How to get pregnant with Low Sperm Count or Oligospermia?

The sperm count of a male plays a vital role in his ability to make a female pregnant. A low sperm count is a very common cause of infertility in couples. A good sperm count is anywhere between 40 to 300 million sperms per mL of semen. Most men have a variable sperm count in day to day life, but it remains within a limited range. If a sperm count is lower than 15 million it is considered a low sperm count for pregnancy to occur. It does not necessarily prevent pregnancy from occurring and a lot can be done to improve the chances of pregnancy.

pregnancy with low sperm count
How to get pregnant with low sperm count

GETTING PREGNANT WITH LOW SPERM COUNT

A low sperm count is also called Oligospermia, Oligozoospermia. Although it is a major cause of male infertility, but men with a low sperm count are still able to produce sperms and the sperms are also found in the ejaculate. The overall quality of the sperm is considered for pregnancy and not just the sperm count, the sperm motility and sperm morphology must also be considered. Because if a sperm is not motile it won’t be able to reach the egg and if it has an abnormal morphology it wouldn’t be able to penetrate the egg.

Some men with oligospermia can achieve a natural pregnancy with their partner, though fertilisation may be difficult and may take some time. It may take more attempts than couples who do not have a fertility issue. As there is a low sperm count in the ejaculate, the chances for the sperm to ascend in the female reproductive tract and reach the fallopian tubes are lower, and hence are less likely to be able to fertilise the egg and get the women pregnant naturally.

Other men with oligospermia may have problem in fertilising their partner’s egg. Depending on its type and its severity there exists treatments, if natural conception is not possible, conception via assisted reproductive technology (ART) is recommended that can help cure this condition of low sperm count and help in the journey of parenthood.

Different types of oligospermia and the way pregnancy is achieved is discussed

Types of Oligospermia Mode of Conception
Normozoospermia Natural pregnancy possible, provided the female has no fertility issues
Mild to moderate oligospermia Natural pregnancy though possible but may take a longer time, Conventional IVF, IUI (in cases of very mild oligospermia) is recommended.
Severe oligospermia / Cryptozoospermia Natural pregnancy not possible. *Multiple semen freezing might be an option for later use, ICSI (Intra cytoplasmic sperm injection) is an ART procedure that is performed in conjunction with IVF in these cases, as it requires only one morphologically selected sperm for fertilisation
Azoospermia Natural pregnancy not possible. Sperm is directly extracted from the testes via microsurgical epididymal sperm aspiration (TESA, Micro-TESE) and later ICSI is performed as it does not require many sperm.

Note: If sperm cannot be found or extracted, then donor sperm could serve as an option.

*Spem cryopreservation is prudent in severe oligospermia, in case it later turns into azoospermia, without frozen sperm backup, such men would otherwise need surgical testicular sperm extraction. If then also no sperm is found donor sperm or adoption would be the only option left for them.

 

Ways to get pregnant with low sperm count
Different types of oligospermia and the way pregnancy is achieved

Natural pregnancy with low sperm count

A man with a low sperm count can achieve a natural pregnancy with his partner despite lower sperm numbers and there might be no need to visit an infertility clinic. Low sperm count though decreases the chance of conceiving naturally, but it doesn’t rule it out completely. Getting pregnant with low sperm count depends on the severity of the case. As the above table shows, natural pregnancy may be possible for men suffering from mild to moderate oligospermia, but it might take some time to impregnate the female, provided the sperm motility is not altered. But natural pregnancy is nil or very poor with severe oligospermia, cryptozoospermia, and in another case where nil sperm count is seen that is azoospermia. In such cases assisted reproductive technology is a helpful procedure in achieving pregnancy. But before resorting to assisted reproductive technology, a doctor might suggest some tips for getting pregnant with low sperm count.

Low sperm count treatment with Assisted Reproductive Technology (ART)

Low sperm count pregnancy can be successful with assisted reproductive technology. If the underlying cause of the male partner’s semen containing low sperm count can’t be treated naturally or with medication, assisted reproductive technology can be helpful. ART treatment options include getting sperm by either natural ejaculation, clinical extraction or sperm from donor. Based on an individual’s situation the doctor would suggest what could be the best treatment available.

The different way to conceive with low sperm count.

  • IUI with low sperm count

    Intrauterine insemination is one of the options for couples where the man has low sperm count. It is generally suggested in case of very mild oligospermia because this treatment requires a certain number of sperms to help in the process of fertilisation which would not be possible in cases of severe oligospermia. It is a simple, cost-effective technique that has usually good outcomes provided the female does not have any infertility issues. In low sperm motility treatments also IUI is recommended. But the sample should contain at least 2-3 million motile sperms after sperm processing.
    For IUI a semen sample is needed, then it is washed, weak inactive sperms are removed, and the sperm cells are directly inserted into the uterus through a catheter that is inserted through the cervix. The reason for this is to put more sperms closer to the egg, so the distance the sperms need to travel is reduced and they have to make a short journey from the uterus to the fallopian tube,

  • IVF with low sperm count

    It is a type of assisted reproductive technology where sperms and eggs are made to fertilise in a petri dish. When the eggs are fertilised, they are implanted as embryos inside the woman’s uterus. In some cases of mild to moderate oligospermia the treatment of choice would be in vitro fertilisation (IVF), if natural pregnancy and IUI has failed.

  • ICSI-IVF with low sperm count

    When oligospermia isn’t easy to treat ICSI (Intracytoplasmic sperm injection) can be considered. It is an assisted reproductive technology that is performed in conjunction with IVF. With ICSI, a single high-quality sperm collected from the male partner is injected directly into the cytoplasm of a woman’s egg in a laboratory. This technique is useful in many cases of low sperm count like severe oligospermia, cryptozoospermia, and in azoospermia. ICSI differs from traditional IVF in that, instead of letting the sperm fertilise the eggs on their own in a petri dish, ICSI injects sperm directly into the eggs which typically has a higher fertilisation rate. ICSI has a fertilisation rate of 75-80%. Sperm freezing before the oocyte pickup is recommended for severe oligospermic and crytozoospermic patients, which can prevent from a lack of sperm on the day of ICSI.

  • Surgical sperm extraction and ICSI-IVF

    Sperm retrievals are largely performed in men whose semen completely lacks sperm (azoospermia) or has very poor-quality sperm and low sperm number in the ejaculate like in cases of very severe oligospermia and even cryptozoospermia where 0 to rare sperms are found, and also in cases where men are unable to produce an ejaculate, then sperms can sometimes be directly extracted from the testes or epididymis by sperm aspiration (TESA, Micro-TESE). Then the extracted sperm can be used for ICSI in conjunction with IVF.

    Note: If sperm cannot be found or extracted even with sperm retrieval process, then a fertility consultant might guide you with your consent on options such as using donor sperm for conception.

Related questions:

Q) How to get pregnant with low sperm count and motility?

A) If a man is diagnosed with low sperm count and motility, he may be recommended with IUI (Intrauterine insemination). For this a semen sample is required, excess semen is washed out and the sperm sample is then injected directly into the female partner’s uterus during her ovulation cycle. So that the distance the sperm needs to travel is reduced.

Q) Can a weak sperm fertilise an egg (pregnancy)?

A) The sperm that is active, stronger, swims faster than other sperms will be able to fertilise an egg. That is the fittest sperm is needed for fertilisation. Weak sperms are not able to fertilise an egg, if also it does it will result in early miscarriage due to some chromosomal abnormality.

Q) How many sperms are needed for pregnancy?

A) It takes just one active sperm to fertilise a woman’s egg. On average each time a man with normal sperm count ejaculates, he releases nearly 100 million sperms. To meet the waiting egg, many sperms must travel from the vagina to the fallopian tube, it is a tough journey which only few sperms can survive.

Q) What is the minimum sperm count required for pregnancy?

A) A minimum count of 15 million and more sperms per mL of semen is considered fine for a pregnancy to occur. If the sperm shape and motility is fine, it wouldn’t be a problem in achieving pregnancy.

Q) Is it possible to get pregnant with 1 million sperm count?

A) Natural pregnancy is not possible with so less sperm count, it is a case of severe oligospermia. A man with 1 million sperm count per millilitre of semen may need assisted reproductive technology to impregnate a female, he may be a candidate for ICSI-IVF.

References :
1. https://www.ncbi.nlm.nih.gov/pubmed/16669917
2. https://www.news-medical.net/health/Causes-of-a-Low-Sperm-Count.aspx
3. https://www.fertstert.org/article/S0015-0282(01)02044-1/fulltext?code=fns-site
4. https://www.astroglide.com/blog/what-causes-a-low-sperm-count/
5. https://www.malefertility.md/male-infertility/sperm-disorders/low-sperm-count-treatment
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349690/

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