Introduction

Have you ever wondered why many couples are unable to conceive children despite having a normal sexual routine? There are many factors involved in successfully conceiving a baby. Sperm count is one of the crucial deciding factors for a couple to become pregnant.

Sperms, also known as male eggs are microscopic cells synthesized in a male reproductive organ known as testicles. These sperms are ejaculated into a female during sex and penetrate an ovum to form a zygote, which is eventually developed into an embryo. Each sperm carries a unique genetic code in the form of DNA that gives the embryo its genetic traits unique to individual couples. 

Definition of oligospermia

The average sperm count ranges from 15 million to 200 million or more per ml of semen in a single ejaculation. According to WHO, if a person’s sperm count is lower than 15 million per millilitre of semen, it can be classified as oligospermia.  

Importance of sperm count in male fertility

Infertility in itself is a taboo subject, primarily among the male population. Men usually tend to avoid the subject of infertility. To understand the importance of sperm count, we first need to understand the fertilisation process.

 In a male with a normal sperm count, millions of sperm are ejaculated at once during sex into a female reproductive organ. These millions of sperm now need to travel quite a long journey until they reach an ovum in the fallopian tube. During this journey, 99% of the sperm dies or gets lost, and only 1% reaches the ovum site. It has been observed that out of 300 million sperm ejaculated during sex, only about 200 are viable by the time it reaches the ovum. Out of these 200, only one can penetrate the outer protective membrane of the female egg and fertilise it to form an embryo.¹

In a male with a low sperm count, the chance of sperm reaching the ovum drastically decreases, which may contribute to having problems conceiving. Having a meagre sperm count can also lead to reduced sexual desire and create relationship issues between couples. It also contributes to unstable emotional and psychological status in the individuals. 

Causes of oligospermia

Medical factors

Hormonal imbalances:

Hormones play a crucial role in sperm production. Imbalances in hormones, such as testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), can adversely affect sperm count.² 

Varicocele:

Varicocele, the enlargement of veins within the scrotum, can lead to overheating of the testicles, impacting sperm production and quality.²

Infections:

Certain infections, such as sexually transmitted infections (STIs), can affect the reproductive system, leading to inflammation and damage to sperm-producing structures.

In addition to these, some medical conditions such as thyroid disorders, adrenal dysfunction, and genetic disorders - Klinefelter syndrome also have been known to contribute to oligospermia.²

Lifestyle factors

Smoking and alcohol

Tobacco smoking and excessive alcohol consumption have been linked to decreased male testosterone, ultimately lowering sperm count. These lifestyle choices can introduce harmful substances that compromise male fertility.³ 

Drug use:

Illicit drug use, including recreational substances, can have detrimental effects on sperm production and overall reproductive health. One out of every four men with substance use history has been observed to develop oligospermia.⁴ Certain medications are also known to have an impact on sperm count. The chart below shows the medications and their mechanism through which they contribute to oligospermia:² 

Obesity and poor diet:

Obesity and a diet lacking essential nutrients can contribute to hormonal imbalances and oxidative stress, negatively impacting sperm quality.

Diagnosis of oligospermia

Semen analysis

Normal sperm count parameters:

Understanding the parameters of a healthy sperm count is crucial for diagnosis. Normal counts typically range from 15 million to 200 million sperm per millilitre. 

Oligospermia thresholds:

Oligospermia is diagnosed when sperm counts fall below 15 million sperm per millilitre, emphasizing the significance of accurate semen analysis.

The WHO criteria for normal range in semen analysis is shown below:⁵

• Minimum Volume: Greater than 1.5 millilitres
• Normal pH: 7.2 -7.8
• Minimum sperm count: 39 million sperm per ejaculate or more
• Minimum sperm progressive motility, or the capacity to swim rapidly: >32% 
• Sperm with normal morphology(shape and size): > 4%

Medical history and physical examination

A comprehensive medical history and a physical examination aid in identifying potential causes and guiding further diagnostic efforts. The key components in the history taking and physical examination are shown in the steps below:²

History:

• Pubertal timing
• Cryptorchidism/testicular surgery
• Sexual function and frequency
• Sexually transmitted infections
• Infections of the prostate or testicle
• Current and former medications
• Use of alcohol, tobacco, illicit drugs
• Systemic disease
• Environmental exposures, including radiation, pesticides, and occupational hazards
• Cancer diagnosis and treatment

Physical examination:

• Presence of sexual hair
• Bitemporal hemianopsia as a result of (pituitary mass)
• Reduced testicular volume (<15 cc)
• Testicular mass
• Presence of vas deferens bilaterally
• Presence of varicocele or other scrotal mass
• Presence of cryptorchidism or hypospadias
• Synovitis of second and third metacarpal-phalangeal joints, “bronzed” appearance or stigmata of liver disease or heart failure
• The presence of marked muscle hypertrophy suggests anabolic steroid use

Additional diagnostic tests

Hormone testing:

Assessing hormone levels, including testosterone and FSH, helps identify hormonal imbalances contributing to oligospermia.

Genetic testing:

Genetic tests can uncover inherited conditions impacting sperm production, providing valuable insights for diagnosis and family planning.

Treatment options

Lifestyle modifications

Diet and exercise:

A healthy lifestyle, including a balanced diet and regular exercise, can positively influence sperm count and overall reproductive health.

Avoidance of environmental toxins:

Minimizing exposure to environmental toxins, such as pesticides and certain chemicals, helps mitigate factors contributing to oligospermia.

Medical interventions

Hormone therapy:

Hormone therapy aims to restore hormonal balance, addressing underlying issues affecting sperm production.

Surgical correction (e.g., varicocelectomy):

Surgical interventions, like varicocelectomy, can rectify physical abnormalities contributing to oligospermia. Surgical corrections can also be useful for patients with retrograde ejaculation. However, in cases of retrograde ejaculations, surgical interventions are used as a last resort as inserting needles can cause severe damage to the testes. Instead, more favourable procedures such as IVF and artificial insemination are preferred. 

Assisted reproductive technologies:

ART procedures, such as in-vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), provide alternatives for conception when infertility cannot be treated by medical interventions and natural fertility is compromised. In most cases, couples prefer IVF with ICSI as it has more success rates than other methods.⁶

Prevention strategies

Maintaining a healthy lifestyle

Cultivating a healthy lifestyle, encompassing balanced nutrition, regular exercise, and adequate hydration, contributes to optimal reproductive health.

Regular health check-ups

Regular health check-ups enable early detection and management of factors contributing to oligospermia, promoting proactive reproductive health.

Awareness and education

Increasing awareness about factors influencing male fertility and educating individuals on preventive measures fosters informed decision-making and proactive health management.

Emotional and psychological impact

Coping with the diagnosis

Acknowledging and understanding the emotional impact of an oligospermia diagnosis is crucial, prompting the need for coping mechanisms and support.

Support systems

Establishing a robust support system, including partners, friends, and healthcare professionals, is essential for navigating the emotional challenges associated with oligospermia.

Counselling and mental health considerations

Seeking professional counselling and addressing mental health considerations is integral to holistic care for individuals and couples facing the emotional toll of oligospermia.

FAQs

Can you get pregnant with oligospermia?

The answer is YES. You can get pregnant even with oligospermia. Remember, it only takes one sperm for conception. However, the chances of becoming pregnant with reduced sperm count are very low. It also depends on the factors causing oligospermia. If the causes are physical or hormonal, the person’s sperm count may return to normal once the underlying cause has been managed. The best course of action would be to consult with an authorised reproductive health professional to determine the viability of the sperm and any intervention required.

What is the best treatment for oligospermia?

There is no fixed treatment for oligospermia. The treatment modalities depend upon what caused low sperm count in the first place. If the condition is caused by anatomical, hormonal, or any other underlying disease or condition, treating those preexisting conditions with surgical interventions, hormone supplementations, and medications, respectively, has been shown to improve the sperm count in people. However, if the condition is genetic or cannot be treated by traditional methods, more recent interventions such as IVF and ICSI are recommended. In any case, the question of the best treatment for oligospermia should be decided by a licensed reproductive health care professional. 

Are oligospermia and asthenospermia the same?

Oligospermia is a condition in which the testicles produce less than a normal amount of sperm. According to the World Health Organization (WHO), In people with oligospermia, the sperm concentration is less than 15 million sperm per millilitre of semen.

Asthenospermia, on the other hand, is a reduction in less than 40% motility, also known as the swimming capacity of sperm. Asthenospermia is often diagnosed by evaluating the percentage of sperms that can move forward to reach the ovum(progressive motility less than 32%). This is important because reduced motility decreases the chance of viable and healthy sperm reaching the fallopian tube and fertilising an ovum.⁷

In most cases of infertility, there is a good chance that the person in question has both oligospermia as well as asthenospermia.

How do we determine the total sperm count for oligospermia?

Oligospermia is regarded as a sperm count lower than 15 million in every millilitre of semen. The average male produces around 20 million to 200 million sperm per ejaculation. Generally speaking, sperm count can calculated by taking the total concentration of sperm per one ml of semen and multiplying that with the total ejaculated volume of semen. However, viable sperm count is a different story. Factors such as sperm concentration, sperm morphology, total ejaculation volume, and sperm progressive motility should all be taken into account to determine the viable sperm count. 

Conclusion

Oligospermia, as defined by the World Health Organization (WHO) is a sperm count lower than 15 million per milliliter of semen. In simpler terms, it means there are fewer sperm cells than normal, potentially impacting fertility. It should be noted that fertility is also influenced by other factors, such as sperm motility (movement) and morphology (shape).

The primary concern with oligospermia is its impact on a couple's ability to conceive. A lower sperm count reduces the chances of fertilization, making it essential for individuals facing this condition to seek medical guidance.

The causes of oligospermia range from lifestyle factors to preexisting medical conditions. Excessive alcohol consumption, smoking, obesity, hormonal imbalances, infections, and genetic abnormalities are among the top contributors to oligospermia. It is crucial to Identify the specific cause and develop a specific treatment plan for the effective management of oligospermia. 

Fortunately, most cases of oligospermia can be managed by simply adopting a healthy lifestyle. A healthy diet, regular exercise, and avoiding harmful habits have been observed to positively influence sperm count. If a medical condition is the root cause, targeted treatments are usually recommended by a healthcare professional. It's important for individuals and couples grappling with oligospermia to approach the situation with patience and seek expert guidance.

In conclusion, oligospermia is a condition that can become problematic and can pose challenges to fertility, especially for those aspiring to start a family. It can be dealt with effectively with lifestyle adjustments and medical interventions under the guidance of a healthcare professional.