Male fertility problems where the sperm count is severely low, less than 5 million per ml, or no sperm known as azoospermia, affects one in 20 men.
- Oligoasthenoteratozoospermia is a condition that includes:
- Oligozoospermia (low number of sperm)
- Asthenozoospermia (poor sperm movement)
- Teratozoospermia (abnormal sperm shape)
The diagnosis is usually made after a semen analysis. The results can come as a shock and frequently aren’t delivered in the best way to men. However, it is important to note that a single test is only a snapshot and only reveals the number of sperm at that point in time. The duration of abstinence and the time from production to analysis can all have an impact. So a repeat test should be arranged to confirm the diagnosis. It takes three months for sperm to be made and therefore it’s worth waiting at least that long before repeating the test.
I was told rather bluntly that I wouldn’t have children. We were devastated. We had just received the worst possible news when trying for a baby and it was delivered abruptly and insensitively with no support or information.
Craig’s Story, HIM Fertility
Checking the diagnosis
The next step should be an assessment by a male fertility specialist. They will take a comprehensive history looking for clues to the potential cause of the problem. This will include asking undescended testicles or hernias as a child, trauma to the groin, previous infections including sexually transmitted infections and mumps.
- Orchitis is when an infection has caused the testicles to swell up. This is painful and when the infection has resolved the testicles may not be a normal size
Smoking, alcohol and caffeine
While smoking, alcohol and caffeine can affect fertility, men with very low or no sperm are more likely to have a more profound reason causing their problem.
Gym Supplements
Anabolic steroids and perhaps more surprisingly, protein supplements have been shown to reduce male fertility. Both interfere with hormone levels, including testosterone, which is essential for normal sperm production. Additionally, the high doses of these supplements can increase the amount of estrogen in the body, which can also reduce sperm count.
Examination
An examination is important to assess for testicular swelling. A common issue is a varicocoele caused by dilated veins in the scrotum. Testicular volume provides some insight into whether the testicles are properly developed and producing sperm normally. Finally, the plumbing needs to work. In some men the vas deferens which sperm flow through to the join with seminal fluid is absent in some men. This can easily be diagnosed with a simple examination.
Tests
If the semen analysis is still low or no sperm after the three-month wait, the man may then need to have a repeat sperm test and a hormone profile, with the test being done in the morning. A karyotype test may also be done to check that the man has a normal number of chromosomes. Some men may have an extra X chromosome in a condition called Kleinfelter’s Syndrome. Y Microdeletion and CF mutation tests may also be done. For most men no cause can be found.
Treatments
There are a number of treatments available for low or no sperm counts. If sperm are present then a type of IVF treatment called intracytoplasmic Sperm Injection (ICSI) can be attempted. Surgical sperm retrieval may be an option.
Donor sperm may not be how you imagined your route to fatherhood and it may take some time and discussion before deciding to go down, or close the door on this route. Some couples decide not to have children, or to think about fostering or adoption.
When it comes to low or no sperm, it is important to be aware that there are options available and to speak to your partner, a fertility specialist and counsellor to decide what is right for you.
Support
Infertility is not just a female issue – men account for around half of all infertility problems – and with male infertility rates reportedly on the rise, it’s time to face the issue head on. Often men don’t like to talk about fertility issues but are known to find this diagnosis distressing.
HIM Fertility is a campaign set up to provide more support for men with fertility problems and provide plenty of useful resources and support.
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Authors
Matt is an NHS Consultant in Newcastle with over ten years of experience. His PhD research into subfertility and miscarriage involved developing a clinical trial and patient engagement.
