Oligospermia – Shushrusha Ayurved & Chikitsa

Oligospermia (Low Sperm Count)

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Overview

What is oligospermia (low sperm count)?

Oligospermia is a term that means you have a low sperm count. One medical definition is that you have fewer than 15 million sperm in 1 milliliter of semen. A typical sperm count is more than 15 million sperm per 1 milliliter of semen.

Besides being known as low sperm count, oligospermia is also called oligozoospermia. A severely low sperm count (fewer than 5 million sperm in 1 milliliter of semen) is also known as severe oligospermia.

What is the difference between oligospermia and azoospermia?

Oligospermia means that you do have a measurable amount of sperm in your semen, but the numbers are lower than the typical numbers. If you have azoospermia, it means there no sperm seen in your semen.

Having a low sperm count is a significant factor in infertility. You may be infertile if you’ve been trying to get pregnant (or get someone pregnant) for a year and haven’t yet done so. This means that for at least a year you’ve been having regular sex without using birth control methods.

How common is oligospermia?

Researchers aren’t sure how many people have oligospermia. The condition isn’t usually diagnosed unless a couple is trying to conceive and can’t. There are an estimated 180 million couples throughout the world who are dealing with infertility.

Infertility among people who have been assigned male at birth contributes to about half of the infertility issues overall. (Healthcare providers may call this male infertility or male-factor infertility.) This figure of about 50% includes situations where male factor infertility is the only factor and those more common situations where there are fertility factors in both partners.

Symptoms and Causes

What are the signs and symptoms of oligospermia?

The main sign or symptom of a low sperm count is the inability to conceive a baby with a partner after one year of unprotected sexual intercourse.

What causes a low sperm count?

There are a variety of things that could cause you to experience oligospermia or other sperm disorders. The list of causes include:

Diseases, including those related to genetics, infection, hormones and obstructions (blockages).
Environmental toxins.
Heat.
Drugs.

Diseases and conditions

Some of the diseases that can cause a low sperm count include:

Genetic conditions such as Klinefelter syndrome and cystic fibrosis.
Infections such as sexually transmitted infections, urinary tract infections, and viral illnesses including mumps.
Issues like low testosterone and other hormonal abnormalities. Hypogonadism is a condition where the sex glands don’t produce enough sex hormones.
Blockages that stop sperm from leaving your body.

Toxins

Toxins aren’t good for any part of your body, including sperm count. Some of the toxins that are present in the environment include heavy metals like arsenic, cadmium, lead and mercury.

Heat

Your testicles work best at a particular temperature, which is slightly lower than your body temperature. Heat-related situations that affect sperm production include:

Having undescended testicles. If the testicles are still up near the groin, they’re too hot.
Having varicocele. These twisted veins can be large and can increase the temperature of the testicles.
Spending a long time in hot tubs. This cause may be reversed – your sperm count could increase once you stop spending time in hot water.

Medications and drugs

Both prescribed medications and non-prescription substances can make your sperm count low. There are many categories of medications that can be involved. Some of these medications include:

Testosterone.
Methadone.
Nitrofurantoin.
Lamotrigine.
Clomipramine.
Paroxetine.
Prednisone.
Methotrexate.
Finasteride.
Sirolimus

There are many other medications that may affect sperm counts. Check with your healthcare provider or pharmacist if you think your medication may be causing problems. Don’t stop taking prescribed medications on your own without discussing with your healthcare provider.

Diagnosis

To diagnose a spermatocele, you’ll need a physical exam. Although a spermatocele generally isn’t painful, you might feel discomfort when your doctor examines (palpates) the mass.

You might also undergo the following diagnostic tests:

Transillumination. Your doctor might shine a light through your scrotum. With a spermatocele, the light will indicate that the mass is fluid-filled rather than solid.
Ultrasound. If transillumination doesn’t clearly indicate a cyst, an ultrasound can help determine what else it might be. This test, which uses high-frequency sound waves to create images of structures, might be used to rule out a testicular tumor or other cause of scrotal swelling.

Treatment

Although your spermatocele probably won’t go away on its own, most spermatoceles don’t need treatment. They generally don’t cause pain or complications. If yours is painful, your doctor might recommend over-the-counter pain medications, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

Surgical treatment

A procedure called a spermatocelectomy generally is performed on an outpatient basis, using a local or general anesthetic. The surgeon makes an incision in the scrotum and separates the spermatocele from the epididymis.

After surgery, you might need to wear a gauze-filled athletic supporter to apply pressure to and protect the site of the incision. Your doctor might also tell you to:

Apply ice packs for two or three days to keep swelling down
Take oral pain medications for a day or two
Return for a follow-up exam between one and three weeks after surgery

Possible complications from surgical removal that might affect fertility include damage to the epididymis or to the tube that transports sperm (vas deferens). It’s also possible that a spermatocele might come back, even after surgery.

Aspiration, with or without sclerotherapy

Other treatments include aspiration and sclerotherapy, though these are rarely used. During aspiration, a special needle is inserted into the spermatocele and fluid is removed (aspirated).

If the spermatocele recurs, your doctor might recommend aspirating the fluid again and then injecting an irritating chemical into the sac (sclerotherapy). The irritating agent causes the spermatocele sac to scar, which takes up the space the fluid occupied and lowers the risk of the spermatocele coming back.

Damage to the epididymis is a possible complication of sclerotherapy. It’s also possible that your spermatocele might come back.

Protecting your fertility

Surgery can potentially cause damage to the epididymis or the vas deferens, and sclerotherapy might damage the epididymis, which can affect fertility. Because of this concern, these procedures might be delayed until you’re done having children. If the spermatocele is causing so much discomfort that you don’t want to wait, talk with your doctor about the risks and benefits of sperm banking.

Preparing for your appointment

You’re likely to start by first seeing your family doctor or a general practitioner. However, you might then be referred to a doctor who specializes in treating the urinary tract and sex organs in men (urologist).

Because appointments can be brief, and there’s often a lot to remember, it’s a good idea to arrive well-prepared. Here’s some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

Write down any symptoms you’re experiencing, including any that might seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any testicular injuries.
Write down questions to ask your doctor.

Your time with your doctor is often limited, so preparing a list of questions can help you make the most of your time together. For spermatocele, some basic questions to ask your doctor include:

What’s the most likely cause of my symptoms?
What kinds of tests do I need? Do these tests require any special preparation?
Is this condition temporary or long lasting?
Will spermatocele affect my ability to have sex?
Will this condition affect my fertility?
Do I need treatment?
What treatments are available, and which do you recommend?
What types of side effects can I expect from treatment?
How long after surgery do I need to wait before returning to normal activities?
How long after surgery do I need to wait before resuming sexual activity?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them might reserve time to go over any points you want to spend more time on. Your doctor might ask:

What types of symptoms are you experiencing?
How often are you having symptoms?
How long ago did your symptoms begin?
How severe are your symptoms?
Does anything seem to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Have you experienced any trauma to your scrotal area?

What you can do in the meantime

If the spermatocele is causing pain, most people can safely take over-the-counter pain medications, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others), to ease the discomfort.