Sperm Counts: How Low Is Too Low if You Want To Be a Dad?

We humans like to count and label things. We order the stars above us into constellations. We organize time into hours, minutes and seconds. We name the colors of the rainbow. We track how many steps we take with widgets on our wrists. Maybe it gives us a sense of control over our big, wide world. Or maybe it helps us feel like we belong. Regardless, we do the same when it comes to male fertility.

We Count Sperm, Too

Semen analysis is another example of how we like to order our world. We have normal values, means and averages, and reference ranges for everything sperm-related, including total number, movement and shape. Does this have real value? Absolutely. Our ability to order the world is fundamental to how we think about things. And this weird habit of ours has certainly helped us to better evaluate and treat male infertility.

Let’s break down the Greek-derived terms given to sperm numbers so it makes more sense:

Polyspermia	High sperm concentration	>100 million sperm/mL
Normospermia	Normal sperm concentration	15-100 million sperm/mL
Oligospermia	Low sperm concentration	<15 million sperm/mL
Cryptozoospermia	Very few sperm present	Sperm on spun semen only
Azoospermia	No sperm present	0 sperm in ejaculate

 

Every Sperm is Sacred

Now, here’s where the ordering and the science goes a little soft on us. Note the following 5 truths about ejaculated sperm numbers:

• There is no known association of polyspermia with male infertility. The more the merrier it seems.
• Having a normal sperm count does not mean you’re fertile. It means that you’re more likely to be fertile. Take a “deeper dive”  into sperm counts and you will discover that at least 25% of men with normal sperm counts are infertile. It’s a quality issue, not just quantity.
• Having a low sperm count increases the probability of being infertile but does not necessarily mean that you are. Perfectly normal babies are conceived by men with low sperm counts, precisely because women don’t need “normal” numbers to get the job done.
• Men with low numbers of ejaculated sperm, which are often nearly impossible to find unless you look really hard, need not fear. A very small number of sperm can do a very good job of making babies with assisted reproduction (IVF-ICSI).
• Having no sperm in the ejaculate is pretty much the only guarantee of male infertility. Many of these cases are due to blockage and can be corrected. Others are due to impaired sperm production, which although generally not correctable, does not necessarily preclude a man from having children. Pregnancy is possible using small numbers of testicular sperm and IVF-ICSI.

So, ordering our thoughts about sperm has led to a better understanding of the root causes of male infertility. But sperm counts are by no means the whole story, only a small part of it. For conception is a performance with many acts, actors and actresses that involves miracles as much as science.