Sperm Count 24 million : Is it enough for pregnancy
In our latest blog post, we discuss an important topic related to male fertility called "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 list of questions to ask yourself if you suspect infertility and explain what doctors will check during an examination. Additionally, we explore additional tests that can be done, the treatability of low sperm count, and the correlation between sperm count and the chances of pregnancy. Finally, we touch upon assisted reproductive techniques and their success rates.
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 any protection, but they still can't get pregnant. It's not because the woman has any problems with her ability to have children, but it's actually because the man has issues that make it hard for them to conceive. And did you know that about 1 in every 5 cases of infertility is because of the man alone?
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What is it called when sperm count is 24 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, which is a measure of the number of sperm cells in your semen, is currently 24 million. Normally, a healthy sperm count is above 39 million. This means that you have a condition called oligospermia, which refers to having a lower-than-normal sperm count. In your case, the grade of oligospermia is classified as moderate. It's important to keep in mind that these numbers are just one factor in determining fertility, and there can be other factors involved.
What are the causes of a sperm count of 24 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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sarcoidosis - inflammation infiltrative pituitary disruption
Sarcoidosis is a condition where small clumps of abnormal cells called granulomas form in different parts of the body, including the pituitary gland in the brain. These granulomas can disrupt the normal functioning of the pituitary gland, which is responsible for regulating hormone production. This disruption can affect the production of sperm, leading to a low sperm count. To investigate sarcoidosis as a cause of low sperm count, doctors may perform blood tests, imaging studies (such as MRI or CT scan), and a biopsy of the affected tissue to confirm the presence of granulomas.
medications - anabolic steroids suppress the hypothalamo-pituitary axis and excess testosterone is converted into estrogen
Certain medications, such as anabolic steroids, can interfere with the normal hormonal balance in the body. Anabolic steroids are often used for muscle building but can suppress the activity of the hypothalamus and pituitary gland, which are important for regulating hormone production. Additionally, excess testosterone can be converted into estrogen, further disrupting the hormonal balance. To investigate medication-induced low sperm count, doctors may review the patient's medication history, perform hormone level tests, and assess the overall hormonal profile.
corticosteroids - suppress hypothalamic gonadotrophic secretion
Corticosteroids are a type of medication commonly used to reduce inflammation in the body. However, long-term use of corticosteroids can suppress the secretion of hormones from the hypothalamus, which is responsible for stimulating the production of sperm. This suppression can lead to a low sperm count. To investigate the impact of corticosteroids on sperm count, doctors may review the patient's medication history, perform hormone level tests, and evaluate the overall hormonal balance.
hyperthyroidism - hyperestrogenic state
Hyperthyroidism is a condition characterized by an overactive thyroid gland, which produces excessive amounts of thyroid hormones. This hormonal imbalance can result in a hyperestrogenic state, where there is an increased level of estrogen in the body. Elevated levels of estrogen can interfere with the normal production of sperm, leading to a low sperm count. To investigate hyperthyroidism as a cause of low sperm count, doctors may perform thyroid function tests, such as measuring the levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH).
pituitary adenoma - exerts mass effect on the gonadotrophs and disrupts LH, FSH production
A pituitary adenoma is a noncancerous tumor that develops in the pituitary gland. This tumor can exert pressure on the cells responsible for producing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for sperm production. The mass effect of the tumor can disrupt the normal production of these hormones, leading to a low sperm count. To investigate pituitary adenoma as a cause of low sperm count, doctors may perform imaging studies (MRI or CT scan) to visualize the tumor and assess its impact on hormone production.
infections - Mumps orchitis
Mumps orchitis is a condition characterized by inflammation of the testicles caused by the mumps virus. This inflammation can affect the normal production of sperm, leading to a low sperm count. To investigate mumps orchitis as a cause of low sperm count, doctors may review the patient's medical history, perform a physical examination, and conduct laboratory tests to detect the presence of mumps antibodies or the virus itself.
infections - Prostatitis
Prostatitis is a condition characterized by inflammation of the prostate gland, often caused by a bacterial infection. This inflammation can affect the normal functioning of the prostate, which plays a role in sperm production and ejaculation. Consequently, prostatitis can contribute to a low sperm count. To investigate prostatitis as a cause of low sperm count, doctors may perform a physical examination, assess the patient's symptoms, and conduct laboratory tests to detect the presence of bacteria or markers of inflammation.
cystic fibrosis - mostly azoospermic, but in some men can cause oligozoospermia and acidic ejaculate
Cystic fibrosis is a genetic disorder that primarily affects the lungs and digestive system. However, in men with cystic fibrosis, it can also impact fertility. Most men with cystic fibrosis have no sperm in their ejaculate (azoospermia). However, in some cases, there may be a reduced sperm count (oligozoospermia) along with an acidic ejaculate. To investigate the impact of cystic fibrosis on sperm count, doctors may review the patient's medical history, perform a physical examination, and conduct genetic testing for cystic fibrosis mutations.
varicocele - sloughing, atrophy, low testosterone
A varicocele is a condition characterized by enlarged veins in the scrotum, similar to varicose veins. These enlarged veins can lead to impaired blood flow and increased temperature in the testicles, which can affect sperm production. Varicoceles can cause sloughing of sperm, testicular atrophy (shrinkage), and lower testosterone levels. To investigate varicocele as a cause of low sperm count, doctors may perform a physical examination, assess scrotal ultrasound results, and measure hormone levels, including testosterone.
congenital adrenal hyperplasia - unregulated ACTH production causes excess adrenal androgens which suppress the pituitary
Congenital adrenal hyperplasia is a genetic disorder that affects the adrenal glands, which produce hormones essential for various bodily functions. In this condition, there is an overproduction of adrenal androgens (male sex hormones) due to the lack of certain enzymes. The excess adrenal androgens can suppress the normal functioning of the pituitary gland, leading to a low sperm count. To investigate congenital adrenal hyperplasia as a cause of low sperm count, doctors may perform hormone level tests, genetic testing for specific enzyme deficiencies, and evaluate adrenal gland function.
obesity - increased risk with high BMI, also leads to increased estradiol and deficiency of androgens
Obesity refers to the condition of having excess body weight, often resulting from a high body mass index (BMI). Obesity can have a negative impact on fertility, including sperm production. It is associated with an increased risk of low sperm count. Additionally, obesity can lead to hormonal imbalances, such as increased levels of estradiol (a form of estrogen) and deficiencies in androgens (male sex hormones). To investigate obesity as a cause of low sperm count, doctors may assess the patient's BMI, perform hormone level tests, and evaluate overall hormonal balance.
Questions to ask yourself for a sperm count of 24 million
Age at which you had puberty
Have you ever experienced the physical changes associated with puberty, such as growth spurts, deepening of the voice, or the appearance of facial hair?
Surgery on testicles
Have you ever undergone any surgery on your testicles? If so, please provide details.
Any trouble with sexual drive or function
Have you ever experienced any difficulties or problems with your sexual desire or ability?
Sexually transmitted infections
Have you ever had a sexually transmitted infection 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, whether currently or in the past, that could potentially affect your sperm count?
Use of alcohol, tobacco, illicit drugs
Have you ever consumed alcohol, smoked tobacco, or used any illicit drugs?
Systemic disease
Have you ever been diagnosed with or experienced any medical conditions or diseases that affect your entire body, not just your reproductive system?
Environmental exposures, including radiation, pesticides, and occupational
Have you ever been exposed to radiation, pesticides, or worked in an occupation that involves potential exposure to harmful substances?
Any Cancer diagnosis or treatment
Have you ever been diagnosed with cancer or undergone any cancer treatments in the past?
What will be done during medical checkup for sperm count of 24 million?
Is your sexual development complete ? - Tanner stage
When a doctor examines a patient for their sexual development, they are trying to determine if the person's body has fully grown and developed in terms of their reproductive system. One way to assess this is by using a method called the Tanner stage. This involves looking at physical changes that happen during puberty, such as the growth of pubic hair, development of genitalia, and changes in breast size (for females). The doctor will compare these changes to a scale called the Tanner scale, which has different stages from 1 to 5, representing different levels of sexual development. By assessing the patient's Tanner stage, the doctor can determine if their sexual development is complete or if there are any concerns that need to be addressed.
Do you show signs of a mass in the brain? - Bitemporal hemianopsia (pituitary mass)
The doctor will check if you have a mass in your brain that may be causing a condition called bitemporal hemianopsia. This means that you might have difficulty seeing things on the outer sides of your visual field. The examination will involve a thorough evaluation of your vision, including testing your ability to see objects on your sides. The doctor may also order imaging tests, such as an MRI, to get a clearer picture of your brain. This will help determine if there is a pituitary mass that could be affecting your vision.
Is your testicle size normal ? Reduced testicular volume (<15 cc)
The doctor will check if your testicles are a normal size. A reduced testicular volume means that your testicles are smaller than they should be, usually less than 15 cc. To examine this, the doctor will gently feel and measure the size of your testicles using their hands. This will help them determine if your testicle size is within the normal range or if it is smaller than expected.
Is there a mass in your testicle? - Testicular mass
The doctor will gently feel your testicles to check for any abnormal lumps or masses. This will be done by using their hands to examine the size, shape, and texture of your testicles. They may also ask you to cough while they hold your testicles to see if any lumps change in size or position. This examination is important as it helps the doctor determine if there are any growths or tumors present that could be affecting your sperm count. It is a simple and painless procedure that can provide valuable information about your testicular health.
Is the natural tube from testicles missing from either side? - Presence of vas deferens bilaterally
The doctor will check if the natural tube that connects the testicles to other parts of the reproductive system is missing on both sides. They will do this by examining the presence of the vas deferens, which is the scientific name for this tube, on both sides of the patient's body. The vas deferens is responsible for transporting sperm from the testicles to other parts of the body. By checking if it is present bilaterally, the doctor will be able to determine if there are any abnormalities or if the patient is missing this important tube.
Is there any cyst or swelling in the testicular sac ? - Presence of varicocele or other scrotal mass
The doctor will check for any cyst or swelling in the testicular sac, which is the sac that holds the testicles. This is done to make sure there are no abnormal growths or fluid-filled sacs that could affect the sperm count.
The doctor will also look for the presence of varicocele, which is a condition where the veins in the scrotum become enlarged. This can cause the testicles to heat up and affect sperm production.
Lastly, the doctor will check for any other scrotal masses, which could be tumors or abnormal growths. These can also affect the sperm count and overall reproductive health.
By examining these areas, the doctor can determine if there are any physical abnormalities that could be contributing to the low sperm count.
Are the testicles missing? - Presence of cryptorchidism or hypospadias
The doctor will check if the testicles are missing or not in a patient with a sperm count of 24. This can be done by examining for two conditions called cryptorchidism and hypospadias. Cryptorchidism refers to the condition where one or both testicles do not descend into the scrotum. The doctor will feel the scrotum area to check if the testicles are present. Hypospadias is a condition where the opening of the urethra is not at the tip of the penis but somewhere along the underside. The doctor will visually inspect the penis to determine if this condition is present. These examinations will help the doctor understand the patient's reproductive health better.
The doctor will check if there are any issues with the joints in the patient's hand. Specifically, they will look for inflammation in the joints between the fingers and the hand bones. They will also examine for any unusual coloration or signs that may indicate liver disease or heart failure, such as a bronze-like appearance. This is important because these symptoms can be related to a condition called hemochromatosis, where the body stores too much iron. The doctor will conduct a thorough examination to determine if these joint problems or signs of liver or heart issues are present.
Is the patient on muscle building steroids? Presence of marked muscle hypertrophy suggesting anabolic steroid use
The doctor will carefully observe the patient's muscles to check for signs of significant growth. If the patient has noticeably larger muscles, it might indicate the use of anabolic steroids, which are drugs that promote muscle growth. The doctor will look for specific characteristics, such as unusually developed muscles in certain areas of the body or a rapid increase in muscle mass. This examination will help determine if the patient has been using muscle building steroids.
What additional tests are to be done for a sperm count of 24 million?
Step 1 : Test FSH, LH, Prolactin and Testosterone levels
When evaluating a patient for infertility, doctors often recommend checking the levels of four hormones: FSH, LH, prolactin, and testosterone. FSH (follicle-stimulating hormone) helps in the production of sperm, so low levels may indicate a problem with sperm production. LH (luteinizing hormone) stimulates the production of testosterone, which is necessary for sperm development. Prolactin is a hormone that regulates breast milk production but high levels can interfere with sperm production. Lastly, testosterone is the primary male hormone responsible for sperm production, and low levels can affect fertility. By checking these hormone levels, doctors can gain insight into potential causes of infertility and guide further treatment.
Step 2 : Are FSH and LH lower than normal?
If a patient has a low sperm count of 24, it could indicate infertility. When the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are lower than normal, it suggests that the pituitary gland, which produces these hormones, may not be functioning properly. In such cases, further investigations like an MRI scan may be recommended to check for any abnormalities in the pituitary gland. Additionally, doctors may also look for systemic diseases like hemochromatosis or sarcoidosis, which could be causing the hormone imbalance.
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 testis is not producing enough sperm. This could be due to various reasons, such as problems in the testicles themselves, autoimmune diseases, or genetic issues. To further investigate, doctors may recommend tests to examine the chromosomes (karyotype) to determine if there are any genetic abnormalities that could be causing the low sperm count.
Step 4 : Are LH and Testosterone Normal?
In simple terms, the LH (luteinizing hormone) and testosterone levels are normal in a patient with a sperm count of 24, which means that the pituitary gland is functioning properly and the cells responsible for producing testosterone are working. However, the FSH (follicle-stimulating hormone) level is higher than usual. This could be due to unknown reasons (idiopathic), genetics, or certain medications. Further investigation is recommended to determine the exact cause of the elevated FSH level and its impact on fertility.
Step 5 : Are LH and Testosterone high?
When a patient has a low sperm count of 24, it could be a sign of infertility. In this case, the levels of LH (luteinizing hormone) and testosterone are expected to be high. However, if LH and testosterone levels are found to be normal or low, it could indicate a condition called androgenic insensitivity. Androgenic insensitivity means that the body is not able to properly respond to these hormones, affecting the development and function of the reproductive system. Further investigation into this condition has been recommended to understand its impact on fertility.
Is there any treatment for sperm count of 24 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 refers to a condition where a man has a low sperm count due to a blockage in the reproductive system, preventing sperm from being ejaculated.
Understanding Ejaculatory Duct and Prostatic Midline Cysts
Ejaculatory duct and prostatic midline cysts are conditions that can contribute to low sperm count in men. These cysts can obstruct the normal flow of semen, leading to decreased sperm production.
Understanding Gonadotropin Deficiency
Gonadotropin deficiency is a condition where the body does not produce enough hormones that are essential for sperm production, resulting in a low sperm count.
Understanding Low Sperm Count
Low sperm count refers to a condition where a man's semen contains fewer sperm than normal, which can affect fertility and the ability to conceive a child.
Understanding Sperm Autoimmunity
Sperm autoimmunity refers to a condition where the body's immune system mistakenly attacks and damages sperm cells, leading to a lower sperm count.
Understanding Varicoceles: Causes and Implications for Low Sperm Count
Varicoceles are enlarged veins in the scrotum that can lead to decreased sperm production, potentially causing low sperm count.
Understanding Reversible Toxin Effects on Sperm Count
Reversible toxin effects refer to temporary changes in sperm count caused by certain harmful substances, which can be reversed with appropriate interventions.
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 Low Sperm Count
Primary seminiferous tubular failure is a condition where the testes produce a lower than normal amount of sperm, leading to a low sperm count.
Understanding Sertoli Cell-Only Syndrome: Causes and Implications
Sertoli cell-only syndrome is a condition where a man has a low sperm count due to a lack of sperm-producing cells known as Sertoli cells.
Understanding Bilateral Orchiectomy
Bilateral orchiectomy is a surgical procedure to remove both testicles, which may be considered in cases of low sperm count.
Is pregnancy possible with a sperm count of 24 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 is a special technique that can help couples who are struggling to conceive due to low sperm count. This assisted reproductive technique involves placing the sperm directly into the woman's uterus, where it has a better chance of reaching the egg and fertilizing it. The procedure is done in a doctor's office and is usually painless. It increases the chances of pregnancy because it bypasses the need for the sperm to travel a long distance. Intra Uterine Implantation is a simple and effective way to help couples achieve their dream of having a baby, even with a low sperm count.
Intra Cytoplasmic Sperm
Intra Cytoplasmic Sperm Injection (ICSI) is a method used in assisted reproductive techniques to help couples who are having difficulty getting pregnant due to a low sperm count. During ICSI, a single healthy sperm is directly injected into an egg to fertilize it. This technique is performed in a laboratory by specially trained doctors. Once the egg is fertilized, it is then transferred back into the woman's uterus, where it can hopefully implant and result in pregnancy. ICSI has been successful in helping many couples achieve their dream of having a baby, even when the male partner has a low sperm count.
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. It involves taking eggs from the woman's ovaries and combining them with sperm in a laboratory dish. This allows the fertilization process to occur outside the woman's body. Once the eggs are fertilized and form embryos, they are carefully placed back into the woman's uterus, where they can hopefully develop into a pregnancy. IVF has been successful in helping many couples achieve pregnancy and become parents, even when low sperm count is a challenge.
What is a good plan ART (assisted reproductive technique) plan of action for a sperm count of 24 million?
Based on the patient's sperm concentration of 8.0 million/ml, the best course of treatment would be Intra Uterine Implantation. This is a less invasive and cost-effective method with a pregnancy rate of approximately 16%. In cases where the sperm count is below 5 million/ml, Intra Cytoplasmic Sperm Injection may be considered as the first line of treatment, as it has an efficacy of around 24.2% in such cases. If Intra Uterine Implantation or Intra Cytoplasmic Sperm Injection is unsuccessful after 3-4 cycles, In Vitro Fertilization can be considered as the second line of treatment with a success rate approaching 48%.
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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