Severe oligospermia is a condition in men characterized by a significantly low concentration of sperm in their semen. This can impact a couple’s ability to conceive naturally. While other aspects of sexual health, such as the ability to achieve and maintain an erection and produce ejaculation, may remain typical, the reduced sperm count presents a challenge for natural conception.
Understanding Severe Oligospermia
Severe oligospermia is diagnosed when the sperm concentration in semen is less than 5 million sperm per milliliter (mL). For comparison, the World Health Organization (WHO) defines a normal sperm concentration as 15 million sperm per mL or higher.
Other classifications of oligospermia exist, highlighting varying degrees of low sperm count. Mild oligospermia is typically defined as a sperm concentration between 10 and 15 million sperm per mL, while moderate oligospermia falls between 5 and 10 million sperm per mL.
Causes of Severe Oligospermia
The causes of severe oligospermia can be categorized based on where they affect the male reproductive system.
Pre-testicular Causes
Pre-testicular causes involve issues outside the testicles that influence sperm production. Hormonal imbalances, such as disorders of the hypothalamus or pituitary glands, can lead to insufficient production of hormones like follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are necessary for sperm development. Genetic conditions, including Kallmann syndrome, may also disrupt these hormonal signals.
Testicular Causes
Testicular causes originate within the testicles themselves. Varicocele, characterized by enlarged veins in the scrotum, can increase testicular temperature, negatively impacting sperm production. Undescended testicles, or cryptorchidism, can also impair fertility.
Infections like mumps orchitis or sexually transmitted infections (STIs) can damage sperm-producing cells. Testicular trauma, genetic abnormalities such as Klinefelter syndrome (XXY chromosomes), and Y-chromosome microdeletions are also direct testicular factors. Additionally, certain medical treatments like chemotherapy or radiation, and some medications, can harm sperm production.
Post-testicular Causes
Post-testicular causes involve issues that occur after sperm production in the testicles, affecting their transport or ejaculation. Obstructions in the ejaculatory ducts or other parts of the reproductive tract can prevent sperm from being released. Retrograde ejaculation, where semen enters the bladder instead of exiting the penis during orgasm, is another post-testicular cause. Previous surgeries in the reproductive area can also lead to blockages or other complications. In a significant number of cases, however, no specific cause can be identified, and these are classified as idiopathic.
Diagnosing Severe Oligospermia
Diagnosis begins with a semen analysis. This test measures sperm concentration, motility (movement), and morphology (shape). Given that sperm production can vary, multiple semen samples are often recommended over a period of time to ensure an accurate assessment.
A physical examination helps identify any structural abnormalities in the reproductive organs, such as varicoceles or undescended testicles. Blood tests are performed to assess hormone levels, including FSH, LH, testosterone, and prolactin, as imbalances in these hormones can indicate underlying causes of low sperm count.
Genetic testing, such as karyotyping and Y-chromosome microdeletion testing, is often recommended, especially when sperm counts are very low (below 5 million sperm per mL), to identify specific genetic conditions. Imaging studies, including scrotal ultrasound, can detect structural issues like varicoceles, and transrectal ultrasound may be used to identify ejaculatory duct obstructions. A post-ejaculation urinalysis can also be performed to diagnose retrograde ejaculation, where sperm might be present in the urine.
Treatment Approaches for Severe Oligospermia
Treatment often depends on the underlying cause. Lifestyle modifications can improve sperm health, including maintaining a healthy weight through diet and exercise, avoiding exposure to environmental toxins, and refraining from smoking and excessive alcohol consumption.
Medical treatments address specific underlying conditions. Hormone therapy may be prescribed to correct hormonal imbalances, for example, using medications like clomiphene citrate or human chorionic gonadotropin (HCG) to stimulate sperm production. Antibiotics are administered if an infection is identified as the cause of the low sperm count.
Surgical interventions address correctable physical abnormalities. Varicocelectomy, a surgical procedure to repair enlarged veins in the scrotum, can improve sperm parameters in some cases. Procedures to clear obstructions in the reproductive tract are also performed to allow sperm to pass freely.
For many cases of severe oligospermia, particularly when other treatments are not successful or applicable, Assisted Reproductive Technologies (ART) offer solutions. In Vitro Fertilization (IVF) combined with Intracytoplasmic Sperm Injection (ICSI) is a frequently utilized approach. ICSI involves injecting a single sperm directly into an egg, significantly increasing the chances of fertilization even with very few sperm. If no sperm are present in the ejaculate, sperm retrieval techniques, such as Testicular Sperm Extraction (TESE) or Testicular Sperm Aspiration (TESA), can be used to obtain sperm directly from the testicles for use in ICSI. Beyond medical procedures, counseling and support services are available to help individuals and couples navigate the emotional challenges associated with male infertility.