Oligozoospermia - Low sperm count
Mild cases might be successful with IUI. More commonly, however, IVF or in severe cases ICSI, may be required.
Asthenozoospermia - Reduced motility and/or impaired progression.
When the number of swimming sperm is reduced or if the sperm aren't swimming effectively, fertility is reduced. When it is just the number of motile sperm that is low, IUI or IVF may be recommended as the motile sperm can be extracted from the ejaculate and concentrated in the laboratory. However, if the ability of the sperm to swim is severely impaired, the chances of fertilisation through IVF may also be low, so ICSI may be recommended.
Teratozoospermia - Raised levels of abnormal sperm
Abnormal sperm have a reduced capacity to fertilise eggs or form viable embryos. In cases of mild teratozoospermia, IVF may be the appropriate treatment. When the number of normal sperm is very low ICSI may be required.
Azoospermia - No sperm present in the ejaculate.
There are various reasons for complete absence of sperm in the ejaculate. There may be a blockage or it may be a partial or complete failure in sperm production in the testes.
In cases of a blockage it is usually possible for a urologist to surgically extract sperm from the epididymis or the testes by MESA or TESE and for the embryologist to use such sperm to achieve fertilization in the laboratory through ICSI.
***In cases where there is no sperm, an exploratory TESE can be done to see if sperm is being produced or not. Occasionally, although the ejaculate may not have any sperm, there may be small pockets of sperm production within the testis and if these can be extracted, the sperm can be used to achieve fertilization through ICSI. ***
Improving Sperm Quality
Supplements that may potentially improve sperm count/quality.
All supplements should be taken long term as the sperm production cycle is approximately 90 days long.
• Zinc – 30milligrams twice daily
Zinc deficiency has been linked with a reduced sperm count. Zinc, in combination with other nutritional supplements (folic acid) has also been shown to improve sperm motility. Zinc is found naturally in meat, wholegrain cereals, seafood, eggs and pulses.
• Selenium – 200micrograms daily
Selenium has been shown to improve sperm motility both on its own and in conjunction with vitamin E. Selenium is found naturally in meat, seafood, mushrooms, cereals and in particularly high levels in Brazil nuts.
• Vitamin E – 400milligrams twice daily
Vitamin E is an antioxidant which may protect sperm from damage. Vitamin E is found naturally in vegetable oils, nuts and green leafy vegetables.
• Folic acid – 5milligrams daily
Folate, of which folic acid is the synthetic form, is essential for sperm production. It has been shown that folic acid in conjunction with zinc can improve sperm count and motility. Folate is found naturally in green leafy vegetables, liver, yeast and fruits.
Lifestyle
Smoking
Smoking as little as 1 cigarette per day directly reduces the number and quality of sperm. Smoking in males has even been show to decrease the success rates of both IVF and ICSI, non-smoking couples are almost twice as successful as those where the male smoked >5 cigarettes/day.
Alcohol
Heavy drinking (>20 units/week) has been shown to double the time taken to achieve pregnancy. There is also evidence to suggest that heavy drinking in men can subsequently lead to higher miscarriage rates.
Occupational exposure to toxins
Exposure to solvents such as paint, lacquers, adhesives, degreasers, printing inks and laboratory solvents on a regular basis has been shown to cause reduced sperm count and quality.
Temperature
Heat affects sperm quality, therefore, regular hot baths, saunas, steam rooms should be best. Loose fitting underwear has also been suggested to avoid problems with overheating of the testes.
