Is Sperm Count of 5.0 Million/ml Enough for Pregnancy? Treatment Options, Causes, and Indian Perspective
In our blog post titled "Is Sperm Count of 5.0 Million/ml Enough for Pregnancy? Treatment Options, Causes, and Indian Perspective," we explore the topic of male infertility and its implications for conception. We cover various aspects such as the causes of low sperm count, questions to consider, and the tests that doctors may perform during an examination. Additionally, we delve into treatment options, including assisted reproductive techniques, and discuss their success rates. If you're curious about the correlation between sperm count and the possibility of pregnancy, this blog post offers insights in a simple and easy-to-understand language.
What is Male Infertility
Male infertility refers to a situation where a man and woman have been trying to have a baby for a year without success, even though the woman is medically confirmed to have no issues with fertility. This means that despite having regular unprotected sex, they haven't been able to conceive a child during this time. Surprisingly, in around 20% of these cases, the man is solely responsible for the infertility problem. In simpler terms, it means that the man's reproductive system is not functioning properly and is preventing the couple from getting pregnant.
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What is it called when sperm count is 5.0 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 currently at
5.0 million per milliliter, which is lower than the normal range. This condition is known as
moderate oligospermia. Oligospermia refers to a lower than average sperm count, and the term "moderate" indicates that the count is not extremely low, but still below the normal range.
What are the causes of a sperm count of 5.0 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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Kleinfelters syndrome - genetic disorder affecting sperm production
Kleinfelters syndrome is a genetic disorder that affects sperm production. It may result in a complete absence of sperm (azoospermia) or a low sperm count (oligospermia) in some men. This condition occurs when a male is born with an extra X chromosome, leading to abnormal development of the testicles. To investigate this cause, doctors can perform a karyotype test to examine the chromosomes and identify any abnormalities.
Sarcoidosis - inflammation causing disruption of pituitary gland
Sarcoidosis is a condition characterized by inflammation that can affect various organs, including the pituitary gland. When the pituitary gland is disrupted, it may lead to hormonal imbalances, including disturbances in the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for sperm production. To investigate sarcoidosis as a cause, doctors can perform blood tests, imaging studies, and biopsies to assess the extent of inflammation and its impact on the pituitary gland.
Congenital adrenal hyperplasia - excessive adrenal androgens suppressing pituitary function
Congenital adrenal hyperplasia is a genetic condition where the adrenal glands produce excessive androgens (male hormones). These elevated levels of androgens can suppress the function of the pituitary gland, leading to disruptions in the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are necessary for normal sperm production. To investigate this cause, doctors can perform hormone level tests, such as measuring adrenal androgen levels, and evaluate the pituitary gland through imaging studies.
Pituitary adenoma - tumor affecting LH and FSH production
A pituitary adenoma is a tumor that develops in the pituitary gland. This tumor can exert pressure on the cells responsible for producing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), disrupting their normal function. LH and FSH play crucial roles in sperm production. To investigate this cause, doctors may perform imaging tests, such as MRI or CT scans, to visualize the pituitary gland and identify the presence of a tumor.
Hyperthyroidism - excessive thyroid hormone leading to hormone imbalance
Hyperthyroidism is a condition characterized by an overactive thyroid gland, resulting in excessive production of thyroid hormones. This hormonal imbalance can lead to a hyperestrogenic state, where estrogen levels are higher than normal. Elevated estrogen levels can interfere with sperm production. To investigate hyperthyroidism as a cause, doctors can perform blood tests to measure thyroid hormone levels and assess the thyroid gland's function.
Kallmann syndrome - genetic disorder affecting hormone production
Kallmann syndrome is a genetic disorder that affects hormone production, including luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for sperm production. This condition is characterized by delayed or absent puberty and a reduced sense of smell. To investigate Kallmann syndrome as a cause, doctors may perform genetic testing to identify specific gene mutations associated with this syndrome and hormone level tests to assess LH and FSH levels.
Varicocele - enlarged veins causing testicular problems
Varicocele is a condition characterized by the enlargement of veins within the scrotum. This can lead to problems in the testicles, including reduced blood flow and increased temperature, which may negatively affect sperm production and testosterone levels. To investigate varicocele as a cause, doctors can perform a physical examination of the scrotum and may also use imaging tests, such as ultrasound, to visualize the varicocele and assess its impact on testicular function.
Infections - Prostatitis
Prostatitis is the inflammation of the prostate gland, often caused by a bacterial infection. Inflammation in the prostate can affect sperm production and quality. To investigate prostatitis as a cause, doctors can perform a physical examination of the prostate, collect urine samples for laboratory analysis, and may also perform imaging tests, such as ultrasound, to evaluate the prostate gland's condition.
Hypothyroidism
Hypothyroidism is a condition characterized by an underactive thyroid gland, leading to insufficient production of thyroid hormones. This hormonal imbalance can affect various bodily functions, including sperm production. To investigate hypothyroidism as a cause, doctors can perform blood tests to measure thyroid hormone levels and evaluate the thyroid gland's function.
Infections - Mumps orchitis
Mumps orchitis is a condition characterized by inflammation of the testicles, typically following a mumps viral infection. This inflammation can impair sperm production. To investigate mumps orchitis as a cause, doctors can assess the patient's medical history, perform a physical examination of the testicles, and may also perform blood tests to detect the presence of mumps antibodies.
Questions to ask yourself for a sperm count of 5.0 million/ml
Age at which you had puberty
Have you ever experienced any changes in your body, such as growth of facial hair or voice deepening, during your teenage years?
Surgery on testicles
Have you ever undergone surgery on your testicles? If so, please provide a brief description of the procedure.
Any trouble with sexual drive or function
Have you ever experienced any difficulties with your sexual desire or ability to perform sexually?
Sexually transmitted infections
Have you ever had any sexually transmitted infections?
Infections of prostate or testicle
Have you ever experienced any pain or discomfort in your prostate or testicles?
Have you ever taken any medications, whether 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 any illegal drugs?
Systemic disease
Have you ever been diagnosed with any medical conditions or diseases that affect your entire body, such as diabetes, hypertension, or thyroid problems?
Environmental exposures, including radiation, pesticides, and occupational
Have you ever been exposed to radiation, pesticides, or worked in an occupation with potential environmental hazards?
Any Cancer diagnosis or treatment
Have you ever received any cancer diagnosis or undergone any cancer treatments in the past?
What will be done during medical checkup for sperm count of 5.0 million/ml?
Is your sexual development complete ? - Tanner stage
In order to determine if your sexual development is complete, the doctor will assess your Tanner stage. This is a simple examination that helps determine the stage of puberty you are currently in. The doctor will look at physical characteristics such as the development of your genitals, pubic hair, and breast tissue (for females). They may also ask you questions about your menstrual cycle (for females) or voice changes (for males). Based on these observations, the doctor will be able to determine if your sexual development is complete or if there are still changes happening.
Do you show signs of a mass in the brain? - Bitemporal hemianopsia (pituitary mass)
During the examination for a possible pituitary mass, the doctor will be checking if you show signs of a condition called bitemporal hemianopsia. This means that you may have a problem with your vision, specifically in the outer sides of both eyes. To determine this, the doctor will ask you to look straight ahead and then test your peripheral vision by showing you different objects or lights from the sides. They will also check for any other symptoms such as headaches or changes in hormone levels. If bitemporal hemianopsia is observed, further tests may be recommended to confirm the presence of a pituitary mass.
Is your testicle size normal ? Reduced testicular volume (<15 cc)
When a doctor examines a patient's testicle size, they are checking to see if the size is normal or reduced. Testicles that have a volume of less than 15 cc are considered to have reduced testicular volume.
This examination involves the doctor gently feeling and measuring the size of the testicles using their hands. They may also use a special tool called an orchidometer, which is a set of beads of different sizes that can be compared to the patient's testicles.
The purpose of this examination is to assess the health and function of the testicles. Reduced testicular volume can be an indicator of various conditions, including hormonal imbalances or problems with sperm production.
If a patient has a sperm count of 5.0, which is below the normal range, the doctor will likely be interested in assessing their testicle size to understand if it could be contributing to the low sperm count.
It is important to note that this examination is a routine part of a comprehensive assessment and should not cause discomfort or pain for the patient.
Is there a mass in your testicle? - Testicular mass
The doctor will check if there is a lump or mass in your testicle. This involves a physical examination where the doctor will gently feel your testicle to see if there is any abnormality. They may ask you to turn your head and cough, which helps them detect any hernias or lumps. This examination is important because a testicular mass could be a sign of various conditions, including testicular cancer. It's a quick and painless process that helps the doctor determine if further tests or treatment are needed.
Is the natural tube from testicles missing from either side? - Presence of vas deferens bilaterally
The doctor will check if the patient has a natural tube connecting the testicles called the vas deferens on both sides of their body. This tube is responsible for transporting sperm. To examine this, the doctor may perform a physical examination by feeling the area where the vas deferens is usually located. They may also use ultrasound or other imaging tests to get a clearer picture. If the doctor finds that the vas deferens is missing on either side, it could affect the patient's fertility and their ability to father a child naturally.
Is there any cyst or swelling in the testicular sac ? - Presence of varicocele or other scrotal mass
The doctor will carefully examine the patient's testicles and scrotum to check for any cysts or swelling. This involves visually inspecting the area and gently feeling the testicles to detect any abnormalities. They will also check for the presence of a varicocele, which is a swollen vein in the scrotum. The doctor may use their fingers to feel for any lumps or masses in the scrotal area. This examination is important to determine if there are any issues that could be affecting the patient's sperm count.
Are the testicles missing? - Presence of cryptorchidism or hypospadias
To determine if the testicles are missing, the doctor will perform a physical examination of the patient's genital area. They will look for signs of cryptorchidism, which means that one or both testicles have not descended into the scrotum. The doctor will gently feel the scrotum to check for the presence of the testicles. They will also examine for hypospadias, a condition where the opening of the urethra is located on the underside of the penis instead of the tip. This examination will help the doctor assess the patient's reproductive health and identify any abnormalities that may be contributing to the low sperm count.
The doctor will check if the patient has any joint problems by examining the second and third finger joints, which are located near the palm. They will look for signs of synovitis, which is inflammation of the joint lining. Additionally, the doctor will observe if the patient's skin has a 'bronzed' appearance, which could be a sign of liver disease or heart failure called hemochromatosis. This examination will help determine if there are any issues with the patient's joints or if they have any symptoms of liver or heart problems.
Is the patient on muscle building steroids? Presence of marked muscle hypertrophy suggesting anabolic steroid use
To determine if a patient is using muscle building steroids, the doctor will look for signs of marked muscle hypertrophy. This means they will examine the patient's muscles for noticeable and significant enlargement. The doctor might observe if the patient's muscles appear much larger than what is typically seen with regular exercise or physical training. They will assess the overall size, shape, and firmness of the muscles, paying particular attention to areas commonly affected by steroid use, such as the chest, arms, and legs. By observing these physical characteristics, the doctor can get an idea of whether the patient might be using anabolic steroids to enhance their muscle growth.
What additional tests are to be done for a sperm count of 5.0 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 testing 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 production of testosterone, prolactin regulates the production of breast milk but can also affect fertility, and testosterone is essential for sperm production. By measuring these hormone levels, doctors can get a better idea of what might be causing the low sperm count and provide appropriate treatments if necessary.
Step 2 : Are FSH and LH lower than normal?
If a patient has a low sperm count of 5.0, it could indicate infertility. When the hormone levels of FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are lower than normal, it suggests that the pituitary gland is not producing enough hormones. In this case, further investigations like an MRI scan may be required to examine the pituitary gland, and tests for systemic diseases such as hemochromatosis (excess iron in the body) or sarcoidosis (inflammation in different organs) may also be recommended. These tests help doctors understand the underlying causes of the low hormone levels and explore potential treatments for infertility.
Step 3 : Are FSH and LH too high?
When a patient's FSH (follicle-stimulating hormone) and LH (luteinizing hormone) levels are high, it suggests that their testis, which produces sperm, may not be functioning properly. This could be due to various factors like local issues, autoimmune diseases, or genetic conditions. To further investigate the problem, doctors may recommend tests to check the patient's genetic makeup (karyotype) and rule out any underlying genetic abnormalities that could be causing the low sperm count.
Step 4 : Are LH and Testosterone Normal?
If a person has a sperm count of 5.0 and is being checked for infertility, the LH (luteinizing hormone) and testosterone levels are normal. This means that the pituitary gland is functioning properly and the cells that produce testosterone are working fine. However, the FSH (follicle-stimulating hormone) level is elevated, which could be due to unknown reasons, genetic factors, or certain medications. Further investigation is recommended to determine the exact cause of the infertility issue.
Step 5 : Are LH and Testosterone high?
A sperm count of 5.0 is considered low, indicating potential infertility in a patient. In this case, if LH (luteinizing hormone) and testosterone levels are high, it may suggest a condition called androgenic insensitivity. Androgenic insensitivity means that even though the body produces enough LH and testosterone, the cells in the reproductive system do not respond properly to these hormones, leading to fertility problems. Therefore, further investigation into this condition has been recommended to understand and address the underlying cause of infertility in the patient.
Is there any treatment for sperm count of 5.0 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
Obstructive azoospermia is a condition where a patient has a low sperm count due to blockages in the reproductive tract, which prevent the sperm from being ejaculated.
Understanding Ejaculatory Duct and Prostatic Midline Cysts
Ejaculatory duct and prostatic midline cysts are conditions that may contribute to a low sperm count, affecting the ability to conceive.
Understanding Low Sperm Count
Gonadotropin deficiency refers to a condition where the body does not produce enough hormones needed for sperm production, resulting in a low sperm count.
Understanding Low Sperm Count
Low sperm count refers to a condition where a man's semen contains fewer sperm than normal, which can affect fertility and the ability to conceive a child.
Understanding Sperm Autoimmunity
Sperm autoimmunity refers to a condition where the body's immune system mistakenly attacks and damages 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 decreased sperm production, causing low sperm count.
Understanding Reversible Toxin Effects on Low Sperm Count
Reversible toxin effects refer to the temporary impact of harmful substances on the production of sperm, which can cause a decrease in sperm count. These effects can be reversed with appropriate measures.
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 Primary Seminiferous Tubular Failure
Primary seminiferous tubular failure refers to a condition where a patient has a low sperm count due to issues with the seminiferous tubules, which are responsible for sperm production.
Understanding Sertoli Cell-Only Syndrome
Sertoli cell-only syndrome is a condition characterized by a significantly low sperm count due to the absence of sperm cells in the semen.
Understanding Bilateral Orchiectomy
Bilateral orchiectomy, also known as removal of both testicles, is a surgical procedure that may be performed in cases of low sperm count.
Is pregnancy possible with a sperm count of 5.0 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 having difficulty conceiving due to a low sperm count. During this procedure, the doctor will take a small sample of your partner's sperm and wash it to select the healthiest sperm. Then, they will gently place these sperm directly into your uterus using a thin catheter. This increases the chances of the sperm reaching the egg and fertilizing it, increasing the chances of pregnancy. It is a relatively simple and painless procedure that can be done in a doctor's office, offering hope to couples struggling with infertility.
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 carefully injected into the woman's egg, with the aim of fertilizing it. This technique bypasses the need for a large number of healthy sperm, as only one is needed for successful fertilization. After fertilization, the embryo is then transferred to the woman's uterus, where it can hopefully implant and result in a 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 a special technique used to help couples who are having trouble getting pregnant due to low sperm count or other fertility issues. During IVF, eggs are collected from the woman's ovaries and mixed with sperm in a laboratory dish. This allows fertilization to occur outside the body. Once the fertilized eggs, called embryos, have developed for a few days, they are carefully placed back into the woman's uterus, where they have a chance to grow into a baby. IVF increases the chances of pregnancy by bypassing the natural reproductive process and giving the sperm a helping hand in fertilizing the eggs.
What is a good plan ART (assisted reproductive technique) plan of action for a sperm count of 5.0 million/ml?
Based on the patient's sperm count of 5.0, the recommended treatment plan would be to first attempt Intra Uterine Implantation (IUI) as a less invasive and cost-effective option. However, since IUI requires a sperm count above 10 million/ml, it may not be suitable for the patient's current condition. In that case, the next option would be Intra Cytoplasmic Sperm Injection (ICSI), which is the best method for very low sperm counts below 5 million/ml. If the sperm count is higher than 5 million/ml, ICSI's efficacy drops to between 1% and 6%, so other techniques should be considered first. If IUI and ICSI fail, In Vitro Fertilization (IVF) can be attempted as a second-line treatment, with success rates ranging from 7% to 48% depending on the sperm count.
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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