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What Causes Oligospermia or Low Sperm Count and How to Treat It

Let's Talk Sex

Sex may permeate our popular culture, but conversations about it are still associated with stigma and shame in Indian households. As a result, most individuals dealing with sexual health issues or trying to find information about sex often resort to unverified online sources or follow the unscientific advice of their friends.

To address the widespread misinformation about sex, News18.com is running this weekly sex column, titled ‘Let’s Talk Sex’, every Friday. We hope to initiate conversations about sex through this column and address sexual health issues with scientific insight and nuance.

The column is being written by Sexologist Prof (Dr) Saransh Jain. In today’s column, Dr Jain explains what Oligospermia or low sperm count is, what causes it and what the treatment options are.

Many people think fertility is a woman’s issue but male infertility is more common than you might think. Oligospermia is one such male fertility issue characterised by a low sperm count. In other words, the fluid (semen) you ejaculate during an orgasm contains low sperm count than normal.

As per the World Health Organisation (WHO), your sperm count is considered lower than normal if you have fewer than 15 million sperm per millilitre (mL) of semen. Anything below that threshold is called oligospermia, which can be classified as:

• Mild oligospermia (10-15 million sperm/mL)

• Moderate oligospermia (5-10 million sperm/mL)

• Severe oligospermia (0- 5 million sperm/mL)

A complete absence of sperm is called azoospermia. Low sperm count is diagnosed via semen analysis. If you’re having trouble conceiving, it’s likely your doctor will do a semen analysis to check for a few potential problems with your sperm. This analysis examines the sperm count and quality, motility, abnormal and normal morphology forms.

How Does Low Sperm Count Affect Fertility?

Having a lower sperm count doesn’t completely rule out the possibility of naturally conceiving, but it does decrease your chances of conception. The less sperm you have, the lower your chances of getting your partner pregnant. Fertilisation may be more difficult, it may take more attempts to conceive than couples without a fertility issue.

Causes of Oligospermia

It’s natural for sperm count to fluctuate, especially as you age. But there are several conditions and lifestyle factors that can increase risk for oligospermia.

Varicocele: A condition where enlargement of veins within the loose bag of skin that holds testicles (scrotum) can create oxidative stress, disrupt proper blood flow to the testes, which can lead to lower testosterone production

Infection: Sexually transmitted infections can reduce the sperm amount in semen.

Medication: Medication like antibiotics and blood pressure may cause ejaculation problems and reduce sperm count.

Retrograde Ejaculation: A condition when semen enters the bladder instead of leaving from the tip of the penis.

Hormonal Imbalance: The brain and the testicles produce several hormones that are responsible for sperm production. An imbalance in any of these hormones may lower sperm count numbers.

Weight: Being overweight or obese increases your risk of low sperm counts in several ways. Excess weight can directly reduce how much sperm your body can make.

Alcohol and Drugs: The use of some substances including marijuana and cocaine may reduce sperm count. Excessive drinking can do the same. Men who smoke cigarettes may have lower sperm count than men who do not smoke.

Treatment of Oligospermia

Treatment for oligospermia varies depending on your case. The treatment options include:

Surgery: If varicocele is the cause of your oligospermia, you may need surgery to close off enlarged veins to redirect blood flow to the testes.

Hormone treatment: If a hormone imbalance is detected, you may require hormone treatment to restore a healthy balance and improve sperm production.

Medication: If you have a bacterial or viral infection, you may need a round of medication (like antibiotics) to clear the infection and inflammation. The medication may help improve sperm count and can prevent further drop in sperm count.

Lifestyle change: In most cases, you may be able to increase sperm count by making healthy lifestyle changes, which includes:

Limit scrotum exposure to warm objects

Quit Smoking

Limit alcohol intake

Reduce stress

Exercise regularly

Eat healthy

Increase intake of vitamins and calcium

Getting Pregnant with Oligospermia

If you’re still unable to get pregnant, you and your partner can work with a fertility specialist to explore your options.

Intrauterine insemination (IUI): This is a fertility treatment where sperm is washed (processed) and placed directly into a patient’s uterus. IUI is an effective, simple and low-cost treatment. Because IUI is one of the least invasive and least expensive assisted reproductive techniques, it’s a good first-line treatment option before attempting more invasive or costly methods.

In vitro fertilisation (IVF): This technique involves removing oocytes from the ovary and combining them with sperm to facilitate fertilisation outside the body. Once fertilised, the embryo is transferred into the uterine cavity. IVF success rates can vary depending on the age of the female partner.

Intracytoplasmic sperm injection (ICSI): This is a treatment where a single live sperm is injected directly into an egg. For people who experience low sperm count, ICSI can also be a promising assisted reproductive technique.

Remember, it’s possible to conceive with oligospermia. Many men with oligospermia are able to fertilise their partner’s egg, despite lower sperm numbers. The first step in a plan of action involves getting a semen analysis. From there, you can choose treatment methods or explore ways that might help improve chances of conception.

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