Author Name: Dr. Trupthi Ganpathi || Mentor Name: Dr. Rinoy S. on April 10, 2020

Sperm count is one of the most important parameters for conception. Sperm count can be determined by doing a semen analysis. Semen analysis is a detailed examination of all semen parameters including sperm count, motility, morphology of sperms, presence of infection etc. It is a vital part of routine evaluation for all infertile couples seeking fertility solutions along with other investigations.

Prevalence of infertility
As per various studies one in 8 women and one in 10 men have experienced infertility. Some studies have shown that in Indian couples seeking treatment, male factor is the cause in approximately 23%.

Understanding the function of male reproductive system.
The male reproductive system produces sperms, stores them, matures them & transports them out of the body. Under the influence of male sex hormone – testosterone, the production of sperms occurs in the testis.
From testis the sperms travel to a structure called epididymis, from epididymis they again travel through the tubes called the vas deferens. It is joined by supporting glands called seminal vesicle & ejaculatory duct. On ejaculation sperm mixes with fluid of seminal vesicles & prostate to form semen. Semen travels through urethra out of the body.

SEMEN PARAMETERS Normal Values
Semen volume (ml) 1.5ML
Sperm concentration (106 /ml) 15
Total number (106 /Ejaculate) 39
Total motility 40%
Progressive motility 32%
Normal forms 4%
Vitality (%) 58%

Semen parameters as per WHO criteria :
When there is reduction in sperm count with or without other semen parameters in at least 2 samples collected one to four weeks apart, then there is difficulty in conception. Not just the sperm count, the semen quality in total is used to assess male fecundity.

Sperm Parameters which meet WHO values can be considered Normozoospermic.
Reduced sperm count is termed Oligozoospermia.
No sperms seen in semen is termed Azoospermia.

Increased abnormal sperms is called Teratozoospermia. Sperm morphology is a very strong indicator of a male’s fertility potential which reflects a male’s reaction to environmental stress besides some genetic causes as well. Assessment of sperm morphology though very important is very subjective.
Sperm morphology can also help in clinical decision making to choose the modality of treatment most likely to yield results.

Motility is classified as rapid progressive , slowly progressive & non progressive. Reduced motility- less than 40% is Asthenozoospermia. Reduced sperm motility can have a genetic cause or an undiagnosed medical condition. It can also be due to environmental factors and unhealthy lifestyle.

Factors affecting sperm count
One of the commonest causes of a low sperm count is incorrect or incomplete collection of a semen sample. That is why most clinics recommend to have two or more semen samples checked before concluding a diagnosis. Clinical studies have seen seasonal variations in the semen count in some patients. Apart from this, lifestyle & occupation hazards also affect sperm count. It has also been noted that lower sperm count is seen among IT professionals who work long hours with their laptops in their lap. This again is probably as a result of high temperature around the testicles. Once an abnormal semen analysis has been reported it is important to know the cause of the abnormal report and accordingly treatment modality can be offered to the couple.

What could be Causes for abnormal semen parameters?

Abnormal semen parameters can be caused by any of the below mentioned causes
1. Hormonal imbalances of key hormones like FSH and LH leading to deficiency of testosterone production manifesting as low sperm counts

2. Genetic causes like Klinfelters syndrome (47XXY), Y chromosome micro deletion.

3. Presence of dilated veins around the testis which is called Varicocele can also lead to low sperm count and motility due to increased temperature around the testicles.

4. Testicular injury due to trauma, torsion

5. Orchitis/ infection of testis may damage the testis or block the tubules carrying the sperms from the testis resulting in decreased or zero sperm count.

6. Exposure to Gonadotoxins like radiation during anticancer therapy, lifestyle toxicants leading to damage of sperm producing tissues in the testis leading to abnormal semen parameters.

7. Presence of Systemic diseases like liver failure, Chronic renal failure can also lower your sperm count

8. Obesity can cause hormonal changes which lower sperm count.

9. High alcohol intake can adversely affect your sperm count. Adopting a healthy lifestyle with weight reduction and abstinence from alcohol and smoking can bring about an improvement

10. Smoking can affect the sperm count, motility and morphology by giving rise to oxidative free radicals which can damage testicular tissue

11. Prior surgery like hernia repair, scrotal surgery can bring about a reduction in sperm parameters.

12. Antisperm antibodies are cells that may identify sperm as a foreign body and try to eliminate them resulting in altered semen profiles.

13. Use of medications like anabolic steroids or testosterone supplements without supervision.

Treatment Overview
A detailed history with local examination is the first step towards identifying the probable cause of low sperm count. Other measures that can be taken are as follows:

1. Hormone profile study and Endocrinologist opinion for further therapy
2. Scrotal Ultrasound along with urologist opinion for medical/surgical management
3. Antioxidant therapy to combat the effects of stress on testicular tissue
4. Lifestyle changes with adequate sleep and hydration
5. Weight reduction
6. Sperm Cryopreservation for males who are scheduled to undergo cancer therapy
7. Avoid alcohol and smoking

Current trend in semen parameters
Current trend shows that male infertility is on the rise. The reason for fall in semen count & quality may be nutritional, socioeconomic , environmental and sometimes unknown causes.

Conclusion
Sperm count is not the only parameter to look for in a semen analysis report. Sperm motility, sperm morphology I.e., size, shape and appearance of the sperm are equally important in determining a male’s fertility potential.
If you have a low sperm count, reduced sperm motility or more number of abnormal sperms you must talk to a Fertility Expert who can address your concerns and suggest treatment options like

1. Intrauterine Insemination- IUI
2. In Vitro Fertilisation-IVF/ Intracytoplasmic Sperm Injection.
Which can help you achieve your dreaming of becoming a parent

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