Among the various problems faced by couples in the 21st century, male infertility is at the top of the list. And Oligospermia (also known as oligozoospermia or low sperm count) is one prominent cause for male infertility.
Infertility can be either male, or female and sometimes both. Though female infertility is a widely discussed issue, male infertility is less discussed. There are some cultures that believe male to be completely fertile, like all the time. But this is not the case. Considerable changes in the lifestyle, behavioral patterns, as well as numerous other reasons in the recent past, have put the male fertility in the decline.
When doing a fertility check for men (Semen Analysis), there are three fundamental points taken into consideration.
They are;
- The count of sperms in the sample
- The morphology
- The mobility
As you see, the count of sperms found in a semen sample is an important factor. If the number goes down than the specified limit, it is considered as a severe case of infertility.
In medical terms this condition is known as Oligospermia.
What is Oligospermia?
Low sperm count also known as Oligospermia and Oligozoospermia is a very common cause of infertility among males. This means that the semen that a person ejaculates contain a fewer number of sperms than normal. This should not be confused with azoospermia where the condition refers to having no sperms.
It is caused through various reasons. The identification of Oligospermia can be challenging because it does not affect any other aspects of male sexual health. With this situation, men will have a delay in getting their partner fertilized.
It is normal for a male to have different sperm counts in their ejaculate through various phases in life. A person with this condition is most likely to be left undiagnosed because pregnancy could occur with time. However, for a person in their youth a healthy amount is required.
According to the World Health Organization (WHO) for a healthy person the count should be at or above 15 million sperm per millilitre.
Three stages of Oligospermia are stated below:
- Mild Oligospermia– 10 to 15 million sperms per millilitre
- Moderate condition – 5 to 10 million sperms per millilitre
- Severe condition – 0 to 5 million sperms per millilitre
The sperm count in the Seminal Fluid Analysis can identify:
- Normozoospermia: Healthy count of sperms
- Oligospermia (Mild, Moderate and severe)
- Cryptozoospermia: Few sperm cells are identified only after centrifuging.
- Azoospermia: No sperms at all.
The risk of having this condition undiagnosed is that a lower count could affect the morphology and mobility of the sperms as well.
The link between fertility and Oligospermia
People with oligospermia are still able to conceive. But the problem is that fertilization could be harder and would take longer than expected.
In other cases, some would find it extremely normal. They will not find any difficulties in conceiving despite having a low number of sperms. However, these conditions could affect the quality of the sperms produced. Hence taking medical and other required remedies to increase the number of sperms is necessary.
Though the sperm count is important it is not the only requirement. The other factors related to the conceiving and giving birth to a healthy child are too hidden in the fertility of sperms (and eggs).
What mainly causes Low sperm counts?
Out of all the modifiable reasons that cause these conditions, the main is the carelessness. Many males are unaware of their fertile nature and are tempted to use harmful drugs. This could be mentioned as the most prominent modifiable reason for the young males to be infertile in this era.
However, all of them can be categorized into three areas as medical, environmental and lifestyle and health related.
What are the medical causes of Low sperm count?
There are more than a handful of medical causes that results in infertility or infertility related conditions. These could be caused by sexually transmitted diseases (STD), problems related to the genes as well as due to various other treatments which causes these conditions as a side effect.
A list of the most common medical causes is given below.
- Varicocele:
Considering the causes of male infertility, Varicocele happens to be mostly spoken. It is the swelling of the veins in the testes causing a hindrance to the blood flow. This hindrance to blood flow will cause the blood to pool up in the testes. This will increase the temperature above the ideal temperature levels for sperm production.
- Infections in the male reproductive system:
Some infections, especially in the male reproductive system could result in various infertility problems. They can interfere with the production of semen and may also block the path of the semen. Sexually transmitted diseases have the highest possibility of resulting in such conditions.
- Problems related to ejaculation (retrograde ejaculation):
There are disorders where an orgasm results in the semen being released to the bladder rather than out from the penis. This condition is known as retrograde ejaculation and is caused by various health disorders. Treatments related to diabetes, blood pressure and other diseased could result in ejaculation problems. Some of these disorders are permanent while some are treatable. Whatever the case is, there are technological developments in which, the seeds are directly retrieved from the testicles.
- Immune system:
Some people suffer from an immune system disorders where their immune system produces antibodies that attack sperms. The system identifies them as harmful antibodies within the person and hence takes action to destroy all the sperms created.
- Tumours:
Cancer cells will invade the healthy tissues of the body and replace them with non-functioning malignant cells. These tumours could be in the glands like pituitary glands, or in the testes. Threfore tumors can affect the sperm production directly in the testes or indirectly by affecting hormone production in the testes (testosterone) or in the Pituitary glands (FSH, LH).
- Medicinal effects:
Certain medications can bring about infertility disorders as side effects. Testicular medications, cancer treatments, testosterone replacement therapies, are among the top few in the list. There are others like antifungal medications and antibiotics too.
- Defects in the chromosomes:
There are instances where these occur as a result of an inherited disorder. They occur due to the various abnormalities in the chromosomes of the male. Some of these inherited disorders are Klinefelter’s syndrome, Kalman’s syndrome and Kartagener’s syndrome.
- Effects of prior surgeries:
In surgeries like vasectomy and hernia repair, damages could occur to sperm transportation system. Testicular surgeries or large abdominal surgeries may also result in poor sperm production.
What are the environmental causes that could result in Oligozoospermia?
There are certain environmental conditions that result both directly or indirectly in the production of the sperms. Overexposure to adverse environments could result in either permanent or temporary defects in the quality of the sperms produced.
A few of the common environmental reasons are given below:
- Exposure to harmful chemicals:
There are chemicals used in various industries that directly affects in infertility. Chemicals like benzene, toluene, herbicides and pesticides, organic solvents, paint pigments as well as chemicals associated with lead can directly result in these conditions.
- Exposure to radiations:
Direct exposure to radiations such as X-ray and infrared radiations could result in infertility or related conditions. It is instructed to not to be exposed to these radiations for a long amount of time. And also, the use of safety wears is always stressed upon.
- Exposure to heavy metals:
Lead and other heavy metals can cause direct infertility. These are commonly used in the industries but many doctors advise to reduce the use of them.
There is a possibility of getting the side effects if you were to use lead-based paints as well. Though these are not prominent the effect of the heavy metals towards the reproductive system is very adverse.
- Exposure to higher temperatures:
Many industries have machinery-based functions in overheated environments. Exposure to these conditions to a considerable amount of time affects the production of sperms as well as the quality of the semen produced.
Even sitting for a considerably long time, using laptops and wearing tight clothes that increases the temperature testicles could have the same effect.
What are the lifestyle choices that adversely affect one’s fertility?
The main reason for infertility among the youth is the lifestyle choices. The use of various alcohols and drugs are extremely unhealthy and are advised to reduce by doctors.
A few of the most common of the wrong choices that people make in their day to day lives are given below:
- Extended use of drugs:
Drugs like cocaine and marijuana have effects in the produced sperms in terms of both quality and quantity. Other drugs that are taken to muscle growth (anabolic steroids) could cause the testicles to shrink.
- Use of alcohol:
Use of alcohol is also a common cause towards infertility. Alcohol is able to affect the level of testosterone produced hence affecting the semen production.
- Occupation:
Certain occupations are directly linked with infertility. Working in adverse environments (mentioned above) for a longer time could result in infertility.
- Smoking:
It is a medically proven fact that men who smoke are liable to infertility more than those who do not smoke. They have disorders related to both the quality of the sperms produced and the number.
- Mental conditions such as stress and depression:
Stress directly affects the hormonal production in the body. This is not just limited to hormones related to reproduction but the entire body. Prolonged stress is a cause of vital health conditions.
Depression too has the same effect on human body. It is very important that the mental health is kept at a considerably positive level.
Overthinking too can have the same effect on human body. Overthinking on the fertility conditions could result in infertility.
- Weight (overweight and underweight)
Weight conditions such as obesity and underweight directly impair the quality and the quantity of the sperms produced. They cause hormonal changes which, in turn, have adverse effects in the reproductive system.
- Issues the sperm testing (semen analysis):
Though this is very rare, this is also a possibility. There might be issues with the sperm testing as well as in the process of collecting the sample by the patient. To reduce the odds of such faults from occurring commonly two samples are collected with a selected time gap. The mental status and the sexual activeness of the patient too have influence on Semen analysis. Hence it is important that at least two samples are tested before coming to any final conclusions.
Symptoms related to Low Sperm count
The main problem with infertility, particularly with this condition is that there are no direct symptoms. The main and the most important symptom would be the inability to conceive a child.
Anyways the following symptoms could occur, but also, they vary from man to man.
- Complexities related to sexual functioning. Difficulties in maintaining an erection for a considerable amount of time.
- Difficulties to ejaculate could occur but are not that common with this condition.
- A pain in the testicle areas, especially during orgasm. Abnormal conditions in the testicle areas such as swelling or a lump.
- Decreased amount of body hair, special facial hair.
If a person is unable to conceive a child after a six months (before the one year waiting period according WHO definition) or so with regular unprotected intercourse and have the following, it is important that they visit a doctor.
- Having a family history of infertility problems.
- Have had a surgery related to groin, testicles or penis.
- Have had an accident related to the testicle areas.
How to treat Oligospermia?
As mentioned above, most causes of male infertility are treatable. The treatment depends on the cause of the low count.
When oligospermia is caused due to infections they are treated with antibiotics.
If a hormonal imbalance or chromosomal problem is identified the treatment is done using medications and hormone replacement.
IVI, IVF and ICSI are considered when the cause to oligozoospermia is not treatable through above methods.
And if the count is zero or almost zero, testicular sperm aspiration procedures are recommended by doctors. In this method the semen is obtained (suctioning and extracting) from the testicles artificially and then is used to conjunct through an IVF treatment.
A few tips to naturally avoid these disorders are given below:
- Avoiding alcohol, drugs, and smoking.
- Maintaining a healthy body weight.
- Taking a balance diet and vitamins as required.
- Maintaining a perfect mental health with reduced stress and depression.
Sources:https://www.who.int/reproductivehealth/publications/infertility/9789241547789/en/
