Sperm Count 18 million : Is it enough for pregnancy
In our latest blog post titled "Understanding Male Infertility: Exploring Sperm Count and its Impact on Pregnancy", we delve into the world of male infertility and its connection to sperm count. We explain what male infertility is, the different grades of oligospermia (low sperm count), and the possible causes behind it. We also provide a comprehensive list of questions to ask yourself if you suspect infertility, what to expect during a doctor's examination, and the additional tests that can be done. Furthermore, we address whether male infertility is treatable, the correlation between sperm count and the likelihood of pregnancy, and the lowest possible count at which pregnancy is still possible. Lastly, we explore various assisted reproductive techniques and their success rates in helping couples conceive.
What is a normal sperm count?
A normal total sperm count is
39 million as per the WHO. For the purposes of this article we assume an ejaculatory volume of 3 ml.[1.5ml - 6ml].
What is Male Infertility
Male infertility is when a man and a woman try to have a baby for a whole year without using protection, but they can't make it happen. In these situations, the woman is perfectly capable of getting pregnant, but the issue comes from the man. It turns out that around 20% of the time, the man is the only one causing the infertility problem.
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What is it called when sperm count is 18 million/ml?
This condition is called oligospermia or a low sperm count.
How is sperm count measured?
A sperm count is assessed by means of a
semen analysis test. In this test you are asked to provide a sample of your semen, and the lab uses special techniques to analyze the semen. The count is estimated by diluting the semen in a special diluent and then using a measurement chamber to visualize the sperms. A complex mathematical formula is employed to estimate the actual sperm count.
What is my grade of oligospermia?
Your sperm count is below the normal range, specifically at 18 million. This condition is known as oligospermia, and it is considered to be of moderate severity. Normally, a higher sperm count is desirable for optimal fertility. However, keep in mind that there are various factors that can affect fertility, and consulting a doctor would provide a more comprehensive understanding of your specific situation.
What are the causes of a sperm count of 18 million?
There are several different causes of oligospermia and they can be one of several categories including due to genetic factors, past cancer, secondary to other diseases, physical factors in the reproductive tract etc.
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Kallmann syndrome
Kallmann syndrome is a genetic disease that affects the production of hormones responsible for sexual development. It causes a lack of puberty or incomplete sexual maturation in both males and females. This condition is caused by a problem in the hypothalamus, a part of the brain that controls the release of hormones. To investigate Kallmann syndrome, doctors may perform a physical examination, blood tests to measure hormone levels, and genetic testing to identify any specific gene mutations associated with the syndrome.
Hyperthyroidism
Hyperthyroidism is a condition characterized by an overactive thyroid gland, which produces excessive amounts of thyroid hormones. This can lead to a hyperestrogenic state, where there is an imbalance of estrogen hormone levels. In men, this can affect sperm production and result in a low sperm count. To investigate hyperthyroidism, doctors may perform blood tests to measure thyroid hormone levels and imaging tests, such as ultrasound or scintigraphy, to examine the thyroid gland.
Craniopharyngioma
Craniopharyngioma is a type of brain tumor that can disrupt the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in the pituitary gland. These hormones are essential for normal sperm production. The tumor's mass effect can interfere with the signaling between the hypothalamus and pituitary gland, leading to reduced sperm count. To investigate craniopharyngioma, doctors may perform imaging tests, such as MRI or CT scans, to identify the presence and location of the tumor.
Infections - Mumps orchitis
Mumps orchitis is a condition that occurs when the mumps virus infects the testicles, causing inflammation and swelling. This infection can lead to a decrease in sperm count. To investigate mumps orchitis, doctors may perform a physical examination, blood tests to detect the presence of mumps antibodies, and ultrasound to assess the testicles for any signs of inflammation or damage.
Prolactinoma
Prolactinoma is a type of pituitary tumor that causes the overproduction of prolactin hormone. This excess prolactin can suppress the hypothalamus, the part of the brain that regulates the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The suppression of these hormones can result in a low sperm count. To investigate prolactinoma, doctors may perform blood tests to measure prolactin levels and imaging tests, such as MRI or CT scans, to identify the presence and size of the tumor.
Cystic fibrosis
Cystic fibrosis is a genetic disorder that primarily affects the lungs and digestive system. In some men with cystic fibrosis, it can also cause a decrease in sperm count (oligozoospermia) and an acidic ejaculate. To investigate the impact of cystic fibrosis on sperm count, doctors may perform a semen analysis to assess the quantity and quality of sperm, as well as genetic testing to confirm the presence of cystic fibrosis gene mutations.
Infections - Prostatitis
Prostatitis is the inflammation of the prostate gland, usually caused by a bacterial infection. This condition can lead to a decrease in sperm count. To investigate prostatitis, doctors may perform a physical examination, urine tests to detect the presence of bacteria, and prostate fluid analysis to assess inflammation and infection.
Pituitary adenoma
Pituitary adenoma is a type of tumor that develops in the pituitary gland and can disrupt the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones are essential for normal sperm production. The mass effect of the tumor can interfere with the signaling between the hypothalamus and pituitary gland, resulting in a low sperm count. To investigate pituitary adenoma, doctors may perform imaging tests, such as MRI or CT scans, to identify the presence and size of the tumor.
Hypothyroidism
Hypothyroidism is a condition characterized by an underactive thyroid gland, which produces insufficient amounts of thyroid hormones. This hormonal imbalance can affect sperm production and lead to a low sperm count. To investigate hypothyroidism, doctors may perform blood tests to measure thyroid hormone levels and evaluate other symptoms associated with the condition.
Sarcoidosis
Sarcoidosis is an inflammatory condition that can affect various organs, including the pituitary gland. Inflammation and infiltration of the pituitary gland can disrupt its normal functioning, including the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This disruption can result in a decrease in sperm count. To investigate sarcoidosis, doctors may perform blood tests to measure hormone levels, imaging tests to assess the pituitary gland, and other diagnostic procedures to evaluate organ involvement.
Questions to ask yourself for a sperm count of 18 million
Age at which you had puberty
Have you ever experienced any changes in your body like growth of facial hair, deepening of voice, or development of sexual characteristics, indicating that you went through puberty?
Surgery on testicles
Have you ever undergone surgery on your testicles in the past?
Any trouble with sexual drive or function
Have you ever experienced any difficulties with your sexual drive or function, such as problems with getting or maintaining an erection or a decreased interest in sexual activities?
Sexually transmitted infections
Have you ever had any sexually transmitted infections in the past?
Infections of prostate or testicle
Have you ever experienced any infections or inflammation in your prostate or testicles?
Have you ever taken any medications in the past or currently taking any medications that could potentially affect your sperm count?
Use of alcohol, tobacco, illicit drugs
Have you ever consumed alcohol, smoked tobacco, or used illicit drugs?
Systemic disease
Have you ever been diagnosed with or experienced any health conditions that affect your entire body, such as diabetes, high blood pressure, or thyroid problems, which could potentially impact your fertility?
Environmental exposures, including radiation, pesticides, and occupational
Have you ever been exposed to radiation, pesticides, or worked in an occupation that may have potential harmful effects on fertility?
Any Cancer diagnosis or treatment
Have you ever undergone any cancer treatment or been diagnosed with cancer in the past?
What will be done during medical checkup for sperm count of 18 million?
Is your sexual development complete ? - Tanner stage
When a doctor examines a patient's sexual development, they are checking if their body has fully matured. This includes looking at the Tanner stage, which is a way to measure the development of sexual characteristics like pubic hair, breast growth, and genital size. The doctor will ask the patient a few questions and may also visually inspect their physical development. This examination helps determine if the patient's sexual development is on track for their age. It is a normal part of a check-up to ensure that everything is progressing as it should be.
Do you show signs of a mass in the brain? - Bitemporal hemianopsia (pituitary mass)
When a doctor examines a patient for signs of a mass in the brain, they may look for a condition called bitemporal hemianopsia. This means that the person may have trouble seeing things on the outer sides of their vision. To check for this, the doctor will ask the patient to do a special vision test. They might also examine the patient's eyes and use a special light to look at the back part of the eyes. These tests can help the doctor determine if there is a mass in the brain that might be causing the vision problems.
Is your testicle size normal ? Reduced testicular volume (<15 cc)
The doctor will examine the size of your testicles to see if they are normal. Testicles that are smaller than 15 cc in volume are considered to have reduced size. This examination is important because testicle size can affect sperm production. The doctor will likely use a special device called an orchidometer to measure the size of your testicles. This will help determine if the reduced testicular volume is contributing to your low sperm count.
Is there a mass in your testicle? - Testicular mass
The doctor will carefully feel and examine your testicles to check for any unusual lumps or masses. They will gently apply pressure with their hands to feel the size, shape, and consistency of the testicles. This is done to identify any abnormalities, such as a growth or tumor, that may be causing the low sperm count. The examination is usually painless and only takes a few minutes. It is an important step in diagnosing the cause of the low sperm count and determining the appropriate treatment options.
Is the natural tube from testicles missing from either side? - Presence of vas deferens bilaterally
The doctor will check if the patient has the natural tube that connects the testicles to other parts of the reproductive system. This tube is called the vas deferens. The doctor will examine both sides of the patient to see if this tube is present. They will do this by gently feeling the area where the tube should be located. If the vas deferens is missing on either side, it means that the tube is not there and it may affect the patient's ability to father a child.
Is there any cyst or swelling in the testicular sac ? - Presence of varicocele or other scrotal mass
The doctor will carefully examine the patient's testicular sac to check for any cyst or swelling. They will gently feel the area to see if there are any abnormal lumps or masses. This is important because cysts or swelling can affect the production and quality of sperm. Additionally, the doctor will check for the presence of varicocele, which is an enlarged vein in the scrotum. If there is any abnormality found, further tests or treatments may be recommended to address the issue and improve the patient's sperm count.
Are the testicles missing? - Presence of cryptorchidism or hypospadias
The doctor will carefully examine the patient's testicles to determine if they are present or not. This is to check for a condition called cryptorchidism, which means that one or both testicles are not in their normal position in the scrotum. The doctor will also look for any signs of hypospadias, which is a condition where the opening of the urethra is located on the underside of the penis instead of the tip. These examinations are important to identify any abnormalities that could potentially affect fertility or require medical intervention.
The doctor will examine the patient's second and third fingers to check for any swelling or inflammation in the joints connecting them to the hand. This could indicate a condition called synovitis.
The doctor will also look for any changes in the color of the skin, specifically a 'bronzed' appearance. This can sometimes be a sign of liver disease or heart failure, a condition called hemochromatosis.
By checking for these signs, the doctor can determine if there are any joint problems or underlying health issues that may be affecting the patient's sperm count of 18.
Is the patient on muscle building steroids? Presence of marked muscle hypertrophy suggesting anabolic steroid use
The doctor will carefully observe the patient's body for signs of excessive muscle growth, which could indicate the use of muscle-building steroids. This examination involves visually inspecting the patient's muscles, looking for abnormally large muscle size and definition. The doctor may also palpate or feel the muscles to check for any unusual hardness or firmness. Additionally, they might inquire about the patient's exercise routine and ask if they have used any medications or supplements to enhance muscle growth. These observations and questions will help the doctor determine if the patient has been using anabolic steroids to build their muscles.
What additional tests are to be done for a sperm count of 18 million?
Step 1 : Test FSH, LH, Prolactin and Testosterone levels
To understand the possible causes of infertility, doctors recommend testing the levels of hormones called FSH, LH, Prolactin, and Testosterone in patients with a low sperm count like 18. FSH is a hormone that helps in sperm production, LH stimulates testosterone production, Prolactin is involved in breast milk production but high levels can affect sperm production, and Testosterone is responsible for male sexual characteristics and sperm production. By checking these hormone levels, doctors can gather valuable information to determine the potential reasons behind the patient's infertility and guide them towards appropriate treatments.
Step 2 : Are FSH and LH lower than normal?
If a person's FSH and LH levels are lower than normal, it suggests that the pituitary gland, which produces these hormones, is not making enough of them. In this situation, doctors may recommend further investigations, such as an MRI scan, to examine the pituitary gland more closely. They may also check for diseases that affect the whole body, like hemochromatosis or sarcoidosis, as these can sometimes affect hormone production. By doing these tests, doctors hope to find the underlying cause of the low hormone levels and address it accordingly.
Step 3 : Are FSH and LH too high?
If the levels of FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are high, it suggests that the testicles are not producing enough sperm. This could be due to various reasons such as issues within the testicles themselves, autoimmune diseases, or genetic factors. To investigate further, doctors may recommend additional tests to determine the karyotype, which means examining the genetic makeup of the individual. By doing so, they can gain a better understanding of the underlying causes of infertility and develop an appropriate treatment plan.
Step 4 : Are LH and Testosterone Normal?
In simple terms, LH and testosterone are at normal levels, which means that the pituitary gland is working properly and the cells responsible for producing testosterone are doing their job. However, the FSH (follicle-stimulating hormone) is higher than usual. This could be due to unknown reasons (idiopathic), genetics, or certain medications. Further investigation is recommended to understand the underlying cause of infertility.
Step 5 : Are LH and Testosterone high?
In this case, if a patient has a sperm count of 18, it means they have a low sperm count, which can contribute to infertility. When it comes to hormone levels, if LH (luteinizing hormone) and testosterone are high, it suggests that the body is trying to compensate for the low sperm count. This could be due to a condition called androgenic insensitivity, where the body is unable to properly respond to these hormones, leading to infertility. Therefore, further investigation into androgenic insensitivity has been recommended to better understand and address the underlying cause of the fertility issue.
Is there any treatment for sperm count of 18 million?
Some causes of low sperm count can be treated, others are not totally treatable. Assisted reproductive techniques are required in those cases where the count cannot be improved to normal levels. Here are a few of the treatable and non-treatable causes
Treatable causes of low sperm count
In case of the following causes, treatment can be provided to directly increase the sperm count.
Understanding Obstructive Azoospermia: Low Sperm Count
Obstructive azoospermia is a condition where the low sperm count is caused by a blockage in the reproductive system, preventing the sperm from reaching the semen.
Understanding Ejaculatory Duct and Prostatic Midline Cysts
Ejaculatory duct and prostatic midline cysts are conditions that can contribute to a low sperm count, where the ducts or cysts in the male reproductive system may be obstructed or causing abnormalities in sperm production.
Understanding Gonadotropin Deficiency and Low Sperm Count
Gonadotropin deficiency is a condition where the body doesn't produce enough hormones needed for sperm production, causing a low sperm count.
Understanding Sexual Function Disorders: Low Sperm Count
Sexual function disorders, such as low sperm count, refer to conditions that affect a man's ability to produce enough healthy sperm for successful reproduction.
Understanding Sperm Autoimmunity
Sperm autoimmunity is a condition where the body's immune system mistakenly attacks and damages sperm, leading to a low sperm count.
Understanding Varicoceles: A Common Cause of Low Sperm Count
Varicoceles are enlarged veins in the scrotum that can lead to decreased sperm production, resulting in a low sperm count.
Understanding Reversible Toxin Effects on Sperm Count
Reversible toxin effects refer to temporary changes in sperm count caused by harmful substances, which can be reversed over time.
Untreatable Causes of low sperm count
In case of these conditions, ART will probably be required as there is no direct treatment to increase the sperm count.
Understanding Primary Seminiferous Tubular Failure: Causes and Implications
Primary seminiferous tubular failure is a condition characterized by a low sperm count, which can be caused by various factors and may have implications for fertility.
Understanding Sertoli Cell-Only Syndrome: Causes and Implications
Sertoli cell-only syndrome is a condition characterized by a complete absence of sperm cells in the semen, resulting in a low sperm count. It is caused by the malfunction or absence of Sertoli cells, which play a crucial role in sperm production.
Understanding Bilateral Orchiectomy: A Procedure for Low Sperm Count
Bilateral orchiectomy is a surgical procedure that involves the removal of both testicles, which may be recommended for patients with low sperm count.
Is pregnancy possible with a sperm count of 18 million?
As per
Martorras et al, 7% of men, with a sperm count as low as 2 million/ ml were still able to conceive spontaneoulsy, with natural means, over a 2 year period of trying. This implies that even a low sperm count DOES NOT MEAN that you won't be able to have a successfull pregnancy. There are several other factors at play, and we try to list them out in the rest of the article. Assisted reproductive techniques can greatly increase the chances of conception.
What IVF or assisted conception options are available for a low sperm count?
Intra Uterine Implantation
Intra Uterine Implantation, also known as intrauterine insemination (IUI), is a technique used to help couples who are struggling to conceive due to a low sperm count. During this procedure, the doctor will collect a sample of sperm from the male partner and prepare it in the laboratory by separating the healthy sperm from the rest. Then, a catheter is used to insert the prepared sperm directly into the woman's uterus, near the time of ovulation. This increases the chances of fertilization because the sperm has a shorter distance to travel. It is a simple and painless procedure that can be done in a doctor's office, and it may be recommended as a first step before considering more complex and expensive fertility treatments.
Intra Cytoplasmic Sperm
Intra Cytoplasmic Sperm Injection (ICSI) is a technique used to help couples who are having trouble conceiving due to a low sperm count. During this procedure, a single healthy sperm is carefully injected directly into the egg to increase the chances of fertilization. The fertilized egg is then placed in the woman's uterus where it can develop into a baby. ICSI is a highly effective method and can help couples achieve pregnancy even when the sperm count is very low. It is a safe and minimally invasive procedure that has brought hope to many couples struggling with infertility.
In Vitro Fertilization
In Vitro Fertilization (IVF) is an assisted reproductive technique that can help couples who are struggling to conceive due to low sperm count. During IVF, eggs from the woman's ovaries are collected and fertilized with sperm in a laboratory dish. This process allows for the creation of embryos, which are then transferred back into the woman's uterus. By bypassing the natural process of fertilization, IVF increases the chances of pregnancy. It is a safe and effective option for couples facing fertility issues, offering hope and the possibility of starting a family.
What is a good plan ART (assisted reproductive technique) plan of action for a sperm count of 18 million?
Based on the patient's sperm concentration of 6.0 million/ml, the first line of treatment could be Intra Uterine Implantation, which has a pregnancy rate of around 16%. However, since the sperm count is below the recommended 10 million/ml for this technique, it may be more appropriate to consider Intra Cytoplasmic Sperm Injection. This method has an efficacy of around 24.2% for very low sperm counts below 5 million/ml. If this technique is not successful, the second line of treatment could be In Vitro Fertilization, which has a success rate approaching 48% in some studies. It is important to note that the efficacy of In Vitro Fertilization varies depending on the sperm count, with lower counts having lower efficacy rates.
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References
Authorotative articles on IVF and oligospermia
Recommended Tests
The following tests are recommeded as additional investigations in a case of oligospermia or low sperm count.
By: Dr.Bhargav Raut