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My partner and I have been trying to have a child for two years. We recently went for fertility testing and were surprised to learn that he has a low sperm count and the quality of his sperm isn’t very good. Is there anything he could be doing to improve the quality or volume of his sperm? What are our options in terms of fertility treatments?

Written by our medical expert Dr. Stephen Hudson, Director of the Victoria Fertility Centre in British Columbia, Canada.

Approximately 1 in 7 couples have difficulty conceiving. In about ¼ of couples there may be a male factor identified. However, there may be multiple causes and in my experience there is often more than one factor. So although in your case a male factor has been identified, it is extremely important that you are also fully assessed.

I’d like to make a few points about the Semen Analysis:

  1. The are 3 important factors we look at in a semen analysis. The count is the number of sperm present. Ideally we like there to be more than 10–15 million sperm per ml. The motility of the sperm means how many are moving and how many are moving progressively forward. The morphology refers to the shape of the sperm. All three factors are important in assessing male fertility. There are also very strict criteria for calling a sperm “normal.” It surprises every couple to know that we only expect 3% to 4% of sperm to look perfect.
  2. A man’s sperm test results may vary from month to month. I always recommend that at least 2 or 3 samples are tested – at least a few weeks apart. It is critical that the sample is correctly collected, to ensure accurate results.
  3. It is very important that the semen analysis is done by an experienced andrologist, to ensure the analysis and interpretation are accurate.

If repeated analyses do show a low sperm count, my usual approach is as follows:

  1. Take a good history, and make sure there are no identifiable medical or lifestyle factors causing the count to be low (e.g., previous surgeries, marijuana use, excessive hot tub use, certain prescription medications).
  2. Conduct a thorough clinical examination including a genital exam to assess the testes and scrotal contents for abnormalities (e.g.,varicocoeles, tumours).
  3. If indicated, do further investigations such as a scrotal ultrasound, blood tests to check hormone levels, and perhaps an infectious disease screen. If the man’s sperm count is under 5 million per ml, I usually also check his chromosomes.

Some of the common causes for male infertility include: varicocoele (a dilated blood vessel in the scrotum that can raise the temperature in the scrotum and affect sperm quality); infections; hormonal problems; oxidative stress caused by the presence of reactive oxygen species (waste products of cell metabolism); blockages or narrowing of the plumbing in the man’s genital tract; smoking; excessive alcohol use; and certain prescription medications for non-related medical conditions. If we are able to identify the cause or causes of the problem, in some cases these can be successfully corrected (e.g. varicocoele repair).

A man may also improve his fertility by: adopting a healthier lifestyle (reducing or eliminate smoking; limiting alcohol use; eating a healthy diet rich in greens); avoiding heat exposure to the genitals (i.e., avoid hot tubs, saunas, high temperature environments); and avoiding exposure to toxins such as solvents, pesticides, organic fumes, etc. Certain nutritional supplements with anti-oxidants may also be helpful. However, in my opinion there is no substitute for a healthy diet rich in greens and a lifestyle that includes regular exercise and adequate water intake.

There are also very effective treatments to help couples where a male factor is identified.

  1. IUI: This stands for intra uterine insemination and is usually combined with the use of a fertility drug to increase the number of eggs released. The expectations for success depend on the sperm count (i.e., it is not suitable if the counts are severely low), and on the female’s age and reproductive health.
  2. In vitro fertilization (IVF) and Intra cytoplasmic sperm injection (ICSI). This is the most advanced form of technology we have and has very good success rates when the sperm parameters are very poor.

My best advice is that you speak with an infertility specialist who can thoroughly evaluate you and your husband, and explain what your options are.

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