Q. My sperm count is less. What should I do?

Answered by
Dr. Sameer Kumar
and medically reviewed by Dr. Nithila A
Published on Aug 24, 2019 and last reviewed on: Aug 26, 2019

Hello doctor,

I am 69 years old male with 184 lb and 6’1" in height. For three years, my volume averaged 0.5 ml antegrade and 1.5 ml retrograde, motility 8 to 17 %, concentration 25 to 80 million. In the past two years, the volume has been 0.2 ml, concentration 20 to 30 million, motility either 0 or < 1 or 17. In the past two weeks, I have produced 0.3 ml total 15,000 sperms w 2 % motile and 0.1 ml with 0 sperms. 1.5-year-old tests done are PSA, FSH, LH, and it is all normal. Testosterone a little low. Prostate 70 cubic cm, no suggestion of ejaculatory duct obstruction.

1. What can be done to determine it?

2. What can be done to increase quality?

3. What is the chance that I will produce viable semen in the future?

4. How long might it take?

5. How many donor or fresh eggs can be inseminated using IVF, ICSI, and a frozen specimen of volume 0.5 ml 70 million / ml concentration motility 15%? Volume 0.25 ml concentration 150 million / ml motility 15%? 0.3 ml total 15,000 sperms 2% motility?

I am under Atorvastatin, clopidogrel, Doxazosin, Metoprolol, and Alfuzosin.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome to icliniq.com.

The causes for retrograde ejaculation can be many rights from drug abuse, chronic conditions like diabetes, Parkinson's disease, spinal cord injury, or any prostatic surgery or medications. They can be evaluated in detail, and the cause can be identified and treated upon. However, antidepressants like Imipramine have shown good results.

However at 69 now, the quality of sperm has reduced drastically and the only viable mode of fertility remains ICSI (intracytoplasmic sperm injection) IVF (in vitro fertilization) in your case where an available single viable sperm can be identified, and the donor or fresh eggs can be fertilized in vitro and then embryo transfer can be done. But the success rate of an ICSI procedure remains universally 38 to 45 %.

Thank you doctor,

The only one of those conditions that hold is prostate medication, which was Tamsulosin, which precipitated a reduction in quality, and was replaced with Alfuzosin which I am continuing. Is Alfuzosin fine? Could the Alfuzosin be discontinued or replaced and see if the condition improves? How long might it be before a difference is seen and at what possible consequence? Then I could produce and save a number of specimens before tending to the prostate problems again.

Antidepressants like Imipramine have shown good results. What are you suggesting to do and with what result after how much time? Is 38 to 45% per cycle or per embryo? I realize that only IVF and ICSI will work now. But how many eggs can be inseminated from each sample that I described? Are the technicians limited in the time they can spend inseminating? Could we add a lot of purchased donor eggs along with my wife’s and use a lot of the thousands of motile sperms available in one specimen to produce, e.g., 20 embryos and freeze them for future use? Then I could make maximum use of the few viable specimens that I currently have.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

I am not asking you to change any medication here but telling you that ICSI is the best option now, where viable sperm can be selected, and any number of eggs you wish to fertilize can be done, after grading the sperm and eggs. At a time, three embryos in the blastocyst stage are transferred in utero, and the remaining can be frozen. The success rate is 38 to 45 % per cycle universally but may vary from center to center.

Thank you doctor,

I am not talking about changing medications, and I said that I realize that only IVF and ICSI will work now. I asked if there are known adverse side effects to Alfuzosin that might be the cause of any of my problems since that is the only one in your list of conditions that holds in my case. So the embryologist is not limited by the time they spend extracting the best sperms and inseminating eggs with them the health of the sperm does not deteriorate if they inseminate 30 eggs instead of 10 or 15 eggs?

How much reduction in success rate is there if an embryo is frozen as opposed to being immediately transferred to the woman? How much decrease in success rate is there if an embryo is transferred to another healthy woman (no difference in the health of the two women) as opposed to being transferred to the woman who is the source of the egg?

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

1. The role of both the medicines are the same in BPH (benign prostatic hyperplasia), and both are known to cause retrograde ejaculation. However, abnormality of sperms as a side effect is less with Alfuzosin as compared to Tamsulosin. The viscosity of semen remains near normal with Alfuzocin even on prolonged usage, unlike Tamsulosin. There is a substantial decrease in sperm motility caused by Tamsulosin, whereas, with Alfuzosin, it was comparable with the placebo in the study. So Alfuzosin is better than Tamsulosin.

2. If you are paying and the eggs are available, then viable sperms can always be used in number for ICSI. No time limits mentioned. Sperms are available in millions so only selected single sperms are used to fertilize a single egg with ICSI technique.

3. There has been no difference in the range of success rate with either immediate or frozen embryos.

4. No difference has been documented in success rates. The success depends on the protocols used and posts ICSI procedure and embryo transfer, and rest is up to nature to nurture the pregnancy. Of course, medical support is offered. Still, the success rate has never been 100 percent.

Thank you doctor,

How much reduction will be there in the number of motile sperms after freezing and thawing vs. using it fresh?

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

If you are talking about sperm freezing and not frozen embryos, then the result is dependent on handling and thawing techniques by the embryologist, and one can expect around 10 percent motility loss, but in good hands, this loss can be minimized.

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