Is Sperm Count 2.0 Million/ml Enough for Pregnancy? Overview, Treatment Options, Causes, and Indian Perspective
In this blog post titled "Is Sperm Count 2.0 Million/ml Enough for Pregnancy? Overview, Treatment Options, Causes, and Indian Perspective," we delve into the topic of male infertility. We discuss what male infertility is, the different grades of oligospermia (low sperm count), common causes, and questions to ask yourself if you suspect infertility. We also explore what a doctor will check during an examination, additional tests that can be done, and whether male infertility is treatable. Furthermore, we explain the correlation between sperm count and pregnancy, revealing the lowest possible count at which pregnancy is still possible. Additionally, we provide an overview of assisted reproductive techniques and their success rates.
What is Male Infertility
Male infertility is when a couple tries to have a baby for a whole year without using any protection but still can't get pregnant. This happens when the man's body has trouble making enough healthy sperm or when the sperm can't reach the woman's egg. Surprisingly, in about 20% of these cases, it's only the man who is unable to make the woman pregnant. It's important to remember that infertility isn't always the man's fault, as it can also be caused by issues with the woman's reproductive system.
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What is it called when sperm count is 2.0 million/ml?
This condition is called oligospermia or a low sperm count.
How is sperm count measured?
A sperm count is assessed by means of a
semen analysis test. In this test you are asked to provide a sample of your semen, and the lab uses special techniques to analyze the semen. The count is estimated by diluting the semen in a special diluent and then using a measurement chamber to visualize the sperms. A complex mathematical formula is employed to estimate the actual sperm count.
What is my grade of oligospermia?
Your sperm count is much lower than what is considered normal. A normal sperm count is typically above 15 million per milliliter. Your sperm count is only 2.0, indicating a severe case of oligospermia. This means that there are very few sperm cells in your semen, which may affect your ability to conceive a child.
What are the causes of a sperm count of 2.0 million/ml?
There are several different causes of oligospermia and they can be one of several categories including due to genetic factors, past cancer, secondary to other diseases, physical factors in the reproductive tract etc.
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hyperthyroidism
Hyperthyroidism is a condition where the thyroid gland produces too much thyroid hormones. These hormones regulate metabolism and affect various body functions, including sperm production. Hyperthyroidism can cause a hyperestrogenic state, which means there is an excess of estrogen in the body. This hormonal imbalance can negatively impact sperm count. To investigate hyperthyroidism as a cause, doctors can conduct blood tests to measure levels of thyroid hormones and thyroid-stimulating hormone (TSH). They may also perform imaging tests, such as ultrasound or a thyroid scan, to assess the structure and function of the thyroid gland.
infections - prostatitis
Prostatitis refers to inflammation of the prostate gland, usually due to an infection. This condition can affect sperm count by disrupting the normal functioning of the reproductive system. To investigate prostatitis as a cause, doctors can perform a physical examination of the prostate gland, check for signs of infection, and analyze a urine sample for the presence of bacteria. They may also conduct a prostate-specific antigen (PSA) blood test to rule out prostate cancer.
craniopharyngioma
Craniopharyngioma is a type of brain tumor that can disrupt the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) by exerting pressure on the pituitary gland. LH and FSH are essential for the normal functioning of the testes and sperm production. To investigate craniopharyngioma as a cause, doctors may perform imaging tests, such as MRI or CT scans, to identify the presence and location of the tumor. They may also measure hormone levels in the blood and conduct a visual field test to assess any impact on vision.
hypothyroidism
Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones. These hormones play a crucial role in regulating various bodily functions, including sperm production. In hypothyroidism, low levels of thyroid hormones can negatively affect sperm count. To investigate hypothyroidism as a cause, doctors can conduct blood tests to measure thyroid hormone levels and TSH. Imaging tests, such as ultrasound or a thyroid scan, may also be performed to assess the structure and function of the thyroid gland.
prolactinoma
Prolactinoma is a type of pituitary gland tumor that leads to excessive production of prolactin hormone. Elevated prolactin levels can suppress the normal functioning of the hypothalamus, which can negatively impact sperm production. To investigate prolactinoma as a cause, doctors may perform blood tests to measure prolactin levels. They may also conduct imaging tests, like MRI or CT scans, to identify the presence and size of the tumor and assess its impact on surrounding structures.
pituitary adenoma
Pituitary adenoma refers to a non-cancerous tumor in the pituitary gland. Such a tumor can exert pressure on the cells responsible for producing LH and FSH, leading to their disruption and affecting sperm production. To investigate pituitary adenoma as a cause, doctors may perform imaging tests, like MRI or CT scans, to identify the presence and size of the tumor. They may also measure hormone levels in the blood and conduct a visual field test to assess any impact on vision.
varicocele
Varicocele is a condition characterized by the enlargement of veins within the scrotum. This can lead to sloughing, atrophy (shrinkage), and low testosterone levels, which can adversely affect sperm count. To investigate varicocele as a cause, doctors may perform a physical examination of the scrotum to assess the presence and severity of varicocele. They may also recommend a scrotal ultrasound to further evaluate the condition and assess its impact on testicular blood flow.
sarcoidosis
Sarcoidosis is a condition characterized by the formation of inflammatory granulomas in various organs, including the pituitary gland. This inflammation can infiltrate and disrupt the normal functioning of the pituitary gland, leading to hormonal imbalances that affect sperm production. To investigate sarcoidosis as a cause, doctors may perform blood tests to check for markers of inflammation and assess hormone levels. They may also recommend imaging tests, like MRI or CT scans, to evaluate the presence and extent of granulomas in the pituitary gland.
congenital adrenal hyperplasia
Congenital adrenal hyperplasia is a genetic disorder characterized by the overproduction of adrenal androgens. Excess adrenal androgens can suppress the normal functioning of the pituitary gland, leading to hormonal imbalances that affect sperm production. To investigate congenital adrenal hyperplasia as a cause, doctors may perform blood tests to measure hormone levels, particularly adrenal androgens. Genetic testing can also be conducted to confirm the presence of specific gene mutations associated with this condition.
medications
Certain medications, such as anabolic steroids, corticosteroids, and other drugs, can have adverse effects on the hypothalamo-pituitary axis, disrupting normal hormonal regulation and affecting sperm production. Anabolic steroids, for example, can suppress the production of testosterone and lead to an excess conversion of testosterone into estrogen. To investigate medications as a cause, doctors may review the patient's medication history and conduct blood tests to assess hormone levels and detect any abnormalities.
Questions to ask yourself for a sperm count of 2.0 million/ml
Age at which you had puberty
Have you ever experienced any physical changes during your teenage years, such as the growth of facial hair, deepening of voice, or the development of pubic hair?
Surgery on testicles
Have you ever undergone surgery on your testicles to address any medical issues or concerns?
Any trouble with sexual drive or function
Have you ever experienced any difficulties with your sexual desire or performance?
Sexually transmitted infections
Have you ever had any sexually transmitted infections or been treated for one?
Infections of prostate or testicle
Have you ever experienced any infections or inflammation in your prostate or testicles?
Have you ever taken any medications, either currently or in the past, that could potentially affect your sperm count?
Use of alcohol, tobacco, illicit drugs
Have you ever consumed alcohol, smoked tobacco, or used illicit drugs? Please provide a brief response.
Systemic disease
Have you ever been diagnosed with any medical conditions that affect your whole body, such as diabetes or high blood pressure?
Environmental exposures, including radiation, pesticides, and occupational
Have you ever been exposed to radiation, pesticides, or worked in an occupation where you may have come into contact with harmful substances that could potentially affect your fertility?
Any Cancer diagnosis or treatment
Have you ever been diagnosed with cancer or received any cancer treatments in the past?
What will be done during medical checkup for sperm count of 2.0 million/ml?
Is your sexual development complete ? - Tanner stage
The doctor will examine your sexual development by assessing your Tanner stage. This involves looking at physical changes that occur during puberty. The doctor will check for the growth of pubic hair, development of breasts (in females), and enlargement of the testicles (in males). They will also assess the size of your penis and evaluate any other changes such as the growth of facial hair or underarm hair. By determining your Tanner stage, the doctor can determine if your sexual development is complete or if there are any concerns that need further evaluation or treatment.
Do you show signs of a mass in the brain? - Bitemporal hemianopsia (pituitary mass)
In order to determine if there is a mass in the brain causing bitemporal hemianopsia (a condition where a person cannot see on the outer sides of their visual field), the doctor will conduct a thorough examination. This examination usually involves a series of tests and procedures.
Firstly, the doctor may perform a visual field test to assess the extent of the patient's vision loss. This test involves looking at a screen and indicating when and where they see flashes of light.
Next, the doctor might order a magnetic resonance imaging (MRI) scan. This is a painless procedure that uses powerful magnets and radio waves to create detailed images of the brain. The MRI scan can help identify any abnormalities, including a pituitary mass, which could be causing the bitemporal hemianopsia.
Based on the results of these tests and the patient's medical history, the doctor will be able to provide a more accurate diagnosis and recommend further treatment options if necessary.
Is your testicle size normal ? Reduced testicular volume (<15 cc)
During the examination, the doctor will assess the size of your testicles to determine if it is normal or reduced. This is important because a reduced testicular volume, which is typically less than 15 cc, can affect your fertility and sperm count. The doctor will gently feel your testicles to gauge their size and check for any abnormalities. This examination is painless and usually takes just a few minutes. Based on the results, the doctor will be able to provide you with further guidance and recommendations.
Is there a mass in your testicle? - Testicular mass
The doctor will check if there is a mass or lump in your testicle. This means they will feel your testicles using their hands. They will gently touch and press different parts of your testicles to see if they can feel any unusual lumps or bumps. This is done to check for any signs of testicular cancer or other conditions that could affect your fertility. It is a quick and painless examination that can help the doctor understand your condition better.
Is the natural tube from testicles missing from either side? - Presence of vas deferens bilaterally
The doctor will check if the natural tube connecting the testicles to the rest of the reproductive system is missing on either side. This tube is called the vas deferens and is responsible for carrying sperm. The examination will involve a physical examination of the scrotum to feel for the presence of this tube. The doctor will gently feel the area to check if there is a tube-like structure on both sides. If the vas deferens is not felt, it may indicate that it is missing or blocked, which can affect the ability to conceive.
Is there any cyst or swelling in the testicular sac ? - Presence of varicocele or other scrotal mass
The doctor will carefully examine the testicular sac to check for any cyst or swelling. This involves feeling the area with their hands and visually inspecting the scrotum. They will be looking for any abnormal lumps or bumps that may indicate the presence of a cyst or swelling. Additionally, the doctor will check for a condition called varicocele, which is the enlargement of veins in the scrotum. They will also look for any other scrotal mass, which could be an abnormal growth or tumor. This examination is important to determine if there are any underlying issues that may be affecting the patient's sperm count.
Are the testicles missing? - Presence of cryptorchidism or hypospadias
The doctor wants to check if the patient's testicles are missing or not. They will look for two conditions called cryptorchidism and hypospadias. Cryptorchidism means that the testicles did not descend properly into the scrotum, and hypospadias is a condition where the opening of the urethra is not at the tip of the penis. The doctor will perform a physical examination to see if the testicles can be felt in the scrotum. They may also ask the patient about any difficulty in urinating or any unusual appearance of the penis. This examination will help the doctor understand if the patient has any of these conditions.
The doctor will look for signs of joint problems by examining the patient's second and third metacarpal-phalangeal joints, which are the joints connecting the hand and fingers. They will check for any swelling, redness, or pain in these joints, which could indicate synovitis, a condition causing inflammation in the joint lining. Additionally, the doctor will also observe the patient's skin for a 'bronzed' appearance, which could be a sign of liver disease or heart failure called hemochromatosis. These signs can help the doctor understand if there are any underlying health issues related to the patient's low sperm count.
Is the patient on muscle building steroids? Presence of marked muscle hypertrophy suggesting anabolic steroid use
To determine whether the patient is using muscle-building steroids, the doctor will examine the patient for signs of marked muscle hypertrophy. This means looking for significant and abnormal growth of muscles in the patient's body. The doctor will carefully observe the patient's physique to check for any noticeable changes in muscle size and shape. They may also ask the patient about their exercise routine and any supplements they are taking to gain muscle. By assessing these factors, the doctor can determine if the patient is using anabolic steroids, which can cause rapid muscle growth beyond what is typically achievable through natural means.
What additional tests are to be done for a sperm count of 2.0 million/ml?
Step 1 : Test FSH, LH, Prolactin and Testosterone levels
In order to understand why a patient has a low sperm count, doctors recommend checking their hormone levels. These hormones include FSH, LH, Prolactin, and Testosterone. FSH (follicle-stimulating hormone) helps in the production of sperm, LH (luteinizing hormone) stimulates the testes to produce testosterone, Prolactin is responsible for milk production in women but can affect fertility in both men and women, and Testosterone is a hormone crucial for sperm production. By checking these levels, doctors can better understand what might be causing the low sperm count and determine the best course of action to help the patient with their infertility concerns.
Step 2 : Are FSH and LH lower than normal?
If a person's FSH and LH levels are lower than normal, it suggests that their pituitary gland, which produces these hormones, is not functioning properly. In this case, further investigations such as an MRI scan may be recommended to assess the condition of the pituitary gland. Additionally, the doctors may also check for diseases that affect the entire body, like hemochromatosis (excessive iron in the body) or sarcoidosis (inflammation that can affect various organs). These tests help in understanding the underlying causes of low hormone levels and infertility.
Step 3 : Are FSH and LH too high?
If a man's sperm count is very low (2.0), it could indicate infertility. When the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are high, it suggests that the testicles are not producing enough sperm. This could be due to various reasons such as problems within the testicles themselves, autoimmune diseases, or genetic issues. To investigate further, doctors may recommend additional tests to examine the genetic makeup (karyotype) and identify any underlying causes.
Step 4 : Are LH and Testosterone Normal?
In simple terms, if a patient's LH and testosterone levels are normal, it means that the pituitary gland, which controls hormone production, is working fine and the cells responsible for producing testosterone are functioning properly. However, if the FSH level is elevated, it could indicate various reasons for infertility, such as unknown causes, genetic factors, or certain medications. Further investigation is recommended to understand the exact cause of the low sperm count.
Step 5 : Are LH and Testosterone high?
When a patient has a low sperm count of 2.0, it is important to understand the role of LH (luteinizing hormone) and testosterone. Generally, when LH and testosterone levels are high, it indicates normal functioning of the reproductive system. However, in the case of androgenic insensitivity, which is being recommended for further investigation, LH and testosterone levels may not be high even though the patient has a low sperm count. This could be an indication that the patient's body is not responding properly to these hormones, which can contribute to infertility.
Is there any treatment for sperm count of 2.0 million/ml?
Some causes of low sperm count can be treated, others are not totally treatable. Assisted reproductive techniques are required in those cases where the count cannot be improved to normal levels. Here are a few of the treatable and non-treatable causes
Treatable causes of low sperm count
In case of the following causes, treatment can be provided to directly increase the sperm count.
Understanding Obstructive Azoospermia: What You Need to Know About Low Sperm Count
Obstructive azoospermia is a condition in which a man has a low sperm count, caused by a blockage that prevents sperm from being released during ejaculation.
Understanding Ejaculatory Duct and Prostatic Midline Cysts
Ejaculatory duct and prostatic midline cysts are conditions that can contribute to a low sperm count in men. These cysts, located in the reproductive system, may affect the quality and quantity of sperm produced.
Understanding Gonadotropin Deficiency
Gonadotropin deficiency refers to a condition where a patient has a low sperm count, which can impact their ability to conceive.
Understanding Low Sperm Count
Low sperm count refers to a condition where a man's semen contains fewer sperm than normal, which may affect fertility and the ability to conceive.
Understanding Sperm Autoimmunity
Sperm autoimmunity refers to a condition where the body's immune system mistakenly attacks and destroys sperm cells, leading to a low sperm count.
Understanding Varicoceles: A Common Cause of Low Sperm Count
Varicoceles are enlarged veins in the scrotum that can lead to reduced sperm production in men.
Understanding Reversible Toxin Effects on Low Sperm Count
Reversible toxin effects refer to the temporary impact certain substances can have on sperm production, leading to a low sperm count. In some cases, removing or avoiding these toxins can help restore fertility.
Untreatable Causes of low sperm count
In case of these conditions, ART will probably be required as there is no direct treatment to increase the sperm count.
Understanding Low Sperm Count
Low sperm count refers to a condition called primary seminiferous tubular failure, where the testicles are unable to produce enough healthy sperm.
Understanding Sertoli Cell-Only Syndrome
Sertoli cell-only syndrome is a condition characterized by a low sperm count due to the absence or dysfunction of cells that support sperm production.
Understanding Bilateral Orchiectomy: A Procedure for Low Sperm Count
Bilateral orchiectomy, a surgical procedure involving the removal of both testicles, may be considered for patients with low sperm count.
Is pregnancy possible with a sperm count of 2.0 million/ml?
As per
Martorras et al, 7% of men, with a sperm count as low as 2 million/ ml were still able to conceive spontaneoulsy, with natural means, over a 2 year period of trying. This implies that even a low sperm count DOES NOT MEAN that you won't be able to have a successfull pregnancy. There are several other factors at play, and we try to list them out in the rest of the article. Assisted reproductive techniques can greatly increase the chances of conception.
What IVF or assisted conception options are available for a low sperm count?
Intra Uterine Implantation
Intra Uterine Implantation is an assisted reproductive technique that can help couples who are struggling to conceive due to a low sperm count. During this procedure, the doctor will carefully place healthy and active sperm directly into the uterus. This increases the chances of fertilization as the sperm are brought closer to the egg. It is a simple and relatively painless procedure that doesn't require any major surgery. Intra Uterine Implantation offers hope to couples who are facing fertility issues and can greatly increase their chances of getting pregnant.
Intra Cytoplasmic Sperm
Intra Cytoplasmic Sperm Injection (ICSI) is an assisted reproductive technique that can help couples who are struggling to conceive due to a low sperm count. During ICSI, a single healthy sperm is directly injected into the egg using a tiny needle. This process bypasses the need for the sperm to naturally penetrate the egg, increasing the chances of fertilization. Once fertilized, the embryo is then transferred into the woman's uterus, where it can hopefully implant and result in a successful pregnancy. ICSI has been successful in helping many couples achieve their dream of having a baby, even when the man has a low sperm count.
In Vitro Fertilization
In Vitro Fertilization (IVF) is an assisted reproductive technique that helps couples who are struggling to conceive due to low sperm count or other fertility issues. During IVF, eggs are collected from the woman's ovaries and sperm from the man are combined in a laboratory dish. This allows fertilization to occur outside the woman's body. The embryos that form are then carefully monitored and, after a few days, one or more are transferred back into the woman's uterus. This increases the chances of pregnancy as the fertilized embryo has a better chance of implanting and growing. IVF has been successful in helping many couples become parents and offers hope to those facing fertility challenges.
What is a good plan ART (assisted reproductive technique) plan of action for a sperm count of 2.0 million/ml?
Based on the patient's sperm count of 2.0 million/ml, the most suitable treatment option would be Intra Cytoplasmic Sperm Injection (ICSI). ICSI is the most effective method for very low sperm counts and has an efficacy rate of around 24.2% in such cases. Other techniques should be attempted first if the sperm count is higher than 5 million/ml. Intra Uterine Implantation (IUI) is only applicable for sperm counts above 10 million/ml and has a pregnancy rate of around 16%. In Vitro Fertilization (IVF) can be considered as a second line of treatment if IUI fails after 3-4 cycles, with success rates ranging from 7% for counts below 5 million/ml to 14.3% for counts above 10 million/ml.
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References
Authorotative articles on IVF and oligospermia
Recommended Tests
The following tests are recommeded as additional investigations in a case of oligospermia or low sperm count.
By: Dr.Bhargav Raut