Low Sperm Count, Volume, Motility or Morphology
Being diagnosed with low sperm counts, volume, motility or morphology can be troubling for couples. The good news is that oftentimes there are things that can be done to help.
The primary factors that doctors look at in the semen analysis include an assessment of: volume, concentration, motility and morphology.
Volume looks at the amount of fluid that is expelled from the urethra when a man ejaculates. This can be low from several causes. There can be some type of mechanical blockage, such as a narrowed area in the urethra tube from a prior surgery. There can be an actual loss of the amount of fluid being produced, such as from a prostate infection or stone. Or there can be a mis-direction of the ejaculate fluid, such as into the bladder instead of out of the urethra. A normal ejaculate volume is more than 1.5 mL.
Low sperm count is an abnormally low number of sperm in the ejaculate. This can be “oligospermia”, which means low sperm count; Or “azoospermia” which means no sperm in the ejaculate. This is expressed in million sperm per milliliter. Low sperm counts (or no sperm) can be due to either an impairment in sperm production or a blockage so the sperm cannot be released into the ejaculate. A normal sperm concentration is 15 million sperm/mL or more.
Motility is the number of sperm that are swimming. This usually includes both the fast swimmers and slow swimmers, because some of the slow swimming sperm will speed up when they enter the female reproductive tract. It is better to have more swimming sperm, because more sperm will be able to swim toward the female egg. The normal value for motility is variable based on the grading system, but is generally considered normal if more than 40% of sperm are swimming.
Morphology is the number of sperm that look normal. This is this is assessed by looking at sperm under the microscope. This number is also dependent on the grading system being used. Of all of the semen analysis parameters, morphology is the most subjective in grading. Most sperm do not look perfect, and a normal percent is usually more than 4% normal.
The causes for abnormalities in the semen analysis can be determined by a careful history and physical exam. We may also need to get specialized sperm tests, blood hormone testing or ultrasound testing.
Many causes of male infertility can be treated with medications alone. This determination is made after a discussion, examination and lab testing. Sometimes there are lifestyle modifications that can help. Other times there are medications that can be used to increase the testosterone and sperm production.
It is important for couples to remember that sperm production takes 3 months, similar to an assembly line. These highly intricate cells have a very specialized function, unlike any other cells in the body. Any lifestyle modifications or medication changes will take 75-90 days to be reflected in a new population of sperm.