Infertility in Men

All about sperm count

There is an almost instant conclusion in society that when a couple cannot conceive, the woman must be the cause; she is barren. Relatives and friends would hope-and sometimes have the audacity to suggest-that the woman should be abandoned. The man should move on with his life. Today there is increasing awareness that men, too, can lack the ability to bear children. It is a devastating thought for most men, but one needs to face reality and seek a solution to the problem. It begins with every man asking himself: ‘Am I fertile?’ or ‘How fertile am I?’

When a couple has had no child for at least a year or more despite regular, unprotected intercourse, the couple is said to have a fertility problem. They should visit a doctor, who will evaluate them and help them identify the cause of their childlessness.

The couple’s history, both individually and as husband and wife, is important to establish the cause of infertility. For instance; suppose a man has two wives, and one wife has two children with the last born being six months old. It is unlikely that the man is infertile, unless he did not sire the two children and he does not know that. The investigations carried out should always follow a logical approach.

Where it all begins
Male fertility depends on the production of normal sperm, and its delivery to a female partner’s egg. The process begins with the development of sperms (the short form for spermatozoon or spermatozoa in plural) in the testicles, or spermatogenesis. Sperm is the male reproductive cell. Sperm cells are produced through a complicated process of cell division, that occurs over a period of several months. Once formed, sperms leave the testicles and are stored and fully develop in the epididymis-an elongated, cord-like structure at the back of the testes with coiled ducts that provide for storage, transportation and maturation of sperm.

They are then pushed through the vas deferens, the tube which leads to the semen sac. During ejaculation the semen containing sperm leaves the semen sac, to pass through the urethra, the duct by which urine is also released from the body. The production and maturation of sperm, require the presence of a favourable environment and good genes.

Male infertility is any condition in which the man has little or no chance, of initiating a pregnancy with his female partner. Most commonly those problems arise when the man is unable to produce or deliver fully-functioning sperm.

Understanding sperm count
A baby is conceived when the male sperm fertilises a female egg (or ovum). Sperms are produced in the male testicles, and are held in fluid referred to as semen. The purpose of semen is purely for reproduction, as a vehicle to carry the spermatozoa into the female reproductive tract. The average volume of semen produced at ejaculation is 2 to 5 millilitres (ml).

Sperm count is the concentration of spermatozoa in a semen sample. Low sperm count or total absence of sperm, is generally an indication of male infertility. The World Health Organisation provides a definition of a ‘normal’ sperm count.

  • the concentration of spermatozoa should be at least 20 million per ml
  • the total volume of semen for every ejaculate should be at least 2 ml
  • the total number of spermatozoa in the ejaculate should be at least 40 million
  • at least 75 per cent of the spermatozoa should be alive (it is normal for up to 25 per cent to be dead)
  • at least 30 per cent of the spermatozoa should be of normal shape and form
  • at least 25 per cent of the spermatozoa should be swimming with rapid forward movement (motility)
  • at least 50 per cent of the spermatozoa should be swimming forward, even if only sluggishly.

Low sperm count and poor sperm motility
A low sperm count (less than 20 million sperms per ml) is referred to as oligospermia, and total absence of sperm in the semen is referred to as azoospermia. It is important to realise that some men with low sperm count will still prove fertile while others with higher count prove infertile because quality of the sperm is also a determinant. Infertility in men has a number of possible causes which lead to low sperm count or lack of motility (ability to move). However, causes to a large number of them are unknown.

Heat can reduce sperm production. This is why the testicles are located outside the body in the scrotum rather than in the abdomen like the ovaries in women. Though medical opinion is divided on how important the following factors are, it is important for men to be cautious when soaking themselves in saunas and hot baths; some overweight men can become sterile because the sagging layers of fat can overheat the testicles; and some men whose jobs involve long durations of exposure to heat may also experience impaired fertility.

Too frequent intercourse (for instance daily), can lead to a dramatic reduction in sperm count and cause the man to be effectively infertile. If you ejaculate as much as two to three times a day you are likely to have a problem maintaining the appropriate sperm count. If you want to be at your most fertile you have to wait for at least three days between each ejaculation!

The workaholic man, on the other hand, can find that fatigue can have similar effects on his interest in intercourse. Another possible cause is disorders of the brain. The main ones are congenital disorders, in which part of the master gland in the brain is structurally defective. For the testicles to be functional there are some hormones that arise from the brain, in the area known as the pituitary or master gland. For a variety of reasons, that area of the brain may not be adequately functional. The master gland controls the functions of all other hormone- producing glands, including those of the reproductive system.

Therefore, if it is defective the whole system fails- resulting in the lack of release of hormones responsible for sperm production.

In some rare cases infertility can also be due to some brain tumours, which render that area of the brain dysfunctional. There is therefore no stimulus to the testicles, to trigger the formation of sperm. This is a potentially correctable problem. The function of the brain can be adjusted in a manner that can reverse the apparent infertility.

Some genital infections lead to blockage of the sperm ducts. These are the passages that spermatozoa pass through after production in the testicles. Obstruction of these passages leads to inability of sperms to move from the site of production to the exit. Majority of such infections are sexually acquired, such as gonorrhea and chlamydia.

Another cause is damage to the seminiferous tubules. These are the structures within the testicles that are responsible for producing sperms. These areas may be damaged, following the use of some types of medication. For example, medication used in the treatment of a variety of cancers can lead to the destruction of the area within the testicles. Destruction can also be due to radiotherapy for the management of cancer, within the genital structures. This is relative as it depends on the severity of damage.

Abusing drugs can also lead to infertility. Smoking over 20 cigarettes a day has been shown to reduce both the sperm count and sperm motility. Stop or reduce smoking! Excessive alcohol intake can also lead to low sperm count.

What are the remedies for male infertility?
The interventions addressing low sperm count, or lack of production of sperm, are aimed at stimulating an increase in sperm production and mobility. The treatment depends on the cause of infertility.

For instance, if ones tubes (that transport the sperms) are blocked, then the potential intervention would be surgical reconstruction- a surgical procedure that would remove obstruction in the passage. This kind of surgery is difficult, and often unsuccessful.

If it is due to lack of production of hormones, the intervention is to give the individual the artificial hormone that is making him infertile.

In the case of cancer treatment where there is the potential of damage to the seminiferous tubule where sperms are produced, prior arrangement can be made to preserve the patient’s sperms in a sperm bank, for possible future artificial insemination. The individual who is about to undergo radiotherapy can produce sperms, which are then stored for many years. After the cancer treatment has been administered, and damage is found to have occurred to the seminiferous tubules, the stored sperms can be used to enable that the individual can conceive.

END: PG 04 DEC 06-JAN 07/12-13

Leave a Comment

You must be logged in to post a comment.