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.
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.
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.