Low Sperm Counts and Male Fertility
As a fertility doctor, I talk about sperm all the time. It's a topic that many people don't feel comfortable discussing, but it's so important when it comes to fertility and family building. Let’s break down the basics of sperm counts and male fertility so you can be informed and empowered.
Sperm Vs. Eggs
The first thing to understand is that sperm is not a constant - it's constantly being made and regenerated in the testes. Unlike eggs, where women are born with all the eggs they'll ever have, sperm is being produced daily in the testes. The entire lifespan of a sperm, from creation to being seen in an ejaculate, is about 3 months. This means that sperm quality and quantity can fluctuate quite a bit based on your health and environment over that 3 month period. This is both good and bad news. The good news is that it means you have some control over your sperm health - the changes you make today can impact your sperm in about 3 months. The bad news is that sperm are quite fragile, so things like medications, illness, stress, and toxin exposure can negatively impact them quickly.
The Semen Analysis
When we do a semen analysis to evaluate sperm, there are a few key things we look at:
Volume: The total amount of fluid in the ejaculate, which should be at least 1.5 mL.
Concentration: The number of sperm per mL, which should be at least 15 million per mL.
Motility: The percentage of sperm that are moving, which should be at least 40%.
Morphology: The shape and structure of the sperm, which should have at least 4% normal forms.
Low Sperm Count
These parameters together give us the total motile sperm count, which is an important overall measure of sperm health. If any of these values are below normal, it can indicate a low sperm count, also known as oligospermia. Oligospermia can be classified as mild, moderate, or severe based on how low the sperm count is. And the frustrating thing is that in about 75% of cases, we can't find a clear reason for the low sperm count. It just seems to be how that person's body is made. Some of the more common known causes of low sperm counts include:
Genetic issues like Klinefelter syndrome (having an extra X chromosome)
Problems with the pituitary gland or thyroid that affect hormone levels
Congenital issues like undescended testicles
Testicular damage from injury, torsion, or varicocele
Medications like testosterone, finasteride, opioids, and antidepressants
Lifestyle factors like obesity, diabetes, chronic illness, and exposure to toxins
The Importance of a Male Fertility Workup
The tricky thing is that in about half of infertility cases, there is a male factor component. So even if you think the issue is with your partner, it's still really important to get a semen analysis done. I've had many patients who were convinced the problem was with their female partner, only to find out there was a significant male factor as well. And here's another important point - just because your sperm count is low, doesn't necessarily mean you can't get your partner pregnant. The total motile sperm count is key. Even with a low count, if the motility and morphology are good, you may still be able to conceive naturally or with some assistance. That's why it's so important to get a full fertility workup, including evaluating both partners. I've seen too many cases where the male partner was never properly evaluated, and valuable time was lost pursuing treatments that may not have been necessary.
What next?
If you do have a low sperm count, don't lose hope. There are many things that can be done to try to improve it, from lifestyle changes to medications to assisted reproductive technologies. But you have to start by getting the right testing and evaluation. I always tell my patients that a semen analysis is like a vital sign for men, just as important as a woman's menstrual cycle. It gives us crucial information about your reproductive health. And the sooner you get that information, the sooner we can start working on solutions. So if you're concerned about your fertility, or if you and your partner have been trying to conceive without success, please don't hesitate to get a semen analysis done. It's a simple test that can provide invaluable insights. Fertility is a journey, and male factor issues are incredibly common. But with the right information and the right care, many men are able to overcome sperm-related challenges and build their families.
