Sperm Count 15 million : Is it enough for pregnancy
In our blog post titled "Understanding Male Infertility: Exploring Sperm Count and its Impact on Pregnancy," we delve into the topic of low sperm count, known as oligospermia, and its implications for fertility. We explore the causes of this condition and provide questions to help individuals assess their own fertility. Additionally, we explain the various examinations and additional tests that doctors may conduct to diagnose and address male infertility, while also discussing the success rates of assisted reproductive techniques as potential treatments.
What is a normal sperm count?
A normal total sperm count is
39 million as per the WHO. For the purposes of this article we assume an ejaculatory volume of 3 ml.[1.5ml - 6ml].
What is Male Infertility
Male infertility is when a man and a woman try to have a baby for a whole year without using any protection, but they can't make a baby. The woman is perfectly fine and can have kids, but the man has something wrong that stops them from getting pregnant. It happens about 20% of the time, so it's not uncommon for the man to be the reason why they can't have a baby.
4
What is it called when sperm count is 15 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 15 million, which is lower than the normal range of 39 million or more. This condition is called oligospermia, and in your case, it is classified as moderate. Oligospermia means that the concentration of sperm in your semen is lower than what is typically considered normal. It is important to note that having a lower sperm count can make it more difficult for you to father a child. However, it does not mean that it is impossible. It is advisable to speak with a healthcare professional for further guidance and advice on potential treatments or lifestyle changes that may help improve your sperm count.
What are the causes of a sperm count of 15 million?
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.
5
Hypothyroidism
Hypothyroidism is a condition where the thyroid gland in the neck does not produce enough thyroid hormone. This hormone is important for regulating many processes in the body, including sperm production. A simple blood test called TSH (thyroid-stimulating hormone) can be done to check for hypothyroidism. If diagnosed, treatment with thyroid hormone replacement medication can help improve sperm count.
Prolactinoma
Prolactinoma is a condition characterized by the presence of a benign tumor in the pituitary gland, which leads to excessive production of the hormone prolactin. This excess prolactin can suppress the hypothalamus, the part of the brain that controls the production of other important hormones. Blood tests can be done to measure prolactin levels, and imaging tests like MRI can help visualize the pituitary gland and detect the tumor. Treatment options include medication to reduce prolactin levels or surgery to remove the tumor.
Sarcoidosis
Sarcoidosis is a condition where abnormal immune cells form small clusters called granulomas, which can cause inflammation and disrupt normal pituitary function. This can affect hormone production, including the hormones involved in sperm production. Diagnosis of sarcoidosis may involve chest X-rays, blood tests, and sometimes a biopsy of affected tissues. Treatment options depend on the severity of symptoms and may include medication to reduce inflammation and manage symptoms.
Hemochromatosis
Hemochromatosis is a genetic disorder where the body absorbs too much iron from the diet, leading to iron buildup in organs such as the pituitary gland. This iron overload can disrupt pituitary function and affect hormone production, including those involved in sperm production. Diagnosis of hemochromatosis involves blood tests to measure iron levels and genetic testing to check for specific gene mutations. Treatment typically involves regular blood removal (phlebotomy) to reduce iron levels.
Testicular Injury
Testicular injury can occur due to various reasons such as torsion (twisting), trauma, accidents, spinal cord injury, chemotherapy, or radiation. These factors can directly damage the testicles and affect sperm production. Physical examination and medical history can help identify the cause of testicular injury. Imaging tests like ultrasound or MRI may be performed to assess the extent of damage. Treatment options depend on the specific cause but may include surgical intervention, medication, or supportive measures.
Infections - Prostatitis
Prostatitis is the inflammation of the prostate gland, which can be caused by bacterial infections. Inflammation in the prostate can disrupt the normal functioning of the reproductive system, including sperm production. Diagnosis of prostatitis involves a physical examination, urine tests, and sometimes prostate fluid analysis. Treatment usually involves antibiotics to target the infection and anti-inflammatory medication to reduce inflammation.
Kleinfelter's Syndrome
Kleinfelter's syndrome is a genetic condition where males have an extra X chromosome, resulting in abnormal testicular development. This can lead to reduced or absent sperm production, known as azoospermia or oligospermia. Diagnosis of Kleinfelter's syndrome involves genetic testing to identify the extra X chromosome. Fertility treatments such as assisted reproductive techniques may be considered for individuals with oligospermia who desire to father children.
Congenital Adrenal Hyperplasia
Congenital adrenal hyperplasia is a genetic disorder where the adrenal glands produce excessive amounts of androgens (male hormones). These elevated androgen levels can suppress the pituitary gland, leading to decreased production of hormones involved in sperm production. Diagnosis involves hormone level tests and genetic testing. Treatment may involve hormone replacement therapy to regulate hormone levels and manage symptoms.
Hyperthyroidism
Hyperthyroidism is a condition where the thyroid gland produces an excess amount of thyroid hormone. This can lead to a state of hormonal imbalance, including increased estrogen levels. Elevated estrogen can negatively affect sperm production. Blood tests, including TSH and thyroid hormone levels, can help diagnose hyperthyroidism. Treatment options may include medication to regulate thyroid hormone levels or, in some cases, radioactive iodine therapy or surgery to remove part of the thyroid gland.
Pituitary Adenoma
Pituitary adenoma refers to a non-cancerous tumor that develops in the pituitary gland. This tumor can exert pressure on the cells responsible for producing the hormones LH and FSH, which are essential for sperm production. Imaging tests like MRI can help detect the presence and size of the tumor. Hormone level tests may also be done to evaluate the impact on LH and FSH production. Treatment options depend on the size and location of the tumor and may include medication, radiation therapy, or surgery.
Questions to ask yourself for a sperm count of 15 million
Age at which you had puberty
Have you ever experienced any physical changes such as voice deepening, growth of body hair, or development of facial hair during your teenage years?
Surgery on testicles
Have you ever undergone surgery on your testicles?
Any trouble with sexual drive or function
Have you ever experienced any difficulties or changes in your sexual desire or ability?
Sexually transmitted infections
Have you ever had any sexually transmitted infections in the past?
Infections of prostate or testicle
Have you ever experienced any infections or inflammation in your prostate or testicles?
Have you ever taken any medications in the past or currently taking any medications that could potentially affect your sperm count?
Use of alcohol, tobacco, illicit drugs
Have you ever consumed alcohol, smoked tobacco, or used any illicit drugs?
Systemic disease
Have you ever been diagnosed with any medical conditions that affect your entire 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 that involves potential harmful exposures? Please provide any relevant details.
Any Cancer diagnosis or treatment
Have you ever received a diagnosis of cancer or undergone any cancer treatments?
What will be done during medical checkup for sperm count of 15 million?
Is your sexual development complete ? - Tanner stage
The doctor wants to check if your sexual development is complete by assessing your Tanner stage. This involves examining physical changes in your body that occur during puberty. The doctor will look at the development of your genitals, pubic hair, and other secondary sexual characteristics such as breast growth for girls or facial hair growth for boys. They will compare these changes to a scale called the Tanner stage, which helps determine your level of sexual maturity. This examination will help the doctor better understand your overall development and may provide insights into your fertility potential.
Do you show signs of a mass in the brain? - Bitemporal hemianopsia (pituitary mass)
The doctor will check if you have a mass in your brain by looking for a condition called bitemporal hemianopsia. This means that you may have a pituitary mass that is pressing on your optic nerves, causing a loss of vision on the outer sides of your visual field. The doctor will perform a visual field test to check if you have this condition. If bitemporal hemianopsia is present, further tests like an MRI or CT scan may be needed to confirm the presence of a pituitary mass. It is important to detect and treat this condition early to prevent any further complications.
Is your testicle size normal ? Reduced testicular volume (<15 cc)
The doctor will examine your testicles to see if they are a normal size. They will gently feel and measure your testicles to check their volume. If the volume is less than 15 cc, it means they are smaller than what is considered normal. This could be a sign of a problem with your fertility. The doctor will discuss the results with you and may recommend further tests or treatments to help improve your sperm count.
Is there a mass in your testicle? - Testicular mass
A testicular mass refers to an abnormal lump or swelling in one or both testicles. To examine for a testicular mass, the doctor will gently feel and inspect the testicles using their hands. This is known as a testicular examination or palpation. The doctor will check for any unusual growths, lumps, or changes in size, shape, or texture of the testicles. The purpose of this examination is to detect any potential abnormalities that may require further investigation or treatment. It is a relatively quick and painless procedure that can provide important information about the health of the testicles.
Is the natural tube from testicles missing from either side? - Presence of vas deferens bilaterally
The doctor will perform an examination to determine if the natural tube that connects the testicles to the urethra is missing on either side. This tube is called the vas deferens. The examination will involve a physical assessment of the scrotum and surrounding areas to check for any abnormalities or signs of the vas deferens. The doctor may also use imaging tests, such as ultrasound, to get a clearer picture. Ultimately, the goal is to determine whether the vas deferens is present on both sides or if there is any absence or blockage that could be affecting the sperm count.
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 to check for any cyst or swelling in the testicular sac. This involves feeling the testicles with their hands to detect any abnormal lumps or growths. They will also look for the presence of varicocele, which is an enlarged vein in the scrotum that can sometimes cause fertility problems. Additionally, the doctor will check for any other scrotal masses that could be causing the low sperm count. This examination is important to help identify any potential issues that could be affecting the patient's fertility.
Are the testicles missing? - Presence of cryptorchidism or hypospadias
The doctor will check if the testicles are missing by performing a physical examination. This involves feeling the scrotum to see if the testicles can be felt. If they cannot be felt, it may indicate a condition called cryptorchidism, where the testicles have not descended into the scrotum. The doctor will also examine the penis to check for hypospadias, a condition where the opening of the urethra is not at the tip of the penis. These examinations will help the doctor determine if there are any abnormalities that could be causing the low sperm count.
The doctor will carefully examine the patient's second and third knuckles to check for any signs of inflammation or swelling, which could indicate a condition called synovitis. They will also closely observe the color of the patient's skin to see if it has a bronzed appearance, which could suggest liver disease or heart failure. This discoloration may be caused by a condition called hemochromatosis, where there is an excess of iron in the body. By conducting these examinations, the doctor aims to gather information and determine if there are any joint problems or underlying conditions that may be contributing to the patient's symptoms or low sperm count.
Is the patient on muscle building steroids? Presence of marked muscle hypertrophy suggesting anabolic steroid use
The doctor will look for signs of muscle growth in the patient's body that may indicate the use of muscle building steroids. This could involve examining the patient's overall physique, particularly the size and definition of their muscles. The doctor may also check for any unusual or disproportionate muscle development in certain areas of the body. Additionally, the doctor might ask the patient about their exercise routine, dietary habits, and any supplements they may be taking to gain a better understanding of their muscle growth. Based on these observations and information, the doctor can determine if the patient is using anabolic steroids to enhance muscle growth.
What additional tests are to be done for a sperm count of 15 million?
Step 1 : Test FSH, LH, Prolactin and Testosterone levels
When a person is experiencing infertility, doctors may want to check their levels of four hormones called FSH, LH, prolactin, and testosterone. FSH and LH are important for sperm production and release. Prolactin is a hormone that can affect fertility if it is too high. Testosterone is a hormone that plays a role in sperm production. By checking these hormone levels, doctors can get a better understanding of what might be causing the low sperm count and help the patient with their fertility concerns.
Step 2 : Are FSH and LH lower than normal?
If a patient has a low sperm count of 15, it may indicate infertility. One possible reason for this could be that the pituitary gland, which produces hormones like FSH and LH, is not functioning properly. If these hormone levels are lower than normal, it suggests that the pituitary is not making enough hormones. In such cases, doctors may recommend further investigations like an MRI to check for any abnormalities in the pituitary gland. Additionally, they may also look for systemic diseases like hemochromatosis (a condition where the body absorbs too much iron) or sarcoidosis (an inflammatory disease) as potential causes.
Step 3 : Are FSH and LH too high?
If a person's FSH and LH levels are high, it suggests that their testicles are not producing enough sperm. This could be due to various factors like problems in the testicles themselves, autoimmune diseases, or genetic issues. To further investigate the cause, doctors may recommend additional tests, such as examining the person's genetic makeup (karyotype). These tests can help identify the underlying problem and guide the appropriate treatment.
Step 4 : Are LH and Testosterone Normal?
If a person's sperm count is 15 and they are being evaluated for infertility, it is important to check the levels of LH (luteinizing hormone) and testosterone. In this case, LH and testosterone are found to be normal, which means that the pituitary gland is functioning properly and the cells responsible for producing testosterone are working as well. However, the level of FSH (follicle-stimulating hormone) is elevated. This could be due to unknown reasons (idiopathic), genetics, or certain medications. Further investigation is recommended to determine the specific cause.
Step 5 : Are LH and Testosterone high?
When a patient has a low sperm count of 15, it is possible that LH (luteinizing hormone) and testosterone levels are high. This could indicate a condition called androgenic insensitivity, which means the body is not responding properly to these hormones. Androgens like testosterone play a crucial role in sperm production, so when the body doesn't respond well to them, it can lead to infertility. To further investigate this condition, doctors may recommend additional tests to determine the exact cause and explore potential treatment options.
Is there any treatment for sperm count of 15 million?
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 refers to a condition where a person has a low sperm count due to blockages in the reproductive system that prevent the release of sperm.
Understanding Ejaculatory Duct and Prostatic Midline Cysts
Ejaculatory duct and prostatic midline cysts are conditions that can contribute to a low sperm count, causing difficulties in conception.
Understanding Gonadotropin Deficiency and Low Sperm Count
Gonadotropin deficiency is a condition where the body doesn't produce enough hormones needed for sperm production, leading to a low sperm count.
Understanding Low Sperm Count
Low sperm count refers to having a lower than normal amount of sperm in the semen, which can affect a man's ability to father a child.
Understanding Sperm Autoimmunity
Sperm autoimmunity is 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 contribute to decreased sperm production, leading to a low sperm count.
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. However, these effects can be reversed once the exposure to the toxin is eliminated.
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: Primary Seminiferous Tubular Failure
Primary seminiferous tubular failure refers to a condition where the testicles are unable to produce enough sperm, resulting in a low sperm count.
Understanding Sertoli Cell-Only Syndrome: A Condition Causing Low Sperm Count
Sertoli cell-only syndrome is a condition characterized by the absence of sperm cells in the semen, leading to a low sperm count.
Understanding Bilateral Orchiectomy for Low Sperm Count
Bilateral orchiectomy is a surgical procedure where both testicles are removed to treat low sperm count in men.
Is pregnancy possible with a sperm count of 15 million?
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 a technique used to help couples who are struggling to have a baby due to a low sperm count. This procedure involves collecting a small sample of the man's sperm and specially treating it in a lab to increase the chances of fertilization. Then, during a woman's natural cycle, doctors place the treated sperm directly into her uterus using a thin tube. This way, the sperm can swim closer to the egg, increasing the likelihood of successful fertilization and pregnancy. Intra Uterine Implantation is a safe and relatively simple procedure that can bring hope to couples who are trying to conceive.
Intra Cytoplasmic Sperm
Intra Cytoplasmic Sperm Injection (ICSI) is a method used to help couples who are struggling to conceive due to a low sperm count. During ICSI, a single healthy sperm is carefully selected and directly injected into the woman's egg using a tiny needle. This technique bypasses the need for the sperm to naturally reach and fertilize the egg. After the injection, the fertilized egg is then placed back into the woman's uterus where it has the potential to develop into a baby. ICSI has proven to be a successful and effective way for couples to overcome low sperm count and increase their chances of achieving a pregnancy.
In Vitro Fertilization
In Vitro Fertilization (IVF) is a technique that can help couples who are struggling to have a baby due to a low sperm count. It involves combining the eggs from the woman with the sperm from the man in a laboratory dish. This allows the fertilization process to happen outside the body. Once the eggs are fertilized, they are carefully monitored to ensure they develop into embryos. The healthiest embryos are then transferred back into the woman's uterus, where they may implant and result in a successful pregnancy. IVF offers hope to couples facing fertility challenges by bypassing the low sperm count issue and giving them a chance to fulfill their dream of having a baby.
What is a good plan ART (assisted reproductive technique) plan of action for a sperm count of 15 million?
Based on the patient's sperm concentration of 5.0 million/ml, the recommended treatment plan would be to start with Intra Uterine Implantation, as it is less invasive and cost-effective. However, since the patient's sperm count is below the recommended threshold of 10 million/ml, Intra Cytoplasmic Sperm Injection may be the more suitable option, with an efficacy of around 24.2% for low sperm counts. If ICSI is not successful, In Vitro Fertilization can be considered as the second line of treatment after 3-4 cycles of IUI, with success rates ranging from 7% to 14.3% based on the sperm count.
123
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