Receiving a diagnosis of male infertility can be emotionally distressing, but there are tests and treatments you can explore. If you are concerned about your sperm health the best thing to do is to go for tests and even if the result is not favorable, the most important thing to know is that one poor result doesn’t necessarily mean you’re infertile for life.
Your semen analysis can be affected by recent illness, anxiety over the examination, and other various factors. Not abstaining from ejaculation for the three to four days before your test can also alter the results. Therefore, an abnormal test result can actually still turn out to be normal because sperm parameters fluctuate. A semen analysis needs to test abnormal twice to truly be abnormal.
Your doctor is likely to order one or two follow-up tests few weeks afterwards to see if the abnormal results repeat. It’s also important to remember that all the semen analysis results need to be considered together. If the only abnormal finding is a high white blood cell count, but other semen parameters are normal, and there are no other signs of infection, then your results may, in fact, be considered normal.
But if a second follow-up test returns poor results, you should see a reproductive urologist and reproductive endocrinologist. If you have very poor semen quality, you are at an increased risk for testicular disease as well. In most cases, there is more emphasis on treating the sperm than treating the man, so it’s important to look at the whole picture.
Before you experienced infertility, you may have only been familiar with sperm count. You are likely to know that having a low sperm count is a problem. You may not have been aware of the many other ways sperm or semen can be abnormal.
Azoospermia is when there is zero sperm in the ejaculate. It is also referred to as having “no sperm count” and is a severe form of male infertility. The semen may appear completely normal otherwise, so the condition can only be diagnosed through semen analysis. Common causes include congenital anomalies of the male reproductive tract and genetic disorders. If you have untreated sexually transmitted infections, they can cause obstructions that lead to azoospermia. It can also result as a complication of hernia repair by a unskilled surgeon.
When the sperm count is lower than normal, it is known as oligospermia, further characterized as being mild, moderate and severe. Frequently, when the sperm count is low, other issues related to sperm health are also present, such as problems with sperm movement and sperm shape.
Environmental conditions, work-related exposure, and lifestyle choices can cause low sperm count. For example, overheating the testicles, toxic chemical exposure at work, smoking, obesity, or recreational drug and alcohol use can reduce sperm counts. In some cases, lifestyle changes may improve sperm count enough to improve fertility. Oligozoospermia is the most common reason for subfertility in men. Men with mild or moderate oligozoospermia might still be able to father a child naturally. However, the lower the sperm count, the less likely it is that the couple will have pregnancy success without the help of fertility treatments. It can also take longer to conceive.
Even though the World Health Organization (WHO) defines poor sperm motility by the percentage of properly moving sperm, research has found that the total number of motile sperm is a better measure of fertility. For example, less than five million motile sperm would be considered to severe male infertility, 5 to 10 million would be moderately infertile, and over 15 million motile sperm would be considered normal.
Sperm morphology or the shape of the sperm is also significant. Normal sperm have an oval head with a long tail. Abnormal sperm may have an oddly shaped head, more than one head, or more than one tail. Sperm shape is essential to the ability of the sperm to move or swim. Therefore, it’s not uncommon for poor sperm morphology to go along with poor sperm movement. If the sperm are not of normal shape and cannot move well, they might not be able to fertilize an egg.
Poor sperm morphology can have a variety of genetic causes. In rare cases, some specific genetic causes lead to all the sperm being the same abnormal shape. Many causes of poor sperm shape can also lead to poor sperm motility or low sperm count.
The normal and abnormal ranges for semen analysis are based on the percentage of men who had a particular result and went on to father a child within a year. Your semen health might be subpar, but you may still be able to conceive. Likewise, normal results on a basic semen analysis do not necessarily guarantee fertility.
Semen analysis is not a test of fertility rather it’s a tool to investigate the possible causes of infertility. For example, a low sperm count is not a diagnosis itself, but a symptom that can be only discovered through semen analysis.
There are a variety of causes for low sperm count. Sometimes, a cause is never found. If your semen analysis shows that you have a low sperm count, your doctor’s goal will be to find out the cause and determine what can be done to help you and your partner have a baby. Beyond basic semen analysis, your doctor might also want to perform other tests depending on your results.
If poor results persist after additional testing is performed, lifestyle changes, medications, or surgery might help. Your best fertility treatment is IVF. Treatment for male infertility is not always straightforward or quick. Your doctor may recommend one treatment and, if it fails to work, may recommend that you try another. Your partner’s fertility will also be taken into account when devising a treatment plan.
Sperm regenerates every three months., so the value of waiting for the sperm to improve versus doing fertility treatments is often dependent on the woman’s testing and age Before making any treatment decisions, it is important to evaluate the fertility potential of both you and your spouse through testing. Infertility testing and treatment is a team sport.
If you’ll be trying out medication, lifestyle changes, or surgery, it’s important to know that your semen health will take time to improve. While sperm might seem to be produced at the moment of ejaculation, it actually takes weeks for sperm to develop within the male reproductive system. Therefore, your doctor may want you to have a follow-up semen analysis three to four months after a treatment plan is put in place.
The reversible changes to semen quality can be effected over two to three months by quitting smoking, reducing alcohol intake, cutting out high fat/high-calorie foods. Stopping any use of steroids or testosterone will also make an improvement.
Abayomi Ajayi
MD/CEO Nordica Fertility Centre
