Oligospermia – Low sperm count

DR MAXWELL ADEYEMI

A common cause of infertility is the male factor known as oligospermia otherwise referred to as low sperm count.

This medical condition occurs when the fluid released or ejaculated during sex, called semen, contain fewer than normal sperm cells.

Sperm count is considered lower than normal if you have fewer than 15 million sperms per milliliter of semen. A normal sperm counts in a normal semen discharge or ejaculum may contain between 50-200 million sperms.

Having a low sperm count has the potential to reduce the chance of a man impregnating his spouse. However, men who have a low sperm count may still be able to father a child in some instances.

Symptoms

Usually the red flag for this condition is the inability to father a child or the man’s inability to impregnate his spouse. In some men, the underlying cause of the problem may cause some signs and symptoms. Such underlying problems can include chromosomal abnormalities, hormonal imbalance or conditions that obstructs sperm flow.

Patients can then have issues with sexual function such as reduced libido or erectile dysfunction, pain around the testicles or abnormal hair distribution as may occur in chromosomal or hormonal abnormalities.

Causes

The process of sperm production is a complex action involving the hypothalamus and the pituitary gland in the brain and also the testes. Once produced, sperms are transported by delicate tubes until they mix with semen and are ejaculated out of the penis into the vagina during sexual activity.

There are many causes of low sperm count

Varicocele – a swelling of the veins that drains the testicles. The mechanism by which this occur may be related to abnormal testicular temperature regulation, and it often results in reduced quality of sperm.

Infection – Certain infections interfere with sperm production or cause scarring of the sperm passage and this can block sperm flow. Infections such as infection of the epididymis [epididymitis], infection of the testes [orchitis] and sexually transmitted infections like chlamydia and gonorrhea can affect sperm production.

Ejaculation disorder – Sometimes instead of ejaculating into the vagina during sex, the sperm can flow backwards into the urinary bladder. This is called retrograde ejaculation. This can be caused by diabetes, spinal injuries or as a post-operative complication of surgeries involving the bladder, prostate or the urethra. It may also be caused by some medications known as alpha blockers used in the treatment of hypertension.

Sperm antibodies – Some immune system cells can mistake sperm cells as harmful agents invading the body and attack these sperm cells. These anti-sperm antibodies can cause significant damage to sperm and cause low sperm count.

Tumors – Cancers affecting the male reproductive organs, especially those glands that release hormones related to reproduction, as well as surgery, radiation or chemotherapy that is used to treat these cancers, can have adverse effects on male fertility and sperm count.

Undescended testes – Failure of the testicles to descend into the scrotal sac from the abdomen, as may occur in some cases, can result in damage to the testicles and cause poor sperm production and consequent infertility.

Hormone imbalance – The production of sperm involves the impact of hormones from the hypothalamus, pituitary and testes, therefore any alteration in the levels of these hormones may impair sperm production.

Tubal blockage – Sperm is transported via tubes to the urethra, obstruction to the free flow of sperm at any level as a result of surgery, traumatic injuries, infections or abnormal development such as seen in cystic fibrosis or any inherited condition can cause poor sperm delivery and low sperm count.

Chromosomal defect – Chromosomal abnormalities that are inherited can cause low sperm count:

Klinefelter’s syndrome in which a male is born with two X chromosomes and one Y chromosome [XXY] instead of one X and one Y[XY] can cause abnormal development in the male reproductive organ and manifestation of feminine characteristics in males.

Medications – certain medications such as testosterone replacement therapy, long-term use of anabolic steroids or performance-enhancing drugs by athletes, cancer medications, antifungal agents, antibiotics and ulcer medications.

Surgery – Surgical procedures such as vasectomy, inguinal hernia repair, scrotal or testicular and prostate surgeries can prevent sperm from being present in the ejaculate.

Environmental factors ­– These may play a significant role in reducing sperm count. Some of these factors include:

– Industrial chemicals such as benzene, toluene, herbicides, pesticides, organic solvents, painting materials.

– Radiation or X-rays: High doses of radiation can cause serious reduction in sperm production.

– Increased testicular heat: Elevated scrotal temperature can impair sperm production. This can happen in frequent use of hot tubs, sauna, sitting for long periods, wearing tight clothing and under garments, working on laptop computers for long hours which may increase the temperature in the scrotum and potentially reduce sperm production.

Lifestyle – Unhealthy habits and other causes of low sperm count may include:

Drug use: Anabolic steroid use shrinks the testicles and leads to reduced sperm production. Cocaine and marijuana may reduce the number and quality of sperms.

Alcohol abuse: Alcohol lowers testosterone and can cause reduced sperm production.

Occupational hazard: Certain occupations, such as truck driving, are associated with prolonged sitting and may increase the risk of oligospermia.

Tobacco smoking is associated with increased risk of low sperm count.

Emotional stress: Prolonged emotional stress including the stress of infertility may interfere with hormone levels needed for sperm production.

Depression causes reduction in sperm concentration.

Obesity can cause hormone changes and lead to reduction in sperm count and fertility.

Investigating oligospermia

The following tests can be done to investigate the cause of this condition in order to determine treatment options:

– Semen analysis, scrotal ultrasound, hormone testing, post-ejaculation urinalysis, genetic testing, testicular biopsy, anti-sperm antibody testing, transrectal ultrasound.

Treatment

Surgery, treatment of infection with relevant antimicrobial agent, hormonal treatment to correct hormonal imbalances, evaluation and discontinuation of certain medication.