Saturday, October 17, 2009

How to increase a low sperm count

One of the commonest questions patients ask me is - Doctor, how can I improve my sperm count ?

Even men with normal sperm counts want a medicine to increase their sperm count ! They feel that the more the sperm they have , the higher their chances of their achieving a pregnancy. After all, more is better ! This seems quite logical in a society which is obsessed with numbers, even though it is not true.

The sad truth is that there really is no way of improving a low sperm count. Unfortunately, patients rarely want to hear the truth, which is why they end up wasting a lot of time, money and energy in trying to do so. The tragedy is compounded by the fact that a lot of doctors ( and quacks) and happy to take advantage the infertile man's desperation.

Why are there still so many myths and misconceptions regarding medications to improve a low sperm count, if nothing works ?

This is because most men expect that their doctor will prescribe a medicine which will help them to increase their sperm count, and fix their problem. After all, they expect that if medical technology has become so advanced, then there must be some treatment available to correct such a common problem !

The problem with the medical treatment of a low sperm count is that for most people it simply doesn't work. After all, just as an example, if the reason for a low sperm count is a microdeletion on the Y-chromosome, then how can medication help to treat a genetic problem ? The very fact that there are so many ways of "treating" a low sperm count itself suggests that there is no effective method available. This is the sad state of affairs today and much needs to be learnt about the causes of poor production of sperm before we can find effective methods of treating it.

However, patients want treatment, so there is pressure on the doctor to prescribe, even if he knows the therapy may not be helpful . Since most people still believe there is a "pill for every ill", they do not want to hear the truth that there is really no effective treatment available today for increasing the sperm count.

Since most doctors know this, they are pressurised into prescribing medicines for these patients, because they do not want the patient to be unhappy with them. They are worried that if they do not fulfill the patient’s expectation of a prescription, the patient will desert them, and go elsewhere, which is why they often do not tell the patient the complete truth. The doctor also remembers the occasional anecdotal successes (who come back for followup , while the others desert the doctor and are lost to followup) is why patients with low sperm counts are put on every treatment imaginable - with little rational basis - clomiphene, HMG and HCG injections ( using the rationale that what's good for the goose must be good for the gander !) proxeed, testosterone,Vitamin E, Vitamin C, anti-oxidants, high-protein diets, hoemeopathic pills , ayurvedic churans and even varicocele surgery. However, the very fact that there are hundreds of medicines itself proves that there is no medicine which works ! ( After all, if one medicine worked, then all doctors would prescribe this, so there would be no need for so many different medicines !)

Many doctors justify their prescriptions by saying - " Anyway it can't hurt - and in any case, what else can we do? " However, this attitude can be positively harmful. It wastes time, during which the wife gets older, and her fertility potential decreases. Patients are unhappy when there is no improvement in the sperm count and lose confidence in doctors. It also stops the patient from exploring effective modes of alternative therapy - such as IVF and ICSI. Today , empiric therapy should be criticised unless it is used as a short term therapeutic trial with a defined end-point.

A word of warning. Medical treatment for male infertility has a low success rate and has unpleasant side effects, so don't take it unless your doctor explains his rationale. The treatment is best considered "experimental" and can be tried as a therapeutic trial. Make sure, however, that semen is examined for improvement after three months and then decide whether you want to press on regardless.

So what should you do if you have a low sperm count ? First, don't panic ! Sperm counts tend to fluctuate quite a bit, so don't jump to conclusions on just one report. Doctors know that
counts do vary over time for reasons which are not clear . This means that just because your counts increase after you took a particular medicine does not mean that this medicine caused the count to improve !

Some of the advise is very basic. You need to stop smoking and stop drinking alcohol; and re-test your sperm count after 2-3 months, from a reliable laboratory.

If the count is persistently low, and you have failed to achieve a pregnancy in over one year, then you should consider going in for ICSI treatment. While this will not improve your sperm count, it is the one option which gives you the highest chance of having a baby !


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