What is low sperm count

A low sperm count, also called oligospermia or oligozoospermia, is where a man has fewer than 15 million sperm per milliliter of semen.

Having a low sperm count can make it more difficult to conceive naturally, although successful pregnancies can still occur.

Problems with sperm, including a low sperm count and problems with sperm quality, are quite common. They’re a factor in around one in three couples who are struggling to get pregnant.

There are treatments available on publicly or privately that can help you become a dad if you have a low sperm count.

Figure 1. Male reproductive system

Figure 2. Hypothalamus and anterior pituitary stimulating sperm production

Figure 3. Normal sperm production

Note: The male reproductive system creates sperm that is manufactured in the seminiferous tubules within each testicle. The head of the sperm contains the DNA, which when combined with the egg’s DNA, will create a new individual. The tip of the sperm head is the portion called the acrosome, which enables the sperm to penetrate the egg. The midpiece contains the mitochondria which supplies the energy the tail needs to move. The tail moves with whip-like movements back and forth to propel the sperm towards the egg. The sperm have to reach the uterus and the fallopian tube in order to fertilize a woman’s egg.

Low sperm count complications

Infertility caused by low sperm count can be stressful for both you and your partner. Complications can include:

• Surgery or other treatments for an underlying cause of low sperm count
• Expensive and involved assisted reproductive techniques, such as in vitro fertilization (IVF)
• Stress related to the inability to have a child

How to know if you have low sperm count

Home sperm count testing kits

There are several male fertility home-testing kits available to buy from pharmacies. These tests claim to indicate whether your sperm count is low.

It may be tempting to try one of the tests if you would rather not see your doctor, but you should be aware that:

• although research by the manufacturers suggests these tests can give an accurate indication of sperm count, they haven’t been extensively studied
• some home-testing kits classify a low sperm count as under 20 million sperm per milliliter of semen, but more recent international guidelines state that anything above 15 million sperm per milliliter of semen is normal
• some kits only check the number of sperm, not other things that can affect fertility such as how well the sperm are able to move (motility) – it’s best to use a kit that measures both these things

While these tests might sometimes give a useful indication of your sperm count, they may also give you false reassurance or may suggest your sperm count is low when it’s actually perfectly normal.

It’s better to see your doctor for a proper semen analysis at an accredited laboratory if you’re concerned about your fertility.

Get advice from a health professional first

It’s important to remember that, if you are taking any medicines, they may affect your test results. It’s worth getting advice from a health professional first, as using a self-test kit may not be appropriate for you.

It’s rare for a self-test kit to give a 100% guarantee that you have or don’t have a particular condition. It may not be as helpful as having a consultation with a doctor or other health professional.

Before using a self-test kit, make sure it has a quality assurance mark. This means that, provided you use it correctly, the kit will work properly and is safe.

If you have any concerns, speak to a healthcare professional, such as a pharmacist, practice nurse or doctor.

What can cause low sperm count

The causes of low sperm count are many and complex. In many cases, it’s not obvious what causes a low sperm count.

The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce hormones that trigger sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production.

Also, there can be problems of abnormal sperm shape (morphology), movement (motility) or function.

However, often the cause of low sperm count isn’t identified.

Medical causes

Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:

• Varicocele. A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it might be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm.
• Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation or infection of the prostate gland (prostatitis), epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including chlamydia, gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
• Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde or lack of ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra. Certain medications also might result in ejaculatory problems, such as blood pressure medications known as alpha blockers. Some ejaculatory problems can be reversed, while others are permanent. In most cases of permanent ejaculation problems, sperm can still be retrieved directly from the testicles.
• Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.
• Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. Surgery, radiation or chemotherapy to treat tumors can also affect male fertility.
• Undescended testicles. During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.
• Hormone imbalances. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal gland, may impair sperm production.
• Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions. Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
• Chromosome defects. Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
• Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
• Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications and other medications can impair sperm production and decrease male fertility.
• Prior surgeries. Certain surgeries might prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockages or to retrieve sperm directly from the epididymis and testicles.

Environmental causes

Sperm production or function can be affected by overexposure to certain environmental elements, including:

• Industrial chemicals. Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead might contribute to low sperm counts.
• Heavy metal exposure. Exposure to lead or other heavy metals also can cause infertility.
• Radiation or X-rays. Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.
• Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs might temporarily impair sperm count. Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also might increase the temperature in your scrotum and slightly reduce sperm production.

Health, lifestyle and other causes

Other causes of low sperm count include:

• Drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana might reduce the number and quality of your sperm as well. Certain medications, including testosterone replacement therapy, cancer medications (chemotherapy), some antibiotics and some antidepressants
• Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.
• Occupation. Certain occupations might be linked with a risk of infertility, including welding or those associated with prolonged sitting, such as truck driving. However, the data to support these associations is inconsistent.
• Tobacco smoking. Men who smoke might have a lower sperm count than do those who don’t smoke.
• Emotional stress. Severe or prolonged emotional stress, including stress about fertility, might interfere with hormones needed to produce sperm.
• Weight. Obesity can impair fertility in several ways, including directly impacting sperm and by causing hormone changes that reduce male fertility.
• Sperm testing issues. Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation; was taken too soon after an illness or stressful event; or didn’t contain all of the semen you ejaculated because some was spilled during collection. For this reason, results are generally based on several samples taken over a period of time.

Risk factors for low sperm count

A number of risk factors are linked to low sperm count and other problems that can cause low sperm count. They include:

• Smoking tobacco
• Drinking alcohol
• Using certain illicit drugs
• Being overweight
• Having certain past or present infections
• Being exposed to toxins
• Overheating the testicles
• Having experienced trauma to the testicles
• Being born with a fertility disorder or having a blood relative with a fertility disorder
• Having certain medical conditions, including tumors and chronic illnesses
• Undergoing cancer treatments, such as radiation
• Taking certain medications
• Having a prior vasectomy or major abdominal or pelvic surgery
• Having a history of undescended testicles

Low sperm count prevention

To protect your fertility, avoid known factors that can affect sperm count and quality. For example:

• Don’t smoke.
• Limit or abstain from alcohol.
• Steer clear of illicit drugs.
• Talk to your doctor about medications that can affect sperm count.
• Maintain a healthy weight.
• Avoid heat.
• Manage stress.
• Avoid exposure to pesticides, heavy metals and other toxins.

Signs and symptoms of low sperm count

The main sign of low sperm count is the inability to conceive a child. There might be no other obvious signs or symptoms. In some cases, an underlying problem such as an inherited chromosomal abnormality, a hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms. Low sperm count symptoms might include:

• Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
• Pain, swelling or a lump in the testicle area
• Decreased facial or body hair or other signs of a chromosome or hormone abnormality.

Low sperm count diagnosis

When you see a doctor because you’re having trouble getting your partner pregnant, he or she will try to determine the underlying cause. Even if your doctor thinks low sperm count is the problem, it is recommended that your partner be evaluated to rule out potential contributing factors and determine if assisted reproductive techniques may be required.

Testing and diagnosis may involve the following:

General physical examination and medical history

This includes examination of your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and your sexual development.

Semen analysis

A low sperm count is diagnosed as part of a semen analysis test. Sperm count is generally determined by examining semen under a microscope to see how many sperm appear within squares on a grid pattern. In some cases, a computer might be used to measure sperm count.

To collect a semen sample, your doctor will have you masturbate and ejaculate into a special container. It’s also possible to collect sperm for examination during intercourse, using a special condom. Because sperm counts often fluctuate, typically several semen analysis tests are done over a period of time to ensure accurate results. Most laboratories require semen  samples to be collected on-site as the semen needs to be examined within 60 minutes after ejaculation in order to maintain the quality of the specimen.

Sperm are very temperature-sensitive. If collection is done at home, the sample should be kept at body temperature (98.6^oF/37^oC) by keeping it next to the body during transportation. It should NOT be left at room temperature for an extended period of time and should NOT be refrigerated.

Sperm motility decreases after ejaculation; thus, timing and temperature are critical to obtaining accurate results. If the sample is poor, repeat testing might be needed.

New sperm are produced continually in the testicles and take about 42 to 76 days to mature. So, a current semen analysis reflects your environment over the past three months. Any positive changes you’ve made won’t show up for several months.

One of the most common causes of low sperm count is incomplete or improper collection of a sperm sample. Most doctors will check two or more semen samples over time to ensure consistency between samples. To ensure accuracy in a collection, your doctor will:

• Ask you to make sure all of your semen makes it into the collection cup or collection condom when you ejaculate
• Have you abstain from ejaculating for 2 to 7 days before collecting a sample
• Collect a second sample at least one to two weeks after the first
• Have you avoid the use of lubricants because these products can affect sperm motility.

What are measured in a Semen analysis

A complete semen analysis measures the quantity and quality of the fluid released during ejaculation. It evaluates both the liquid portion, called semen or seminal fluid, and the microscopic, moving cells called sperm. It is often used in the evaluation of male infertility.

Semen is a viscous, whitish liquid that contains sperm and the products from several glands. It is fairly thick at ejaculation but thins out, or liquefies, within 10 to 30 minutes. Sperm are reproductive cells in semen that have a head, midsection, and a tail and contain one copy of each chromosome (all of the male’s genes). Sperm are motile, normally moving forward through the semen. Inside a woman’s body, this property enables them to travel to and fuse with the female’s egg, resulting in fertilization. Each semen sample is between 1.5 and 5.5 milliliters (about one teaspoon) of fluid, containing at least 20 million sperm per milliliter, and varying amounts of fructose (a sugar), buffers, coagulating substances, lubricants, and enzymes that are intended to support the sperm and the fertilization process.

A typical semen analysis measures:

• Volume of semen. The typical volume of semen collected is between 1.5 and 5 milliliters (about a teaspoon) of fluid per ejaculation. Decreased volume of semen would indicate fewer sperm, which diminishes opportunities for successful fertilization and subsequent pregnancy. Excessive seminal fluid may dilute the concentration of sperm.
• Viscosity—consistency or thickness of the semen. The semen should initially be thick and then liquefy within 15 to 20 minutes. If this does not occur, then it may impede sperm movement.
• Sperm count—total number of sperm
• Sperm concentration (also called sperm count or sperm density)—number of sperm per volume of semen. this is measured in millions of sperm per milliliter of semen. Normal is at least 20 million or more sperm per milliliter, with a total ejaculate volume of 80 million or more sperm. Fewer sperm and/or a lower sperm concentration may impair fertility.
• Sperm motility—percent able to move as well as how vigorously and straight the sperm move. The percentage of moving sperm in a sample; it is graded based on speed and direction traveled. At least 50% should be motile one hour after ejaculation, moving forward in a straight line with good speed. The progression of the sperm is rated on a basis from zero (no motion) to 4, with 3-4 representing good motility. If less than half of the sperm are motile, a stain is used to identify the percentage of dead sperm. This is called a sperm viability test.
• Number or percent of normal and abnormal (defective) sperm in terms of size and shape (morphology). The study of the size, shape, and appearance of the sperm cells; the analysis evaluates the structure of the sperm. More than 50% of those cells examined should be normal in size, shape, and length. The more abnormal sperm that are present, the greater the likelihood of infertility. Abnormal forms may include defective heads, midsections, tails, and immature forms.
• Coagulation and liquefaction—how quickly the semen turns from thick consistency to liquid
• Fructose—a sugar in semen that gives energy to sperm. Fructose—concentration should be greater than 150 milligrams per deciliter of semen.
• pH—measures acidity. Semen pH—should be between 7.2 and 7.8. A pH of 8.0 or higher may indicate an infection, while a pH less than 7.0 suggests contamination with urine or an obstruction in the ejaculatory ducts.
• Number of immature sperm.
• Number of white blood cells (cells that indicate infection). White blood cells—there should be fewer than 1 million white blood cells per milliliter.
• Agglutination of sperm—this occurs when sperm stick together in a specific and consistent manner (head to head, tail to tail, etc.), suggesting the presence of antisperm antibodies. Clumping of sperm in a nonspecific manner may be due to bacterial infection or tissue contamination.

Semen analysis results

Normal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semen. You are considered to have a low sperm count if you have fewer than 15 million sperm per milliliter or less than 39 million sperm total per ejaculate.

Your chance of getting your partner pregnant decreases with decreasing sperm counts. Some men have no sperm in their semen at all. This is known as azoospermia.

There are many factors involved in reproduction, and the number of sperm in your semen is only one. Some men with low sperm counts successfully father children. Likewise, some men with normal sperm counts are unable to father children. Even if you have enough sperm, other factors are important to achieve a pregnancy, including normal sperm movement (motility).

Other tests

Depending on initial findings, your doctor might recommend additional tests to look for the cause of your low sperm count and other possible causes of male infertility. These can include:

• Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.
• Hormone testing. Your doctor might recommend a blood test to determine the level of hormones (testosterone, FSH, LH, prolactin) produced by the pituitary gland and testicles, which play a key role in sexual development and sperm production.
• Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
• Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might also be ordered to diagnose various congenital or inherited syndromes such as Klinefelter syndrome, cystic fibrosis, or other chromosomal abnormality.
• Testicular biopsy. This test involves removing samples from the testicle with a needle. The results of the testicular biopsy can tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport. However, this test is typically only used in certain situations and is not commonly used to diagnose the cause of infertility.
• Anti-sperm antibody tests. These tests, which are used to check for immune cells (antibodies) that attack sperm and affect their ability to function, are not common.
• Specialized sperm function tests. A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there’s any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change treatment recommendations.
• Transrectal ultrasound. A small lubricated wand is inserted into your rectum to check your prostate, and for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).

In some instances, additional imaging tests such as CT scan, or MRI may be required. Sometimes a test called cryosurvival is done to see how well semen will survive for long-term storage if a couple would like to store sperm for future pregnancies.

Low sperm count treatment

Treatments for low sperm count include:

• Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
• Treating infections. Antibiotics can cure an infection of the reproductive tract, but this doesn’t always restore fertility.
• Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
• Hormone treatments and medications. Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
• Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used for in vitro fertilization or intracytoplasmic sperm injection.

How to get pregnant with low sperm count

Your doctor may initially suggest trying to conceive naturally for a little longer. Many couples conceive within the second year of trying.

You can help maximize your chances of conceiving by:

• Having sex every two or three days
• Having sex around the time your partner ovulates (when an egg is released from the ovary) will increase your chances of conceiving.
• Moderating your alcohol consumption and stopping smoking
• Staying in good shape, exercising regularly and having a healthy, balanced diet

The best time to get pregnant

Your partner will most likely to get pregnant if you have sex within a day or so of ovulation (releasing an egg from the ovary). This is usually about 14 days after the first day of her last period, if her cycle is around 28 days long.

An egg lives for about 12-24 hours after being released. For pregnancy to happen, the egg must be fertilized by a sperm within this time.

Sperm can live for up to seven days inside a woman’s body. So if you’ve had sex in the days before ovulation, the sperm will have had time to travel up the fallopian tubes to “wait” for the egg to be released.

It’s difficult to know exactly when ovulation happens, unless you are practising natural family planning or fertility awareness.

Natural family planning (Fertility awareness)

The aim of the natural family planning is to prevent pregnancy by avoiding sex, or using barrier methods of contraception, during the woman’s fertile time. However, you and your partner can use the natural family planning method to increase her chance of getting pregnant.

Natural family planning is a method that teaches you and your partner when during the month you can have sex without contraception and with a reduced risk of pregnancy. The method is sometimes called fertility awareness.

It works by plotting the times of the month when your partner fertile and when she’s not. Your partner learn how to record fertility signals, such as her body temperature and cervical secretions (fluids or mucus), to identify when it’s safer to have sex.

Natural family planning is more effective when more than one fertility signal is monitored.

• You and your partner can’t learn natural family planning from a book. It has to be learned from a specialist teacher.

At a glance: facts about natural family planning

• If the instructions are properly followed, natural family planning methods can be up to 99% effective , depending on what methods are used. This means that one woman in 100 who use natural family planning will get pregnant in one year.
• It will be less effective if it’s not used according to the instructions – estimates suggest that it may only be around 75% effective because of mistakes.
• There are no physical side effects, and you can use it to plan when your get pregnant.
• Your partner have to keep a daily record of her fertility signals, such as her temperature and the fluids coming from her cervix – it takes three to six menstrual (monthly) cycles to learn the method.
• Your partner’s fertility signals can be affected by factors such as illness, stress and travel.
• You want to have sex during the time when she might get pregnant.

How natural family planning works

Natural family planning involves using your body’s signs and symptoms to assess if you’re currently fertile and likely to get pregnant if you have sex.

It is important that you are taught natural family planning by a suitably qualified teacher.

The information in this section is designed to serve as an overview – it is not a substitute for proper instruction and training.

There are three different fertility indicators you can use together to increase the effectiveness of natural family planning. These are:

1. the length of your partner’s menstrual cycle
2. daily readings of her body temperature
3. changes to the mucus secretions from her cervix

Her menstrual cycle

Your partner’s menstrual cycle lasts from the first day of her period until the day before your next period starts. The length of a woman’s menstrual cycle can vary. Anything from 24 to 35 days is common, although it could be longer or shorter than this. The average length of the menstrual cycle is 28 days.

Ovulation

During your menstrual cycle:

• hormones are released to stimulate her ovaries
• a tiny egg stored in one of her ovaries begins to grow and mature
• when the egg is mature, it’s released from her ovary (a process called ovulation) and travels down the fallopian tube

Occasionally a second egg is released, within 24 hours of the first egg.

• Ovulation occurs roughly halfway through your menstrual cycle, usually around 10 to 16 days before the start of your next period. Ovulation could happen earlier or later than this, depending on the length of her cycle.

When calculating your partner’s fertile time, you need to take into account the uncertainty over exactly when she ovulate.

For pregnancy to happen, a sperm needs to meet the egg to fertilize it. Sperm can live in a woman’s body for up to seven days after sex.

As the length of a menstrual cycle can vary over time, to make sure her calculations are as precise as possible, she will need to measure her menstrual cycle over the course of 12 months.

Calculating the length of your partner’s cycle is not a reliable way of working out her fertile time and should not be used on its own as a fertility indicator.

The temperature method

The temperature method is based on the fact that there is a small rise in her body temperature after ovulation.

She will need to use either a digital thermometer or a thermometer specifically designed for natural family planning. Ear or forehead thermometers are not accurate enough to be used in this way.

The temperature method involves:

• Taking her temperature every morning before she gets out of bed. This should be done before eating or drinking anything, before smoking and ideally at the same time every morning.
• Look out for three days in a row when her temperature is higher than all of the previous six days. The increase in temperature is very small, usually around 0.2C (0.4F). It is likely that she is no longer fertile at this time.

Cervical secretion monitoring method

There is a change in the amount and texture of the mucus secreted from her cervix during different times in your partner’s menstrual cycle.

She can check this by gently placing her middle finger into her vagina and pushing it up to around her middle knuckle. For the first few days after her period, she will probably find that her vagina is dry and she cannot feel any mucus.

As the levels of hormones rise to prepare your body for ovulation, she will probably find that her cervix is now producing mucus that is:

• moist and sticky
• white and creamy

This is the start of the fertile period of your partner’s menstrual cycle. Immediately before ovulation the mucus will get:

• wetter
• clearer
• slippery, a bit like raw egg white

This is when she’s are at your most fertile.

The mucus should then soon return to being thicker and sticky, and after three days she should no longer be fertile.

Combining fertility awareness methods

It is best to combine all three methods to give you a more accurate picture of when your partner is likely to be most fertile.

She can use fertility charts to record information from all three methods, which she can then track over the course of each menstrual cycle.

Figure 4. Female Fertility Charts

[Source ¹⁾]

Things that affect your partner’s fertility signs

Some factors can disrupt normal fertility signs, for example if she:

• has irregular periods
• has recently stopped taking hormonal contraception
• has recently had a miscarriage or abortion
• has recently given birth and are breastfeeding
• regularly travel through different time zones
• has an infection in her vagina such as thrush or an sexually transmitted infection

Other factors that affect your partner’s body’s natural signs include:

• altering how and when she takes her temperature
• drinking alcohol
• taking certain medication
• illness
• some long-term conditions

Gonadotrophin medication

If you have very low levels of gonadotrophin hormones (which stimulate the production of sperm), you should be offered treatment with gonadotrophin medication to improve your fertility.

But if no cause has been found for your abnormal sperm count, you will not be offered hormone-based medicines as they are not known to improve fertility in these cases.

IVF

In vitro fertilisation (IVF) may be an option if you have a slightly low sperm count and you’ve been trying to conceive naturally with your partner for at least two years.

During IVF, an egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory. The fertilised egg is then returned to the woman’s womb to grow and develop.

Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is a type of IVF technique, in which a single sperm is injected directly into an egg to fertilise it. The fertilised egg is then transferred to the woman’s womb.

Intracytoplasmic sperm injection (ICSI) may be offered if you’ve been trying to conceive naturally with your partner for at least two years and you have either:

• few or no sperm in your semen
• poor quality sperm

Before having ICSI, you and your partner will need to have an assessment to ensure the treatment is appropriate.

This will involve questions about your medical and sexual history, and screening tests to check for infections or genetic problems that could affect your baby and the chances of ICSI working.

When treatment doesn’t work

In rare cases, male fertility problems can’t be treated, and it’s impossible for a man to father a child. If this is the case, you and your partner can consider either using sperm from a donor or adopting a child.

Donor insemination

Donor insemination means using sperm donated by another man.

You may wish to consider using donor insemination as an alternative to intracytoplasmic sperm injection (ICSI), particularly if the man has a genetic disorder that could be passed on to any children. It can be used as part of IVF if necessary.

If you’re considering donor insemination, you should be offered counseling as a couple about the implications for you and your children.

Lifestyle and home remedies

There are steps you can take at home to increase your chances of getting your partner pregnant, including:

• Increasing the frequency of sex. Having sexual intercourse every day or every other day beginning at least four days before ovulation increases your chances of getting your partner pregnant.
• Having sex when fertilization is possible. A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. This will ensure that sperm, which can live several days, are present when conception is possible.
• Avoiding lubricants. Some products such as Astroglide or K-Y jelly, lotions, and saliva might impair sperm movement and function. Ask your doctor about sperm-safe lubricants.

Alternative medicine

Evidence is still limited on whether — or how much — herbs or supplements might help increase male fertility. None of these supplements treats a specific underlying cause of infertility, such as a sperm duct defect or chromosomal disorder. Some supplements might help only if you have a deficiency.

Supplements with studies showing potential benefits on improving sperm count or quality include:

• Alpha-lipoic acid
• Anthocyanins
• L-arginine
• Astaxanthin
• Beta-carotene
• Biotin
• L-acetyl carnitine
• L-carnitine
• Cobalamin
• Co-enzyme Q10
• Ethylcysteine
• Folic acid
• Glutathione
• Inositol
• Lycopene
• Magnesium
• N-acetyl cysteine
• Pentoxifylline
• Phosphodiesterase-5 inhibitors
• Polyunsaturated fatty acids
• Selenium
• Vitamins A, C, D and E
• Zinc

Talk with your doctor before taking dietary supplements to review the risks and benefits of this therapy. Taking some supplements in high doses (megadoses) or for extended periods of time might be harmful.