Low Count

This is especially important if your sperm count is under 5 million per ml as there is a major drop in fertility. The chance of spontaneous conception after diagnosis over 1 year falls from 50% to 5%.

This may be due to many factors.

Hormonal

There are 2 situations. Firstly if your FSH level is high this is indicative of testicular failure. It is unlikely that any treatment will improve the count and it will slowly get worse over time. How fast is unknown but it is usually a slow process over months /years rather than days.

If your FSH hormone is normal or low and your testosterone level is low then its likely that there is a hormonal deficit causing the low count. This may be treated with hormones. Do not treat this with testosterone supplementation as this will make it worse. Treatments such as Clomiphene, tamoxifem or gonadotrophins injections should only be given by a specialist.

Genetic

About 5% of men with low counts (under 5 million) have a genetic abnormality of their general make-up. This is detected by a blood test and measures chromosome make up.

Some men with very low counts have a defect upon their Y chromosome. This may be up to 7-16%, if the count is very low. It is called a Y chromosome microdeletion. The test is a simple blood test but is more specialised than the general chromosome test as the area to be detected is very small. It is not correctable

If you have a treatment such as ICSI there is a significant risk of passing this on to a male child. As yet it is not clear what affect it will have on their reproduction but it is likely to have the same affect as on the father.

Selenium

Selenium is a trace element and is found in small quantities in the soil. Normally you get small amounts of selenium in you diet from anything that is grown in the soil. Some areas, however have deficiency in the soil. There is some evidence that treatment with selenium can increase very low sperm counts. Supplimentation is widely available from health food stores

Zinc and Folate

Suleiman 1996-Journal Andrology 17.530: Correcting Zinc deficiency may lead to a increase in spermatogenesis as may Folate as they are both involved in DNA and RNA synthesis. A Zinc and Folate supplementation for six months showed an increase in sperm concentration but also an increase in abnormal forms (Wai Fertility and Sterility 2002 77:491). Beta-carotene may increase both motility and count.

Omega 3

Foods rich in omega 3 may improve sperm count. Healthy volunteers taking walnuts in their diet had an increase in their count whereas controls did not (2012).

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Toxins

Lead and cadmium exposure:

This may occur in Lead, welders, smelters, alkaline batteries, fossil fuels, cadmium, paint, batteries smoking (especially Cadmium).

These patients have a high level of abnormally shaped sperm (called teratozoospermia) and also a decreased count.

Cadmium is usually a bio-product of production of other metals such as Zinc, Cooper and Lead, it is used in the production of batteries, metal coated plastics, pigments and metal alloys.

High Calcium supplementations are protective in Lead and Cadmium poisoning. High diet phosphate potentiates Lead poisoning, probably by chelating the Calcium.

In order to reduce Lead content:

1. Run the tap for a few minutes or use a filter when drinking tap water
2. Be careful when removing paint put in before 1978
3. Avoid home remedies which contain Lead
4. Avoid Lead solder and smoking.

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Nutrition

Increasing the amount of Iron and Calcium in the diet, foods that will help this are: red meat, liver, greens, spinach, tofu, baked beans and fortified cereal for Iron. For Calcium: milk, yoghurt, cheese, cooked greens.

The 1997 total diet study showed the amount of Lead in diet generally is falling, the amount of Selenium is falling and the amount of Cadmium is steady.

Food and Cadmium:

predominantly in crab, lobster, mussels and offal such as liver and kidney (also some vegetables but unclear which). Increasing Zinc intake may reduce Cadmium toxicity-- Journal of Nutrition 1967 93:30.

The Agency for Toxic Substances and Disease Registry July 1999- advises that reduction of Cadmium can be proved by firstly identifying the source and secondly a balanced diet including Calcium, Iron, protein and Zinc.

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Temperature

Testes work best at about 2 degrees below body temperature

Currently there is some evidence varicocele treatment does not helps fertility

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Advice

We advise that men with low count should

1. check hormones FSH, LH, Testosterone, Prolactin
2. Get advice about chromosome (genetic) analysis.
3. Take selenium for 3 months then recheck if no improvement add in both folic acid and zinc supplimentation for further 3 months and retest could continue up to 12 months
4. Stop smoking
5. Smokers to stop, take zinc supplementation and check protein calcium adequate
6. Boxer shorts
7. Avoid risks such as occupational exposure

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