- Welcome to Fertile Minds.
Today's programme is going to look at sperm counts
or at least the worst news,
low sperm counts.
I'm Professor Michael Chapman.
I'm a Senior Fertility Specialist with IVF Australia
and I've been dealing with all parts of infertility
for over 35 years.
The worst news I have to break to anybody, male
or female is telling a man that his sperm count's not good.
It is a threat to their virility
and obviously a blow in terms of working
towards what they want, which is a baby.
So can we do anything about it?
Well, the first thing is to investigate.
so that involves more than just one sperm count
and more than just the basic count.
In IVF Australia we do a comprehensive andrology assessment
that includes sperm antibodies,
it involves looking at motility, looks at survival of sperm
through swimming tests that we do on the sperm
and looking for DNA fragmentation.
That's the breakdown of the genetic material
that's held inside the head of the sperm.
So that's the first step we do
is a comprehensive investigation of the sperm itself.
We're also going to look at the hormones
that drive sperm production.
They're the ones that come from your brain
and they tell the production line in the testicle to work.
If the production line is broken,
the hormones in the brain keep trying to make the guys work
but they don't.
And so the levels of those hormones rise
and rise and rise a bit like women who go
through the menopause when their ovaries have failed,
those hormones rise and rise and rise.
And if we find high levels of hormones
and we have a low sperm count,
we have a problem that's probably not soluble
other than by collecting sperm from the testicle itself.
So the other tests that are done are an ultrasound.
So the ultrasound of the scrotum,
to look at the testicles themselves
to see whether there's any reason
why structurally the sperm count might be low.
So we're going to look for varicose veins.
Why do we look for varicose veins?
Well, God made our testicles swing in the breeze
so that their temperature was around 35 and a half degrees
which is lower than the general body temperature.
But the production line for sperm needs
that lower temperature.
If you raise that temperature, they all go to sleep
the production line doesn't work, or at least it's reduced.
So big varicose veins can cause a problem.
And obviously surgically or radiologically
we can block them off and improve the situation.
The other thing we do an ultrasound for is to make sure
there's no tumours, no lumps in the testicle,
because there is an association between testicular cancer
and low sperm counts.
We don't quite know why,
but if you look at men with low sperm counts
there's a higher chance
albeit still low of cancer of the testis.
And obviously that needs to be dealt with.
Now we've done the blood tests,
we've had another look at the sperm
and sadly that it is confirmed that the count is low,
what can we do?
Lifestyle things do influence sperm counts.
So recent stress, men who've been losing their jobs
during COVID, I wouldn't be surprised
if their sperm counts were a bit lower now
than they were at the beginning of the year.
So stress can have an impact just as it does in women.
When women are under stress, their periods can stop
because the hormones of the brain are switched off.
So that's one thing and that's reversible, that will improve
once the anxiety goes away.
Alcohol.
Excessive alcohol does knock
around the sperm production for sure.
Obviously it also has a problem if it's very bad on libido
and getting an erection
that's not gonna help getting pregnant.
What is excessive alcohol?
Well, probably drinking more than two
or three pints a week of beer, and more than the glass
or two of wine is not probably gonna impact on sperm count
but it's really the excessive drinking
where that we really get into trouble.
Marijuana.
Now marijuana can impair sperm counts
and probably more importantly abnormalities
within the sperm seem to be higher.
The DNA fragmentation I was talking about earlier,
it's more common in marijuana smokers.
So lifestyle, Oh, well the last one
in a man's lifestyle is weight.
There is a relationship between sperm quality and weight.
So if you are grossly obese, 110, 120 kilos or more
your sperm count is likely to be slightly lower.
So losing weight can be helpful
'cause it also has an impact
on the hormonal drive for spermatogenesis.
Now there is a group of men where those results
that I was talking about the blood results in particular
show not high levels of hormones,
which we can't do anything about
but low or normal levels of hormones.
And in those patients who I see
medication stimulating hormone levels
may improve sperm counts.
So what we're talking about there is giving drugs
that make the brain produce more FSH.
And those particular hormones are the clomiphene
which we give to women but we can also give to men,
letrozole can be helpful.
You take a half a tablet every couple of days
over a long period of time,
because it's not an instant cure.
That what we need to see is our gap of around 90 days
from the beginning of a sperm being produced
to being a mature sperm.
So it takes a good three months
to see whether any effect is gonna happen.
On top of that rather than tablets, injections can be used
and either HCG the pregnancy hormone every two or three days
or FSH itself has been used to try
and improve sperm counts in men
where the hormonal abnormality is what is the cause
of the low sperm counts.
I'd have to say that's in a very small number of patients.
So other than that,
the majority of low sperm counts
we are left with, with nothing to do
in terms of producing an increased natural pregnancy rate.
Now that doesn't mean nothing.
I mean, I certainly have seen men in the last three months
has been one guy came who had a count of 2 million
and we were planning to do IVF.
And we came to wait for the first day of her period
and it never came because they'd conceived.
But at 2 million per mil, the odds of a pregnancy
in a year are around only one or two in a hundred
but it doesn't mean it won't happen.
So I never say never, but the odds are low.
Now with IVF, we can do things.
All we need to fertilise an egg
in an IVF scenario is one sperm.
In nature we need something in the order
of 15 million sperm to start with.
And we need around 50,000 sperm around the egg
in the fallopian tube to achieve a pregnancy.
And even when we do normal IVF, we need that 50,000 sperm
around the egg to get good fertilisation rates.
But we can bypass nature in the laboratory.
We can take a single sperm
pick it up in a very fine needle, hollow needle
and stick that into the egg itself.
So we're doing nature's job.
We're putting the sperm inside the egg and it works.
And it works to the same extent as natural IVF
with a man with normal sperm.
So a low sperm count isn't the end of the road
in terms of having a baby.
We have technology and that technology,
the ICSI technology it's called,
has been around since the early '90s.
Now in Australia, over 60% of cycles, ICSI is involved.
Most of those are because of male problems,
some are because we've had failed fertilisation
but whatever the reason, ICSI works
and we're getting better at it.
So the outlook for a male who comes to me
holding in their hand, a piece of paper from their GP
with a semen analysis on it saying poor count -
we can do things.
First investigate, then try treatments that are appropriate
for that small group of men and then we have IVF.
The other area in terms of treatment
that I haven't mentioned because I don't believe in it,
is the use of other medications.
If you go on the internet
you'll find a hundred different tablets
or nutrients or vitamins or whatever
that are claimed to improve pregnancy rates
or at least improve sperm production.
The scientific evidence that any of these work is zero,
so I don't suggest taking them.
Perhaps the one exception to that is if someone
has that DNA fragmentation that I talked about earlier.
If they have DNA fragmentation, antioxidants may be helpful.
The drug that's pushed most around in the chemist shops
is a drug called menevit,
which has a variety of antioxidants in it.
But to be honest
simple antioxidants are vitamin C, vitamin E
and some food stuffs and not to mention red wine,
so they're cheaper and do the job just as effectively.
And there are randomised studies that suggest
in situations of DNA fragmentation excess, these may work
but that's the only medication
that I would be thinking about
and only in that specific group of patients.
Lots of people are making lots of money out of trying
to convince men that all these adjuvants work,
but they don't, so don't bother.
So we've talked today about low sperm counts,
what we have to do when we see them as a specialist,
what treatments we can provide.
But we always know that as long
as we've got one or two sperm using IVF with ICSI
we can get good pregnancy rates.
So thanks for watching Fertile Minds
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