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:
Gonadotrophins: 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.