Low Sperm Quality Success Stories

Ever since the World Health Organization (WHO) published the very first edition of the Laboratory Manual for the Examination and Processing of Human Semen in 1980 experts have consistently reported spontaneous pregnancies among men with theoretically low sperm quality.

This then begs the question, if low sperm quality doesn’t necessarily mean the man is infertile, then what are the chances of success and how long does it take to conceive?

Let’s take a look at the success rates for each type:

• Low sperm count
• Low sperm motility
• Low sperm morphology
• Low sperm count and motility

Low Sperm Count Success Rates

There are countless success stories online about men who have managed to conceive with low sperm count (also known as oligospermia). This is because truthfully it is quite common for men with low sperm count to be able to conceive naturally after diagnosis without any treatment assuming there are no female reproductive issues.

Analysis of several studies clearly shows that the chances of pregnancy for men with low sperm count (oligospermia), within 5 years of diagnosis and no treatment, varies from 57% to 16% according to the type of oligospermia.

The 3 types of oligospermia are:

• Mild oligospermia (10-15 million sperm count per mL)
• Moderate oligospermia (5-10 million sperm count per mL)
• Severe oligospermia (< 5 million sperm count per mL)

Mild Oligospermia

Men diagnosed with mild oligospermia naturally have the highest chance of success. According to modelling by Keihani et al. the chances of pregnancy for men with mild oligospermia varies between 53% to 62%. This model also shows that the time-to-conception for successful men with mild oligospermia can range from 42 to 60 months.

Moderate Oligospermia

Men diagnosed with moderate oligospermia (5 to 10 million sperm count per mL) have a significantly lower chance of success compared to men with mild oligospermia. In fact, the chances of pregnancy for men with moderate oligospermia is approximately 27%.

According to Van Zyl and Menkveld, 13 out of 49 men with moderate oligospermia were successfully able to conceive naturally after diagnosis in their study. This is most likely to occur within 48 months of diagnosis.

Nevertheless, approximately 3 in 4 men with moderate oligospermia did not conceive naturally and would need Medically Assisted Reproduction (MAR) treatment to help them conceive.

Severe Oligospermia

Men diagnosed with severe oligospermia (5 million sperm count per mL) also have a significantly lower chance of success compared to men with moderate oligospermia. In fact, the chances of pregnancy for men with severe oligospermia is approximately 16%.

According to two studies, 82 out of 562 men with severe oligospermia were successfully able to conceive naturally after diagnosis. This is most likely to occur within 36 months of diagnosis among men with higher sperm counts.

For example (according to Van Zyl and Menkveld):

• Men with 4 million sperm count per mL have a 14.2% chance of pregnancy naturally. This means only 23/161 men with 4 million sperm count/mL were successful.
• Men with 3 million sperm count per mL have a 8.7% chance of pregnancy naturally. This means only 12/138 men with 3 million sperm count/mL were successful.
• Men with 2 million sperm count per mL have a 4.6% chance of pregnancy naturally. This means only 5/108 men with 2 million sperm count/mL were successful.
• Men with 1 million sperm count per mL have a 3.7% chance of pregnancy naturally. This means only 3/82 men with 1 million sperm count/mL were successful.

Overall, at least 8 in 10 men with severe oligospermia did not conceive naturally and need Medically Assisted Reproduction (MAR) treatment to help them conceive.

There is also a 1 in 4 chance that sperm counts decline further towards virtual azoospermia among men with severe oligospermia. If this appears to be happening after the second or third semen analysis, your doctor may strongly advise sperm cryopreservation in lieu of treatment.

Low Sperm Motility Success Rates

Similarly, there are also many success stories online about men who have managed to conceive successfully with low sperm motility (also known as asthenospermia). This is because it is not uncommon for men with low sperm motility to be able to conceive naturally without any treatment assuming there are no female reproductive issues. In fact, almost 30% of fertile men presenting for vasectomy had low sperm motility in one study.

However, studies show that the chances of pregnancy for subfertile men with low sperm motility (less than 40%) is 6 times less likely than comparable men with normal sperm motility. Therefore, for a majority (80%) of these men time-to-conception can take up to 5 years. While men with sperm motility less than 10% are highly unlikely to be successful, irrespective of time trying to conceive, according to Van Zyl and Menkveld.

Low Progressive Motility

According to modelling by Keihani et al. the chances of pregnancy for men with low progressive motility (less than 32%) is as high as 55%. In fact, 403 out of 794 men in this study were successful with low progressive motility. Although the time-to-conception for these men can be as long as 5 years compared to under 2.5 years for other subfertile men with normal progressive motility (≥ 32%).

Nevertheless, almost 1 in 2 men with low progressive motility did not conceive naturally and would need Medically Assisted Reproduction (MAR) treatment to help them conceive.

Low Sperm Morphology Success Rates

Likewise, there are numerous success stories about men who have managed to conceive successfully with just low sperm morphology (also known as isolated teratozoospermia) assuming it was diagnosed correctly (i.e. checking more than 1500 sperm).

A study in 2015 reported that the natural chances of pregnancy for men with low sperm morphology (less than 4%) was 43% within 3 years of diagnosis. This means 26/60 men with low sperm morphology were successful while 34 men would still require Medically Assisted Reproduction (MAR) treatment.

Interestingly, even during IUI treatment the chances of pregnancy per cycle for men with less than 4% normal sperm morphology is similar to those with normal sperm morphology of 4% or greater (12.3% vs. 13.6%).

According to Deveneau et al. this result does not change with the exact percentage of low sperm morphology:

• 17.2% pregnancy rate per cycle among men with sperm morphology of 3% to 4%
• 16.7% pregnancy rate per cycle among men with sperm morphology of 0% to 2%

Even in cases of just 0% sperm morphology, 6/24 (25%) of men conceived naturally twice during a 3-year study by Kovac et al.

Overall, these results suggest other unknown sperm factors causing infertility in some men with low sperm morphology and explains why teratozoospermia is seemingly just as prevalent in fertile men according to Candela et al.

This finding is supported by a more recent study which reported 56% (38/68) of fertile men seeking a vasectomy had low sperm morphology.

Low Sperm Count and Motility Success Rates

Unsurprisingly, you will find countless success stories about men who have managed to conceive successfully with low sperm count and motility (also known as oligoasthenospermia). This is because, as explained previously, it is not uncommon for men with either low sperm count or low sperm motility to conceive naturally. Hence a diagnosis of oligoasthenospermia does not prevent natural conception entirely.

A study in 2015 reported that the natural chances of pregnancy for men with low sperm count and motility was 29% within 3 years of diagnosis. This means 52/181 men with oligoasthenospermia were successful while 129 men still required Medically Assisted Reproduction (MAR) treatment.

A similar finding was reported in an older study of fertile men after vasectomy reversal. Post-surgery, 25 out of 32 men, with a total motile sperm count less than 10 million (equivalent to oligoasthenospermia), were able to conceive again naturally during a 10-year follow-up period. Although there is some evidence that sperm counts and or motility can spontaneously increase (for reasons unknown) which may explain the high pregnancy rate in this group of subfertile men.

In reality, no doctor would ever recommend a couple try to conceive naturally for longer than a few years, so although it may be possible for most men with oligoasthenospermia to conceive naturally, the majority won’t before seeking medical assistance.

A Final Tip from Fertility SCIENCE

Many men with low sperm count, motility or morphology conceive naturally without ever needing treatment. Of course, this is conditional on their being no female factors that impact the couple’s fertility further. However, a large number of men with low sperm quality also fail to conceive naturally no matter how long they try.

Therefore, it is important both partners undergo a traditional extensive infertility work-up after the man is diagnosed with low sperm quality to check for other known causes of infertility and discuss how much longer to keep trying naturally before asking for medical assistance (i.e. Assisted Reproductive Technology).

Finally, although the statistics are in your favour, trying to conceive for a long period of time can stress the relationship beyond repair so it’s important to keep that in mind when discussing the options with your partner and doctor.

fertilPEDIA

Low Sperm Count Overview

Low sperm count, also known as oligospermia or oligozoospermia, happens when a man has 15 million or less sperm per millilitre (mL) of…. Read more

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Asthenozoospermia, is defined as reduced or absent sperm motility (< 32%) in fresh ejaculate. It is one of the main causes of infertility in... Read more