Oligospermia | The Turek Clinic

Oligospermia – Low Sperm Count

What is Oligospermia?

oligospermia

Oligospermia is a male fertility issue that is defined as low sperm concentration in the ejaculate. Low sperm concentration means there are fewer sperm than normal in the semen that is ejaculated during an orgasm. The World Health Organization originally defined low sperm count as fewer than 15 million sperm per milliliter of semen.

 

 

Low sperm count is often a natural biomarker of future health in men.”

— Dr. Paul Turek


Levels of Low Sperm Count

In the latest statement of semen quality (2010), the WHO now considers a sperm count of 15 million sperm/mL to be low for fertile men. The table below shows how low sperm counts are described:

Table 1. Levels of Low Sperm Count

Definition Sperm Concentration in Ejaculate
Mild Oligospermia 10 million to 20 million sperm/mL
Moderate Oligospermia 5 million to 10 million sperm/mL
Severe Oligospermia 0 to 5 million sperm/mL
Cryptoozospermia 0-rare sperm
Azoospermia 0 sperm

 

What is the Meaning of a Low Sperm Count?

Fertility and Infertility

Having a low sperm suggests that it may be difficult to conceive naturally. It does not necessarily mean that it will be harder to conceive. Remember, it takes two to conceive and the health of the female partner matters significantly for conception. In addition, no exact correlation exists between the severity of oligospermia (Table 1) and conception rates. In summary, the most important points about the sperm count and fertility are:

  • Reference ranges for sperm counts are defined in fertile (not infertile) men.
  • Except when no sperm are found, the sperm count is not a good measure of fertility.
  • Many men conceive without trouble having low sperm counts.

Overall Health

What is clear and has been confirmed by Dr. Turek’s research, is that a low sperm count can be an indicator of a general medical problem or a genetic condition. In 2% of men, low sperm counts may be due to hormonal imbalance from prolactinoma. In addition, one of the most common causes of low sperm counts is a varicocele, a surgically treatable condition. Increasingly, genetic abnormalities are being found in men with severe oligospermia. Missing regions on the Y chromosome (microdeletions) occur in 6% of men with low sperm counts and 15% of men with no sperm counts. In addition, 2% of men with low counts and 15-20% of men with no sperm counts will harbor chromosomal abnormalities detected by cytogenetic analysis (karyotype). These include conditions such as Klinefelter syndrome (47, XXY) and exchanges of genetic material in non-sex chromosomes and are detected by blood tests. It is also important to remember that sperm counts are a relatively sensitive measure of overall health. The consistent use of hot tubs or baths, alcohol, tobacco, cocaine, marijuana, or a fever from the flu or other infections can all lower the sperm count in otherwise healthy men. Additionally, chronic stress from sleep disorders, traveling, work, or emotional issues can also lower sperm count. Generally, their effects are reversible upon recovery. This explains why Dr. Turek’s male infertility practice is so sensitive to the flu season and requires him to postpone reassessment of semen quality in men with the flu for 2 months after the illness. Notably, pills such as Viagra, Levitra and Cialis do not cause low sperm counts. Table 2 is a list of conditions known to be associated with low sperm counts:

Table 2. Medical Conditions Known to be Associated with Oligospermia

Obesity Syndromes: Noonan, myotonic dystrophy, gonadal dysgenesis, Youngs, Prune belly, 5-alpha-reductase deficiency
Heart disease Wet heat exposure, smoking; recreational drugs
Diabetes Medications: antiandrogens; sulfa agents, Ca+ channel blockers; alpha blockers
Varicocele Autosomal dom. polycystic kidney (ADPK)
Undescended testicle Sexually transmitted diseases
Anabolic steroid use Benign prostatic hypertropy
Myelodysplasia Occupational exposures, heat, benzene, creosote
Multiple sclerosis Sickle cell anemia/B thalassemia
Organ failure: liver, renal failure; thyroid Industrial toxins: Dioxin, PCBs, bisphenol A
Hemachromatosis Lower general health status
Chronic opiate use Congenital absence of the vas deferens
Metabolic syndrome (ED) Hypogonadotropic hypogonadism
Congenital adrenal hyperplasia Surgical procedures: TURP, vasectomy, orchiectomy, hernia repair
Y chromosome deletions Androgen receptor defects
Karyotype anomalies Infections – epididymitis
Testis cancer and cancer treatment Spinal cord injury
Kartagener syndrome Prolactinoma
Mumps orchitis

 

Low Sperm Count and Risk of Cancer

Finally, as Dr. Turek’s research has shown, low sperm counts can also mean that a patient is at higher risk of developing both testicular cancer (2.8x higher) and prostate cancer (2.6x higher) later in life. In this sense, then, a low sperm count can be a natural biomarker of future health in men. For these reasons, all infertile men with a low sperm count should be evaluated with a thorough history and physical examination by a specialist. This assessment should also include a measure of the pituitary gonadal hormones testosterone, FSH and prolactin. After this, it is not uncommon to prescribe lifestyle changes, offer medical therapy or recommend surgical treatments (i.e. varicocele repair) to correct and improve sperm counts and augment natural fertility. If correctable conditions are not found or genetic infertility is established, then reproductive technologies such as intrauterine insemination (IUI) or IVF (in vitro fertilization) may be used to conceive. However, these technologies are generally more expensive than treatments that seek to correct male factor issues. Getting help from Dr. Turek at The Turek Clinic is easy. Take the first step and schedule a consult with the oligospermia expert Dr. Turek today.

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