are mostly affected, causing lower testosterone concentrations in serum, impaired spermatogenesis and increase in gonadotrophins.
Secondary hypogonadism (also called hypogonadotropic hypogonadism) is defined by low testosterone concentration in serum, reduced spermatogenesis and low or abnormal levels of gonadotrophins.
Although low levels of testosterone (TT < 264ng/dL) was not significantly linked to impaired semen parameters, in a recent study of males with total sperm count > 5 million. In this context further studies are needed to identify the specific cut-off value for when low testosterone begins to impair semen parameters significantly.
Source: Di Guardo F, et al. (2020)
Primary hypogonadism and secondary hypogonadism can both be caused by congenital disorders or acquired after birth.
In acquired cases of secondary hypogonadism, such as obesity, high levels of exercise may in fact cause an increase in inflammation, resulting in no improvement of gonadotrophin or testosterone levels and thus no change in sperm quality.
Source: Chang B, et al. (2021)
Overall the hypothalamic-pituitary-testis (HPT) axis in males is finely balanced with changes in energy balance, between exercise and inflammation, regulating the expression of kisspeptin, which controls the levels of GnRH (gonadotropin-releasing hormones), LH, FSH and testosterone.
Symptoms of low sperm count
The main sign of low sperm count in a male is the inability to conceive a child despite 1 year of frequent and unprotected intercourse.
The inability to conceive despite 1 year of frequent and unprotected intercourse is defined as infertility in a couple.
Other symptoms may include:
- Low sex drive or erectile dysfunction
- Swelling, lump and pain in the testicular area
- Low facial or body hair
Risks associated with low sperm count
Men suffering from low sperm count are susceptible to further issues such as
- Stress, loss of self-esteem and relationship issues due to difficulties trying to conceive
- Increased risk of cancer
There have been studies undertaken that have linked low sperm count to a higher risk of cancer. Although, no cause-and-effect relationship was directly established infertile men should consult their Doctor to discuss long-term monitoring strategies.
Source: Hanson H A, et al. (2016); Eisenberg M L, et al. (2015); Eisenberg M L, et al. (2013); Jacobsen R, et al. (2000)
Causes of low sperm count
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