By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

LOW SPERM COUNT NEEDS EVALUATION BY MALE FERTILITY SPECIALIST

Question: My husband and I have been trying to conceive. We've been having trouble so we went to the doctor. After several tests, we were told that the problem is due to his low sperm count. Can you tell me more about male fertility problems?

Answer: Infertility affects about 15 percent of all couples trying to conceive. According to the National Health Information Center, a couple is considered infertile if they cannot conceive after a full year of regular, unprotected sex. About one-third of all cases are caused by male factors. An equal number are caused by factors in the female. In the remaining cases, the cause is unknown or is due to problems with both partners.

Since your question deals with male infertility, I will focus on that topic. Men can be infertile if they produce too few sperm cells, sperm cells of poor quality, or have retrograde ejaculation, where some of the seminal fluid is pushed back into the bladder.

You mentioned that your husband was diagnosed with a low sperm count, so let’s look more closely at that issue. There are several physical factors that can lead to a low sperm count in men. A condition where the valves within the veins along the spermatic cord don't work properly -- called varicocele -- is a common cause, as is an undescended testicle. Infection from a sexually transmitted disease can also cause decreased sperm production. Likewise, underdeveloped testicles can fail to produce enough semen.

Social or environmental factors can contribute to this problem as well. Exposure to excessive heat can decrease sperm production. The testicles, where sperm is produced, are external to the body because the normal body temperature is too high for optimal testicular function. Heat exposure, such as in a hot tub or sauna, can decrease sperm production. Men who work outdoors in cold climates can overheat the testicles with the several layers of clothing they wear for their work. For some men, even wearing snug underwear – that is, “tighty whities” – that hold the testicles too close to the body can decrease the sperm count.

Smoking of a pack a day of cigarettes has been shown to decrease sperm production. Alcohol consumption also lowers production. Fatigue and poor health can be factors.

A common misconception about conception (what a pun!) is that having intercourse more frequently will increase the likelihood of becoming pregnant. This is a myth. In fact, having intercourse too frequently can seriously depress the sperm count. Having intercourse less often -- at least 48 hours between encounters -- can substantially increase the sperm production.

Other environmental factors that can decrease a man’s sperm count are drugs and chemical substances. For instance, anabolic steroids, medicine used to treat gout, some antibiotics, and certain high blood pressure medications can be problematic.

It is probably a good time to seek advice from a male fertility specialist. Further testing may be needed, as well as a thorough history and physical for your husband.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.