In terms of the male’s role, conception really is a game of numbers. Fundamentally, the more sperm cells a man produces, the greater the likelihood that one of the billions will hit their target – the egg cell.
A man’s normal range of sperm production is 40 million to 300 million sperm per milliliter of ejaculate. (An ejaculate volume of 1.5 milliliters to 5 milliliters is normal.) Sperm counts below 10 million per milliliter of ejaculate are considered poor; counts of 20 million or more may be acceptable, if motility and morphology are normal.
Yet here’s good news for some men: Because the normal male reproductive system is continually producing new sperm cells, the causes of low sperm count are sometimes temporary — for example, in cases of illness (especially with fever), unusually high stress levels, and poor nutrition. In many of these situations, low sperm levels can be reversed. While sperm count is not the only important factor in male fertility, it is a measurement that could greatly affect whether more advanced fertility treatment is necessary for conception. Below are some options.
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Oligospermia refers to very low sperm count. For men with oligospermia and no other fertility factors in either partner, intrauterine insemination (IUI) is frequently a successful solution. Other cases will benefit from the more advanced treatment of in vitro fertilization (IVF).
Azoospermia refers to a sperm count of zero in the ejaculate – a result of either obstructive or non-obstructive causes. As difficult as such news may be for some men to hear following a semen analysis, a zero count may not be a sign to give up hope for biological fatherhood. In certain cases, a physician can use one of several sperm retrieval techniques to obtain sperm cells from within the reproductive tract. Additionally, the technique of intracytoplasmic sperm injection (ICSI) – the microscopic insertion of sperm into an egg in the laboratory – may be combined with IVF to help men with azoospermia become fathers.
If no sperm are present, the semen will be tested for seminal fructose, normally produced by the seminal vesicles. If no fructose is present, the patient may have congenital absence of the vas deferens or seminal vesicles or obstruction of the ejaculatory duct.Other factors in terms of semen analysis related to sperm count include total volume and liquefaction.
A very low ejaculate volume indicates that the seminal vesicles may not be making enough fluid or that these ducts may be blocked. It may also indicate a problem with the prostate gland.
Normal semen, which is liquid at ejaculation immediately, coagulates into a pearly gel that liquefies within 20 minutes. Failure to coagulate and then liquefy may indicate a problem with the seminal vesicles, as would increased thickness or the presence of white blood cells.
Total motile sperm count (TMC) is calculated by multiplying three factors of a semen analysis; ejaculate volume, sperm concentration and motility. Average TMC is 20-40 million sperm. Men with a TMC of 20 million sperm or less are likely to have significant male factor infertility and if the TMC is 5 million or less, the patient is classified as having severe male factor infertility.