Oligospermia (too few sperm)
Having too few sperm can be one of the most challenging fertility issues. A careful evaluation and understanding of you and your partner’s reproductive needs will be critical to help you find the best reproductive option for you.
Dr. K, how can a profile of my hormone levels help out? Will it tell us if I am a candidate for some type of medical therapy?
The production of sperm and testosterone takes place in the testicles (the “factory”). Your brain controls how much sperm and testosterone are produced by sending hormone messages down to the testicles. The brain hormone that should increase sperm production is Follicle-Stimulating Hormone or FSH. The brain hormone that should increase testosterone production is Luteinizing Hormone or LH. Some infertile men may be oligospermic (too few sperm) because the testicles and the brain are not communicating well. When the problem is that the brain is not sending enough FSH down to the testicle (the FSH is lower than expected for a low sperm count), then these men may be candidates for certain medical therapies such as clomiphene citrate or FSH.
Clomiphene citrate is often used in women to help improve their fertility potential. The medication is taken by mouth, used off label and tricks the brain into making more FSH and testosterone which in some men may increase the amount of sperm production (Whiten et al. Fertility and Sterility 2006). This is an active area of research since we have not figured out exactly which men will respond. The other medication that may be another option is injectable medications such as FSH. FSH therapy acts directly on the testicle and tries to “whip” the testicle into making more sperm. The obvious advantage is that you don’t have to depend on the brain and wait for it to do a better job. The disadvantage is that this FSH therapy is considerably more expensive. The bottom line is that a hormonal profile will be important to obtain since it may be a critical piece of your reproductive puzzle that can tell us if you are a candidate for some of these medical therapies.
Dr. K, are there medications that may be hurting my fertility potential?
Yes, medications can hurt your sperm and your fertility potential. Below I have listed medications in two groups:
1. Medications where the data and literature strongly support that they impair a man’s fertility:
Androgens/Anabolic steroids (sometimes found amongst body builders, testosterone, oxandrolone, stanazolol)
Sulfasalazine (used for Inflammatory Bowel Diseases such as Crohn’s)
Spirinolactone (used for high blood pressure)
Nitrofurantoin, Erythromycine and Sulfa Antibiotics
Chemotherapy such as cisplatin, cyclophosphamide, adriamycin and vinblastine)
Opioids (Morphine, Methadone)
Finasteride and Dutasteride
2. Medications where the data and literature softly suggest that there they impair a man’s fertility but it is not convincing that there is an adverse effect:
Ca Channel blockers, thiazides, beta blockers, alpha blockers (Antihypertensives)
Dr. K, are there social habits that I should be avoiding?
You bet. We know that tobacco smoking, heavy alcohol intake, marijuana and cocaine are not going to help your cause towards building a family.
Dr. K, are there exposures that I should be avoiding at work or at home?
Sure. we know that being repeatedly exposed (chronic) to certain pesticides,heat, industrial chemicals, anilene dyes and radiation can hurt your your sperm production. Make sure you mention whether your work is associated with chronic exposure to any of these items. Other environmental exposures that may decrease sperm production are lead, cadmium, and boron.
Dr. K, does my weight have any impact on my sperm?
Increased weight is associated with many medical conditions and the its association with abnomal sperm parameters is growing in strength. A recent study from Utah found that the chances of oligospermia steadily increase as one’s weight increases. Specifically if your BMI is <25, 5% of men were found to be oligospermic whereas if your BMI was greater than 30, the chances of oligospermia increased to 15% (Hammoud et al 2008 Fertility and Sterility). Dr. K, is there something wrong with my genetics?
It is estimated that 5000 properly working genes may be required for normal male fertility!!! With so many genes involved in the process, it is a wonder that male infertility isn’t more common (Matzuk and Lamb 2008 Nature Medicine). As research and technology advances, we are finding more and more genetic issues with men facing the challenges of male infertility. For severe oligospermia (<5 Million>
2. Y Chromosome Deletion
All the information and blueprint instructions for becoming a human being are recorded on our chromosomes which is like owning a copy of the Encyclopedia Brittanica. For men, the complete Encyclopedia series includes a total of 46 books of which one of them is the Y chromosome. A karyotype is our way of checking to make sure that your Encyclopedia series is complete. The librarian makes sure you are not missing any books, own too many copies and makes sure that no one has ripped out critical chapters or even switched chapters between books. For infertile men, including men with oligospermia, karyotype abnormalities can be found in 5.8% when it is only found in only 0.5% of fertile men. It is important to diagnose any genetic problems since it may identify potential health risks to the patient and to any offspring.
Up to 6% of men with oligospermia will be missing a part of their Y chromosome. The Y chromosome is where the blueprints are to instruct your body to become a man. On the Y-chromosome, there are specific pages of the blueprints that outline how sperm should be made. Some azoospermic men may be missing some or all of these pages. It is important to check the integrity of the blueprints of the Y chromosome since any male child will inherit any problem on the Y chromosome.
In 2007-2008, newer technology has allowed us to actually look inside sperm and make sure that they are carrying the proper number of chromosomes. It is called FISH or Fluorescent In Situ Hybidization. It is a fancy word for our ability to paint specific chromosomes with certain colors. We then use a microscope to look inside the head of sperm to count the number of certain chromosomes. Recent data suggest that infertile men have a 10-fold increase in sperm-specific chromosomal abnormalities. We are using this test for men with oligospermia and for couples with recurrent pregnancy losses. For oligospermic men, abnormalities can be found in up to 60% of them when XY sex chromosomes were analyzed and up to 45% of them when non-sex chromosomes were looked at. This work has been pioneered by Dr. Dolores Lamb at Baylor University in Houston, TX. Unfortunately, the FISH test can be quite costly and is not readily available around the country. The Southwest Fertility Center for Men anticipates that we will have this test here within the year.
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