How To Know Sperm Count Without Test ?

posted in: Male Infertility | 0

Hi!

This is Dr. Shah, Consultant in Male Infertility and Sexual Health and in today’s short post we are going to discuss on the question – “How To Know Sperm Count Without Test?”

Now, I am sure you are aware of the fact that male infertility is rampantly rising all around the globe.

But, most men, who come to a fertility clinic to meet and infertility specialist frequently shy away from any type of testing related to sperm or semen in general.

However, you can’t blame them!!

Furthermore, the feeling of discomfort further rises when these guys meet an infertility specialist who is not a female!. This is more so true in a conservative city like Chennai.

Most men who come to me for an infertility evaluation are pretty open about their problems, yet, a small fraction of them ask me this question time and again…

“How To Know Sperm Count Without Test?”

Here is the honest answer…

There is no accurate way to determine the exact sperm count without a proper and full-fledged semen analysis!


how to know sperm count without test


Sorry to disappoint, but that is the absolute truth!. I swear!

There are numerous sperm check at home kits being sold online that claim to tell if your sperm count test is normal

Sadly

That is very, very, I mean very far from the truth

Just remember, that none of these kits can ever guarantee your ability to father a child!.

Sadly, none of these at home kits that claim to assess sperm count are sensitive or specific enough to detect zero sperm count specifically.

However, there are few kits that are sensitive enough for sperm counts up to 2 million/ml, I will reserve my judgment on them.

The semen analysis test even for a single male can change from place to place and time to time.

I only recommend doing a proper semen analysis as per the WHO 2010 Laboratory andrology guidelines from a well-certified lab

I good report usually will give you the following metrics on your semen

  1. Sperm count
  2. The Sperm motility along with three subtypes as follows a) sperm progressive motility b) sperm non-progressive motility c) immotile sperm
  3. The Sperm morphology and other types of sperm defects
  4. Vitality of sperm
  5. Semen Volume, Ph and a host of other data

And, that is not the end of the story!

Every man who ever has a semen analysis should get a clinical workup that includes

  1. an in-depth male history taking
  2. and also a thorough physical examination of his testis size and other reproductive organs

At this juncture, I should also tell you that your semen is a very complex fluid.

Every parameter of semen, and especially the sperm count, motility and morphology can change from one report to another.

Anything about Sperm biology usually is darn confusing!. 

Normal sperm count | How To Know Sperm Count Without Test ?

Lastly,

What is the normal sperm count?

That is about 15 million sperms per ml of semen!. Just remember that, the next time you look at your test results.

Oh…

And do not get upset if you get a bad result, just get it rechecked in a proper well-certified andrology laboratory!

I hope you enjoyed this short read on…

“How To Know Sperm Count Without Test?”

This is Dr. Shah, Consultant in Male Infertility & Sexual Health,

Do drop in your questions in the form below!

References

  1. Sperm Fertility check at home article
  2. Semen analysis and spermiogram as per the WHO 2010


You are also welcome to visit us in person at the address below…

 

Sperm Motility

posted in: Male Infertility | 1

Hi,

This is Dr. Shah, Consultant in Male Infertility & Sexual Health. In this post, I am going to tell you everything about sperm motility

But, first, let us understand a little about normal sperm motility.

What is normal sperm motility?

Did you know, that the normal sperm motility as stated by the WHO 2010 Andrology Laboratory Guideline values is 40%. 

Most men fear they will never father a child when their semen analysis or sperm test report shows a sperm motility range less than 40%.

This cannot be farther from the truth! Here is a saying I absolutely love, take a look below…


Sperm motility | normal sperm motility | normal sperm motility for pregnancy


In my long years of clinical experience as an Infertility specialist, I have seen over 286 men who had extremely low sperm motility, in the range of 10  to 20%. All these men were told to go in IVF (In Vitro Fertilization) because the professionals who treated them believed that getting pregnant with low sperm motility is not possible. 

I advised each and every one of them the exact opposite of what they were told. Yes, I agree they all suffered from poor sperm motility, but, that does not ever mean that it is not possible to improve it.

With the right treatment and medications, we were able to increase sperm motility naturally for each and every one of them.

Now here comes the bigger truth,

Remember, I told you the WHO 2010 manual recommends a sperm motility index of 40 %?

This value came from a study performed on over 3000 fertile fathers who were able to get their partners pregnant in the 1st year of marriage. The WHO study assessed data only from European men who gave a semen test. It chose to ignore India and China

The big joke is how can you extend an apply sperm motility data from one geography or study population to another population of Indian men??

It’s like telling the apples and oranges are the same!…Read on…. the interesting stuff has not even begun…


sperm motility varies from place to place | normal sperm motility


The sperm analysis or semen test data that we use to assess Male infertility is not even based on study findings from our Indian population!. The WHO did not include Indian men when doing their study. They simply said that the 40% normal sperm motile range as prescribed is for reference purpose only! and that every clinic or lab should come to a conclusion based on their own data and metrics!

Thus, that is exactly why I strongly believe that with the right treatment it is possible to improve sperm progressive motility

Okay now bearing this in mind..

let’s discuss on our second topic

What is the normal sperm motility for pregnancy?

So how much motility is required for pregnancy?..

Well to be honest, all you need is one sperm to fertilize that egg at the right time. But truth be told, not all men are lucky enough for such a scenario. If that was the truth why would there be male infertility issues in the first place?


male infertility | normal sperm motility for pregnancy


In my clinical experience, what the lowest sperm motile range below which pregnancy chances seriously fall, is about 2% to 5%.

Again the statement I make here is highly relative.

In all my years, I was able to treat only one patient who had severely low sperm motility in the range of 1 to 5%. However, this patient also conceived naturally without any aggressive fertility based therapies.

All said and done, for Indian men, motile sperm percentage of 35% or above is good for pregnancy.

This is especially true, when his sperm count, shape, and semen volume is normal!.

Because we have no other options, we try to use the WHO 2010 reference values. We do not swear by it, In all our treatments for male infertility, it is a combination of our data and clinical experience that help us make the right decision for each couple.

There is and always be will chance of pregnancy with low sperm motility least for a few couples. But we cannot directly predict for whom pregnancies will happen.

Thus to conclude this section, you must understand that there is strictly no normal sperm motility for pregnancy. For all practical purposes, we recommend a range of 30 to 40% sperm motility as normal

Now let us further our understanding, about spermatozoa and its motility

Sperm motility can be broadly classified as follows

  1. Sperm that are progressively motile.
  2. Sperms that are non progressively motile.
  3. Sperms that are immotile.

We will discuss the significance of each type –

Sperm progressive motility : 

A sperm is said to be a progressively motile sperm if it moves linearly from one field to the next. This kind of movement is called progressive in nature. What this in principle means is that, the sperm is able to move from one place to another place. Both the number of sperms (sperm count) and the total number of progressively moving sperm in the semen play a key role in pregnancy.

The concept should be fairly easy to understand, remember only sperm that are able to move can reach and fertilize the egg!.

While a lot of fuss was initially made about the speed of sperm movement, we now know for a fact that speed of sperm movement is not or no longer a clinically useful tool to predict pregnancy. As long as you have at least over 32% of progressively motile sperm in the ejaculate, things should turn out normal.

However, do remember that even if you have sperm progressive motility lesser than 32%, pregnancy is still possible. It is only at very low values of 2 to 5% were the chances of pregnancy become less.

Have a quick look at the image below to understand progressive sperm motility


Sperm progressive motility | sperm motility| normal sperm motility | normal sperm motility for pregnancy


Sperm non-progressive motility : 

Okay, now let’s discuss sperm non-progressive motility. A sperm is said to have non-progressive sperm motility if it moves in circles, or if it simply vibrates around a set point. Non progressively motile sperm may become progressively motile over a later period of time. But we do not know to what extent this phenomenon occurs.

Hence for all practical purposes, the total sperm motility in a given sample = sperm progressive + non-progressive motility. Total sperm motility gives us a good sign of the total number alive sperms in the semen.

Have a look at the image below to understand sperm non-progressive motility.


Sperm non progressive motility | sperm motility | normal sperm motility | normal sperm motility for pregnancy

Immotile sperm : 

Immotile sperm as you can clearly understand from our very definition, simply means that the sperms are not moving or mobile.

A very important distinction has to be made here though, just because a sperm is not moving, it does not mean it is dead!!!. When a semen analysis report shows a higher range of immotile sperm, most people think or tend to assume that the sperms are all DEAD.

But that is absolutely not true!. Which is exactly why in a semen analysis report we have a separate section to assess sperm vitality.

All said and done, immotile sperm do not contribute to the chances of achieving a pregnancy. Having over 80% of immotile sperm in the semen is definitely strongly associated with male infertility.

Also interestingly, some men suffer from sperm flagellar defects, this also results in immotile sperm.

The causes of immotile sperm are summarized below

  1. Oxidative stress from poor lifestyle habits can result in immotile sperms
  2. Smoking and excess alcohol consumption can lead to immotile sperms
  3. Hormonal deficiencies can lead poor sperm count and immotile sperm
  4. Sperm tail defects can also be genetically inherited can also lead to immotile sperms
  5. Cystic fibrosis is a genetically inherited condition is also associate with immotile sperm
  6. Kartageners syndrome is also associated with immotile sperm
  7. Sexually transmitted infection can also increase the percentage of immotile sperm
  8. Excess heat exposure can also increase the proportion of immotile sperms
  9. Numerous other sperm production problems due to genetic mutations in the Y-chromosome can also lead to sperm immotility with extremely low sperm counts.
Sperm motility range chart –

Alright then, let’s take a look at the WHO Semen analysis normal reference values!

Semen Analysis Normal Values

The WHO 2010 Semen Analysis normal reference values.

As you can clearly see, these values are based on studies done on European men. While we still use these reference values in our day to day practice we do not SWEAR by them.

If you have taken a recent semen test, you can compare it with the table above. You can also get in touch with me at my fertility clinic. I will try my best to help you.

That apart, I hope you got some understanding of sperm motility. Now let’s look at ways to improve sperm motility

How to increase sperm motility?

So, how to increase sperm motility fast?, here are some ways that you should definitely try to follow

A. Exercise, exercise and keep exercising to improve sperm motility –

Exercise does not mean hitting the gym and lifting heavy weights and wearing out yourself. Healthy exercise for sperm motility can be a simple act of walking regularly for over 45 mins every day for a period of 8 weeks.


walk to improve sperm motility | normal sperm motility improves by walking


Walking for a period of 8 weeks tremendously improves your bodies free testosterone, testosterone is a key hormone required for normal sperm production. When you regularly walk, this hormone rises in your body exponentially, and definite improvement in sperm motility is seen after a period of 8 weeks.

Walking is one the most common strategies we advise patients when they have problems with their sperm motility percentage.

B. Eat lots of Antioxidant-rich fruits and vegetables –

No two thoughts on that, a healthy diet goes a really long way in drastically improving the results of your semen test, more so the motility of your sperm. Oxidative stress is constantly generated by free radicals production in our body.

Free radicals can bind to the sperm cell plasma membrane and damage sperm severely leading to low sperm quality in general. This is exactly why you need to gorge on lots of fruits and vegetables to significantly improve the motile sperm fraction in your semen.


eat fruits and vegetables to improve sperm motility | normal sperm motility for pregnancy


Of course, we have an awesome fertility friendly diet we give patients who come to us for a treatment .

C. Take the prescribed antioxidants from the right male infertility specialist –

I am sorry to say this, male infertility doctors are far and few in between, most patients sadly resort to native treatments for years together at a stretch.

Sadly speaking, lost time simply means you are losing the best years of your life as far as your fertility is concerned. With increasing age, and with more time lost with ineffective non-scientific treatments, fertility for both men and women decreases.

Numerous studies have found a strong correlation between decreased sperm quality and increasing male age.

My advice to you…

Take the right treatment with right expert at the right time

Lost time is lost sperm quality and lost fertility | with increasing age sperm motility is also lost


The Male infertility industry currently sells over 1000 different combination of medications, but which is the right one?. Truth is…

“There is no one right combination drug for improving sperm parameters”

Medicines to improve sperm motility that has some effect are mostly CoQ10, Folic Acid, Vit A, E, C, D3, Carnitine and a few other combination of these chemicals. Again, there is no guarantee that these medicines can actually improve sperm motility. Studies find some benefit but these findings are still not robust.

Over long years of treating many fertility patients, we have found a that a few of these drugs may work in combination with dietary and lifestyle modifications. Never ever take sperm motility tablets sold online without a prescription. These medications will do more harm than good

D. Avoid carrying your cell phone in your pant pocket –

Smartphones are not smart, they cannot do everything!. Sometimes they can do more harm than good.

I think the image below should tell the rest!


smart phones and sperm motility


you see, cell phones emit EMR Radiation which is electromagnetic waves and these waves can ultimately destroy the motile sperm fraction in semen!

Remember the aforementioned tips are probably the best way to increase sperm quality in general. Remember it is not enough if your motility is alone is good. Having a sperm concentration of 1 million per ml with 40% motility is still no good for achieving a pregnancy.

In these scenarios, it is best to visit an expert who understands male infertility in and out and then seek ways to improve sperm motility.

In the last section let us look at…

Zero Sperm Motility –

You must bear in mind that men diagnosed with zero sperm motility are genuinely sterile and cannot most of the time father a child naturally. This is truly one of the most extreme forms of male infertility.

In these scenarios, we must repeat the semen analysis at least over 4 to 5 different times in well-certified andrology labs.

A trial attempt can be made with medications to improve motility, but most of the time, these do not work so well.

Zero sperm motility is usually because of severe genetic defect called 9+0 Syndrome. In this conditions, there is a severe problem with the production of a mature sperm tail at the level of the testis.

The only way to treat this condition is by resorting to ICSI (Intracytoplasmic sperm injection)

In this technique were natural barriers, to fertilization are bypassed. A single normal appearing sperm is taken and injected straight into the egg. A picture of the same is depicted below


icsi ivf | male infertility | male fertility | ivf process
icsi – ivf involves the injection of a single sperm directly into the egg. icsi -ivf is used to treat severe forms of male infertility

The embryo thus formed can then be transferred back to the partner’s uterus after 3 or 5 days of culture. IVF-ICSI is probably a patient’s best bet when he is diagnosed with zero motile sperm (also called total asthenozoospermia)

What is again very important to understand here is that ICSI success rates are better when the sperms are immotile but alive. In some scenarios sperms are both immotile and are dead, in such clinical scenarios, doing ICSI itself remains more of a gamble.

So I hope you thoroughly enjoyed reading this article on sperm motility. I am sure you are now empowered to help people around you when anyone asks you something about sperm motility in general. Do share this article with all your freinds and loved ones!. and remember male infertility no matter how bad is treatable.

This is Dr. Shah, Consultant in Male Infertility & Sexual Health, and if you do have more questions, know that I will be more than happy to answer them at the earliest

References

  1. WHO Reference values for human semen characterization
  2. Semen analysis with respect to sperm number and sperm morphology and other factors – Asian Journal Of Andrology

 

Contact us here!

You are most welcome to visit us in person!


Semen analysis : The Hard Truth

Semen Analysis: What you should know?

 

Semen analysis also called sperm test in layman terms remains the gold standard test of Choice to assess a male’s fertility potential.

semen analysis | sperm test

Hello!!!

This is Dr. Shah, and I am Consultant Andrologist and Sexologist doctor in Chennai and in this article, I am going to share with you some very interesting facts about the semen test.

 

Here is the interesting bit…

 

Now, when you look back into the past 20 or 30 odd years, it is very interesting to note a few things….

 

Such as…

  1. Over 3.5 million babies are born every year through fertility therapies
  2. IVF procedures world over are increasing month on month and there seems to be no let off.
  3. Over 60% of the time, male infertility is the biggest cause of childlessness in a couple.
  4. What’s even sadder is that men are seldom blamed for fertility issues in conservative societies (eg:  India)
  5. Over 20 to 30% of the time semen analysis tests would reveal true causes of male fertility like Azoospermia.

 

This is exactly why we urge all men who come to our clinic to get a semen analysis done!. 

 

Now, as per the WHO 2010 reference laboratory values…

 

A man is said to have a normal sperm test if he has

 

  1. A sperm concentration greater than 15 million/ml
  2. A sperm motility greater than 40%
  3. And last but not the least, his normal sperm shape should be around 3%

 

However, there is a catch!…

semen analysis

Just having your semen report within those values mentioned above DOES NOT GUARANTEE A  PREGNANCY!.

 

Nature ultimately decides when a pregnancy should happen, our job is to optimize the chances of a couple to achieve a pregnancy. Thus, it becomes very important for a thorough evaluation of both partners in a fertility clinic.


Hope you enjoyed the Video and the short Article, Do share it with your friends and loved ones. And feel free to drop me questions through the contact form given below!

 

This is Dr. Shah, and I look forward to seeing you soon with more information to help you through your fertility journey.

 


References: 

  1. Semen Analysis: Basics

 

Visit us below..

 

 

 

 

Male fertility: What’s the Big Deal?

Male fertility issues are rampantly rising around the globe. The WHO recently declared infertility as a public health problem.

 

 

Hello and welcome!

 

 

This is Dr. Shah founder of the THE ANDROLOGY CORNER!

and in today’s post I am gonna share with you 15 points on infertility in men…

 

 

first of all, I want you to quickly read the content in the image below..


Male infertility | Male fertility | Infertility in men | male infertility test
5 awesome and simple things you should know about male infertility

Infertility in men is not an easy issue to tackle. Men diagnosed with male infertility frequently breakdown emotionally and feel  sense of worthlessness and/or failure..

 

 

Thus from a medical viewpoint it becomes imperative that these issues are handled delicately and the medical practitioner should empathize with the patient.

 

 

Now keeping this in mind, lets look at a few common questions that I keep getting asked in my clinic time and again.

 

 

MALE FERTILITY FAQ’s

 

A. What are the causes of infertility in men?

 

Surprisingly, a large number of diseases can consequently lead to Infertility in men. A few of them are as follows

 

1. A problem affecting brain structures like the pituitary or hypothalamus

 

2. Genetic problems like Klinefelter’s syndrome/chromosomal anomalies

 

3. Y-chromosome Micro-deletion

 

4. Idiopathic infertility (cause is unknown). In 30% of men we really do not know, why infertility occurs!

 

5. Trauma to the Testis can also damage and affect the sperm output

 

6. An infection that affects the testis and its ducts that transport sperm. This can block sperm transport

 

7. Testicular tumors can effectively destroy the testis and hence sperm production

 

8. A testis that has not descended into the scrotum

 

9. Chemotherapy/radiation for other cancers

 

10. The use of Certain drugs

 

11. Sexual problems like erectile dysfunction/pain during sex/no ejaculation

 

12. Other severe systemic diseases

 

 

B. Are their any Male infertility Symptoms?

 

Unfortunately, most of the time their are absolutely no symptoms of infertility in men…

 

First of all, male fertility problems are usually the suspect only when no pregnancy has happened spontaneously for the female partner even after one year of regular unprotected sexual intercourse….

 

….but, some male fertility issues could be a suspect when a man sometimes has difficulty in achieving and/or maintaining erections.

 

Since if a man has a difficulty in performing sexual intercourse, this is suggestive of a male hormonal deficiency,

 

…although one must rule out other associated psychological causes of the sexual problem.

 

Hence, it would be wise to get a thorough physical examination and also get a hormonal evaluation with a medical professional at the earliest. A semen analysis is a must and is also probably the first line investigation for male fertility assessment.

 

 

C. Are their physical symptoms of low sperm count or are their any signs of low sperm count?

 

This is probably the most commonest question I get!. Unfortunately their are absolutely no physical symptoms a man would feel if he has a low sperm count.

 

Men usually have a normal sexual life and are also most of the time completely unaware that they producing semen with low sperm counts. Most men are caught by surprise only on the day when a male fertility assessment is done.

 

Interestingly, many men who presented to our clinic in the last couple of years have been diagnosed with AZOOSPERMIA (which means no sperm in the ejaculate). Some men with male infertility will also have extremely low sperm motility and a combination of very low sperm count

 

These men while sadly infertile, seem to have a normal sexual life…. at-least till the time they were diagnosed with this dreaded condition!. A diagnosis of male infertility in itself sometimes can severely affect a mans sexual life

 

 

D. Is their a Male fertility test or a Male infertility test?

 

Male fertility is best assessed with a simple semen analysis that can be done at any well certified laboratory that have trained personnel for performing the test.

 

The semen sample is usually collected by masturbation into a sterile on toxic wide mouthed container provided by the laboratory using a DRY HAND. The collection is preferably done in a private room within the laboratory premises.

 

Exercise caution and stay away from ill equipped laboratories that are not designed to do Semen Analysis!. Since over 70% of the time you could an erroneous report. A misdiagnosis is very common in this speciality.

 

Male fertility test | semen analysis
I am sure you do not want a wrong report!

 

As semen analysis is a complex test that requires some degree of training and orientation. Sadly their is an absolute paucity of trained places in our country were you could get an accurate report. Feel free to drop me a mail and I will be happy to help you through.

 

E. Male fertility test cost?. Is it expensive?. Are their other male fertility tests?

 

A simple semen analysis can range from anywhere between Rs 200/- to Rs 1200/-. Cost usually widely varies from place to place. Other tests for male fertility assessment are listed below.

 

HINT : Never go for an automated semen analysis estimation

 

A. A Hormonal Workup is done usually as a routinely for patients, but preferably if patients are suspected to have hormonal deficiency

 

B. Ultrasound scan of the testis may be able to give an accurate estimation of testis size. Interestingly, a certain degree of correlation is seen between testis size and sperm output

 

C. Karyotyping as a test is recommended only in select groups of patients were a genetic problem is suspect, in addition to Y-chromosome micro-deletion mentioned below

 

D. Y-chromosome micro-deletion assessment in addition is preferably done for all patients who present with a sperm count less than 5 million/ml. The normal sperm count for male fertility as per the WHO is 15 million/ml of semen

 

E. Finally, patients can undergo a semen culture if and when the doctor suspects a urinary tract infection or if the semen shows many round cells.

 

 

F. How common is it for a man to be infertile?

 

Male infertility affects 50% of married couples on a global average.

 

That is a shocking figure indeed. If we estimate 1 in 6 married couples finding difficulty in achieving a pregnancy, then the number of infertile men contributing to the cause is rather very very high!

 

Let me give you a ballpark estimate

 

Say you have 100 couples trying for a pregnancy and have not yet achieved it. Then in that case..

 

A. In 30 to 40 of 100 couples the problem would lie in the female partner

 

B. In 30 to 40 of 100 couples the problem would lie in the male partner

 

C. In 20 – 30 their would be a problem both in the male and female partner

 

 

Thus it is very common for a man to be diagnosed with some form of infertility when a pregnancy does not occur within a year or two of marriage.

 

Furthermore, at-least 10 to 15% of all men presenting to an infertility clinic would definitely have no sperm in their ejaculate a condition called AZOOSPERMIA.

 

 

G. Can male infertility be treated?

 

Of course it can!. Read on….

 

Medical management of Male infertility:

 

Hormonal deficiencies caused by central problems affecting brain structures can be corrected by giving hormonal supplementation with FSH, hCG or HMG injections

 

Antioxidants/Dietary modification/lifestyle changes can be tried for men with male infertility were a specific cause is not identifiable

 

Intra-uterine insemination (IUI) of sperm can be done to overcome mild male factor infertility.

 

Surgical management of Male infertility:

 

Surgically retrieval of sperm from the testis (TESE) can be done in cases were men present with semen report showing no sperm in the ejaculate. These men are diagnosed as AZOOSPERMIC

 

Other surgical procedures done for male fertility restoration includes reversal of vasectomy. The success rate of this procedure though is poor


Treatment for male infertility | male fertility


Assisted Reproductive Technology in the management of Male fertility issues:

 

This includes complex procedures like IVF (In-vitro fertilization) and/or ICSI (Intracytoplasmic sperm injection)

 

Their is a crucial difference between these two procedures though, just look at the image below

 

In an IVF procedure approximately 100,000 sperms are kept close to the egg. The sperm has to do the Herculean task of swimming to the egg, attaching to the egg, penetrating the egg and ultimately fertilizing it.


ivf | test tube baby
In an ivf procedure about 100,000 sperms are kept adjacent to the egg in a specialized dish holding both gametes suspended in a specialized culture media. The sperm has to swim, attach, penetrate and then fertilize the egg. ivf is more natural in the sense it mimics natural fertilization to a certain extent.

BUT…..

 

In an ICSI (intra-cytoplasmic sperm injection) procedure one sperm is directly injected in to the egg by thereby bypassing all natural sperm selection methods. Thus, ICSI is a more invasive treatment for male infertility. The sperm only has to fertilize the egg after the procedure.


icsi ivf
icsi – ivf involves the injection of a single sperm directly into the egg. icsi -ivf is used to treat severe forms of male infertility