According to WHO (World Health Organisation) sperm health is considered normal if :
If the count of sperm is less than 15 million per ml it is called oligospermia (low sperm count) and if no sperms are seen in the semen sample it is called azoospermia.
Oligospermia is further divided into 3 categories, depending upon the severity:-
Mild: Sperm concentration is between 10 to 15 million/ml.
Moderate: Sperm count is between 5 to 10 million/ml.
Severe: Sperm concentration is less than 5 million/ml
Low sperm count is one of the important causes of male infertility.
One in every three cases of infertility is due to problems in a male partner.
● Infections: Various bacterial and viral infections can disrupt the process of sperm formation and thus affect the quality of sperms or cause scarring of the passages which carry the sperms from testes to the outside world. The infection can be of testes (orchitis) or epididymis (epididymitis). Many sexually transmitted diseases like gonorrhea and chlamydial infection can affect fertility. Mumps and tuberculosis can also be the infectious causes of low sperm count. Sometimes these infections can cause long-term problems that cannot be fixed, but quite often good quality sperms can be retrieved despite the infection.
● Varicocele: Dilation of veins around the testes is called varicocele, which causes local increase in temperature of testicles. Only severe degree like grade three or four varicocele needs to be treated surgically.
● Retrograde ejaculation : In this condition, instead of coming out of urethra, semen goes backward into the urinary bladder at the time of ejaculation. It can be due to diabetes, spinal injury, or the previous surgeries done on bladder, prostate or urethra.
● Antisperm antibodies : Antibodies are the defence mechanism of body against foreign invaders but sometimes these antibodies erroneously identify sperms as foreign bodies and destroy them leading to infertility.
● Cancer of testis for which chemotherapy or radiotherapy is given to the patient. These treatments destroy the sperm forming capabilities of the testes.
● Undescended testes : During foetal life testes are placed in flanks in the abdomen and they slowly descend down to the scrotal sac. If these are not able to descend down then it leads to increase in the temperature of testicles and impairs the sperm formation process.
● Hormonal imbalances in males : Hypothalamus and pituitary are those parts of the brain that regulate the production of hormones required for sperm formation. Alteration in this hormone as well as thyroid and adrenal gland hormone imbalances can be a cause of infertility.
● Genetic disorders: Many syndromes known to cause infertility are enumerated below: –
o Kleinfelter’s syndrome (XXY)
o Kartagener syndrome
o Cystic fibrosis
o Kallman syndrome
o Y chromosome microdeletion
● Celiac disease: It is due to gluten sensitivity which is found in wheat and wheat is consumed in a large part of India. This disorder can cause male infertility.
● Steroid abuse: Testosterone treatment and extensive anabolic steroid use to increase muscle mass by bodybuilders can lead to infertility.
● Surgical reasons: some surgeries like the following can cause make infertility
o Inguinal hernia repairs
o Testicular, scrotal surgeries
o Prostatic surgeries
o Abdominal surgeries for cancers, rectal cancers
2 .Environmental factors:
● Industrial chemicals like benzene, toluene, xylene, herbicides, pesticides, organic solvents, painting components, or lead may cause low sperm count.
● Heavy metals and radiation exposure
● Overheating of testicles: Though not confirmed the following can be the reasons for low sperm count:-
o Regular use of saunas, hot tubs.
o Sitting for long hours with a laptop on the thigh area.
o Tight-fitting clothes.
● Drug abuse like anabolic steroids, cocaine, marijuana.
● Heavy alcohol consumption.
● Cigarette smoking.
● Professions that cause an increase in scrotal region temperature like automobile driving, welding, mining works.
● Stress and anxiety.
● Excessive weight.
There may be NO evident symptom of low sperm count other than inability to conceive.
Sometimes low sperm count symptoms could possibly include: –
● Reduced sexual desire or problems sustaining erection.
● Pain in the testicular area, swelling, redness.
● Reduced facial and body hair and voice not having male character.
If a couple is planning pregnancy and not able to have a baby even after six months to one year of normal, unprotected intercourse then it’s time to consult your fertility specialist.
You may have to consult earlier in the following situations:-
● Reduced sexual desire or having other sexual dysfunctions.
● Pain, swelling, redness in the testicular area.
● Previous history of surgery or diseases in the testicular, prostatic, or rectal area.
● Surgery in the groin, testis, penis, scrotum, or rectal area.
● Detailed history as well as physical examination of patient.
● Semen evaluation.
● Additional tests like
o Scrotal ultrasound, transrectal ultrasound
o Hormonal assessment
o Post ejaculation urine analysis
o Chromosomal tests to rule out hereditary causes
o Antisperm antibody check
o Testicular biopsy.