Oligozoospermia (Low Sperm Count) in Indian Men | MFine

Oligozoospermia or oligospermia is a medical term that refers to low sperm count in men. Oligozoospermia is a male fertility problem and can often be accompanied by other sexual health issues in males such as erectile dysfunction and the inability to ejaculate during orgasm.

What is low sperm count? How does oligozoospermia affect fertility in males?
Oligospermia or oligozoospermia meaning low sperm count refers to the semen a man ejaculates during sexual orgasm having fewer than normal sperms. A low sperm count in a man reduces the chances of sperm attaching to an ovum, thus reducing the likelihood of pregnancy in couples. However, studies have shown that males who suffer from oligozoospermia have still been able to have a child through various other infertility treatments.

When is a sperm count considered healthy or normal?
Sperm count is calculated by the number of sperms per ml of semen. A sperm count is classified as healthy when a semen sample contains 15 million sperm up to 200 million sperm per ml. Anything less than this number is low sperm count and diagnosed as oligozoospermia.

There are many factors influencing the quality or health of the sperm. Males can have a normal sperm count but unhealthy sperm that is unable to journey from the vagina all the way to the fallopian tubes. A specialist identifies the health of your sperm based on three aspects:
– Quantity – this is the amount of sperm in a male semen sample. A healthy sperm count is categorized by a sperm count of 15 million sperm up to 200 million sperm per ml of semen or more.
– Motility – this refers to the movement of sperm and how quick and agile it is in its ability to travel through to the embryo. A motility rate of 50% or more is considered healthy in males.
– Shape or structure – this refers to the shape of the sperm. Healthy sperms have heads resembling an egg shape with long tails at the end. This shape is crucial in helping the sperm swim to their destination. Therefore, the higher the normal-shaped sperm in your count, the easier it is for them to travel.

When is a sperm count considered low?
A sperm count is considered low when the quantity of sperm in semen is less than 15 million sperm per millilitre.
– Mild oligozoospermia is categorized by a sperm count between 10 and 15 million per millilitre.
– Moderate oligozoospermia is categorized by a sperm count ranging between 5 and 10 million per millilitre
– Severe oligozoospermia is categorized when the sperm count ranges from 0 sperm and 5 million sperm per millilitre.

Low sperm count conditions
Sperm counts in males change from time to time throughout a lifetime. A healthy sperm count, however, is crucial for fertility. Some other conditions that are associated with low sperm count are:
– Azoospermia – this refers to the complete absence of sperm in male semen. Conception is virtually impossible in this condition.
– Oligoasthenospermia – males can be diagnosed with a low sperm count yet have healthy sperm motility. However, oligoasthenospermia is a more serious condition where a low sperm count is coupled with low sperm motility rate. Severe oligoasthenospermia, in many cases, is treatable.
The next few chapters discuss the causes, symptoms, diagnosis and treatment of oligozoospermia in detail.

Common oligozoospermia causes can be divided into three categories – medical, external and lifestyle.

1. Medical causes

• STDs and Infections – infections such as epididymitis and orchitis, the inflammation of the epididymis and testes respectively are known to impair sperm production in males. Sexually transmitted diseases such as HIV and gonorrhoea are also attributed to a decreased sperm count.
• Retrograde ejaculation – this is a common oligozoospermia cause that is associated with semen being released into the bladder instead of out of the penis during orgasm.
• Varicocele – this condition refers to the swelling or enlarging of veins in a male’s scrotum that hinders blood flow to the testicle. This can cause the testes to develop a higher temperature which has an adverse effect on sperm production.
• Undescended testes – this condition is another reason for low sperm count that may occur during fetal development where either one or both testicles do not descend into the scrotum from the abdomen. Fertility is seen to be less likely in men with undescended testes. This condition is usually diagnosed using a scrotal USG test.
• Sperm attacking antibodies – sometimes a male’s immune system may mistakenly see sperm as harmful foreign substances and develop antibodies to attack it causing oligozoospermia.
• Hormonal imbalances – As mentioned earlier in the section, hormonal production is necessary for triggering sperm production and therefore, imbalances in the hormones produced by the hypothalamus, pituitary or even the adrenal glands can cause oligozoospermia meaning negatively impact sperm count.
• Tumours – the male reproductive organs may be directly affected by tumours or cancers present in the body through hormone-releasing glands.
• Blockage of tubules – Blockage of the many delicate tubes that carry sperm is another common reason for low sperm count. This can happen due to injuries, damage, trauma, to the area or inherited conditions that may cause abnormal development of the tubules.
• Drugs and Medications – certain strong medications such as anabolic steroids, chemotherapy, blood pressure medications, antibiotics and antifungal medications have the ability to hinder fertility in men and cause oligozoospermia meaning care should be taken to consult a fertility specialist first before taking any over-the-counter medication.
• Gluten allergy – gluten or celiac allergy is a digestive condition that results from gluten intolerance. This also may cause infertility in males.
• Past surgeries – specific surgeries such as a vasectomy, hernia surgeries, testicular or prostate surgeries and cancer-related surgeries of the male reproductive organs can affect sperm count in the ejaculate.
• Genetic disorders – Klinefelter’s syndrome, cystic fibrosis, Kartagener’s syndrome and Kallmann’s syndrome are a few hereditary chromosomal disorders that are associated with oligozoospermia and are reasons for low sperm count.

2. External causes

• High temperatures – Some studies show that sperm count is temporarily impaired when the testicles are exposed to elevated temperatures or activities that lead to a temperature increase in the testicles. For eg. saunas, tight clothing, keeping a laptop on the lap, sitting for prolonged periods.
• Prolonged exposure to X-rays and radiation therapy – Radiation therapies and X-rays have never been ideal for sperm production and sometimes have the ability to cause close to permanent impairment.
• Chemical and metal exposure – Prolonged exposure to industrial chemicals and solvents including paint and pesticides have shown to impact sperm counts. Lead or metal exposure has also been attributed to male infertility in some cases.

3. Lifestyle causes

• Mental Health – hormonal imbalances due to mental health issues such as depression, extreme stress and anxiety can lead to the body producing lesser sperm than normal.
  Smoking, drug and alcohol abuse – excessive smoking, drug and alcohol use is linked to reduced testosterone levels and lower sperm count and may also cause the testes to shrink in size. Cocaine and marijuana use have known to affect overall sperm quality as well.
• Obesity – Obese males are more likely to experience oligozoospermia due to hormonal imbalances caused by obesity that directly impact fertility and sperm count.

The inability to conceive is the predominant sign of a decreased sperm count in males. Most males diagnosed with oligozoospermia come to know about their condition only after they’ve approached a doctor with the former problem, or when they have erectile dysfunction or any pain during ejaculation. If the underlying cause of oligozoospermia is due to a hereditary or chromosomal disorder, a tubule blockage, hormonal imbalance or varicocele symptoms may include,

• Erectile dysfunction
• Decreased sex drive
• Inability to ejaculate semen during orgasm
• Swelling, pain or lump in the testicular area
• Decreased body or facial hair, a common sign of a chromosome or hormonal disorder.

When to seek medical assistance?

If you and your partner have been trying to get pregnant at least for a year by frequent unprotected sex and are unable, it is best to consult a fertility specialist to assess whether you may have:

• Issues with sexual function such as ED and diminished sex drive
• Pain while sex, discomfort or swelling of the testes
• A family history of prostate or testicular issues
• Issues from a recent surgery of the reproductive organs

Our fertility specialists on Mfine can help you with a thorough diagnosis if you happen to experience any of these symptoms.

A thorough oligozoospermia diagnosis may generally include:

1. 1. A physical examination – where the doctor physically examines your genital area and asks questions about your symptoms, family history, sexual habits, past surgeries and anything that could possibly affect fertility
   2. Analysis of semen – next a semen analysis is done where the patient’s semen sample is examined under a microscope to check for abnormalities in sperm quality that may be affecting sperm count.

Other tests that aid in identifying the underlying cause of oligozoospermia may be conducted. These include,

1. Ultrasounds – two types of ultrasounds may be conducted to identify issues in the reproductive organs -scrotal ultrasound and transrectal ultrasound.
2. Blood test – blood tests may be conducted to identify any genetic or hormonal issues that may be causing low sperm count.
3. Urine analysis – a urine sample right after ejaculation is analysed to identify if oligozoospermia is being caused due to retrograde ejaculation.
4. Sperm function tests – these tests are performed to check the survival rate of your sperm right after ejaculation and also issues around the penetration or attachment to the embryo.
5. Anti-sperm antibody tests – these tests are done primarily to identify anti-sperm antibodies if any that the body may be producing that is mistakenly attacking sperm cells.

So how to treat low sperm counts? The treatment for oligospermia includes:

1. Antibiotics and medication – Antibiotics may aid in curing an infection of the reproductive organs but may not always increase sperm count. It’s important to consult a fertility specialist to clarify what is the best medication for oligozoospermia suited to your specific cause.

2. Medication and counselling for sex – This treatment has proved to help increase sperm count in many cases when the male partner is dealing with premature ejaculation, a low sex drive or erectile dysfunction also because of mental health issues.

3. Surgery – some causes of low sperm count such as varicocele can be treated with surgery. Previous vasectomies in males can also be reversed by surgery. In cases of severe oligozoospermia, where zero sperm is present in the ejaculated semen, sperm retrieval techniques can be implemented to increase sperm volume by directly recovering sperm from either the epididymis or the testes.

4. Hormonal treatments – in some cases, hormonal imbalances may be the primary cause of infertility and so doctors may recommend hormone medication that seeks to restore the balance and by that increase sperm count in males.

5. Assisted reproductive technology (ART) – in cases where natural conception seems distant due to irregularities in sperm quality, sperm may be either obtained through ejaculation, or surgery, or even from donors only to insert it artificially into the female genital tract.

Home Remedies for Oligozoospermia

Oligozoospermia treatments can sometimes be painful and require patience and constant observation and monitoring. There are few oligospermia natural treatments, home remedies, that doctors may recommend to increase fertility in men. The most common low sperm count treatments at home are:

• Engaging in sexual intercourse around ovulation – Many have wondered how to get pregnant with low sperm count and motility. Having sexual intercourse at the right time is the best oligospermia natural treatment in this case. The likelihood of your partner getting pregnant in the ovulation stage of her menstrual cycle is very high. Ovulation occurs during the middle of the menstrual cycle and sex during this time can ensure that sperm is actively present when the environment for conception is perfect. Therefore engaging in unprotected sexual intercourse around ovulation and more frequently increases the chances of your partner conceiving.
• Avoiding the use of lubricants – Some lubricants or lubes come with spermicidal properties that impair sperm function and motility in males. It is best to consult a physician about lubricants that are safe to use and that doesn’t hinder fertility or sperm count in any way.

1. What is low sperm count?
A sperm count is considered low when there is less than 15 million sperm per millilitre of semen. This condition is also known as oligozoospermia or oligospermia. Low sperm count results in male infertility and can be classified into 3 categories depending on the count – mild oligozoospermia (sperm count range between 10 and 15 million sperm/ml), moderate oligozoospermia (sperm count range between 5 and 10 million sperm/ml) and severe oligozoospermia (sperm count range between 0 and 5 million sperm/ml).

2. What are some oligozoospermia causes?
Oligozoospermia or low sperm count may be caused due to multiple medical, external and health and lifestyle factors. Some common ones include varicocele, STDs and infections, retrograde ejaculations, hormonal imbalances, undescended testicles, blockage of sperm tubes, mental health, radiation or high heat exposure and much more. If you’re wondering how to treat low sperm count, there are many ways to treat oligozoospermia, increase sperm volume and prevent it from recurring.

3. How to get pregnant with low sperm count and motility?
Some ways pregnancy is possible in these circumstances, otherwise known as oligoasthenospermia, is by having sexual intercourse when your partner is ovulating. The ovulation environment is one that is conducive to conception and increases your chances of conceiving despite low sperm count and motility. Another way is to implement assistive reproductive techniques to help with pregnancy.

4. What are some effective low sperm count treatments?
Low sperm count treatments may include medication, surgery, hormonal treatments and assisted reproductive treatments. Some oligozoospermia treatments for conception also involve home remedies such as increasing the frequency of sexual intercourse, avoiding lubricants and having sexual intercourse during your partner’s ovulation period to increase chances of fertility.

5. Is there a link between oligoasthenospermia and natural pregnancy?
Females can have a natural pregnancy even if their partners suffer from oligoasthenospermia, a condition associated with low sperm count and low sperm motility. By implementing appropriate assisted reproductive techniques and having sexual intercourse when your partner is ovulating, you can increase the chances of having a natural pregnancy despite oligoasthenospermia.

6. Is severe oligoasthenospermia curable?
In most cases, oligoasthenospermia despite its intensity is curable. The treatment method used will depend on the aetiology. It is advised to ask a fertility specialist for the best form of treatment to cure oligoasthenospermia.