Low Sperm Count
Azoospermia (complete absence of sperm) or severe oligospermia (greatly reduced sperm count) can be caused by pre-testicular (usually a lack of stimulating hormones being produced by the brain), testicular (a problem with sperm production by the testes) or post-testicular (sperm are produced by can’t make their way into the ejaculate). The following tests are designed to elucidate the cause of the lack of sperm in the ejaculate.
Luteinizing hormone, follicle stimulating hormone – LH, FSH (very low levels in conjunction with a low oestradiol and low testosterone suggest a pre-testicular cause)
Testosterone (total) (this must be collected before 10am in the morning as testosterone levels fluctuate during the day, testosterone levels taken later in the day are difficult to interpret)
Oestradiol (raised oestradiol levels will suppress LH and FSH production in the brain and can impair sperm count)
Prolactin (elevated prolactin will decrease LH and FSH production by the brain)
Karyotype (Klinefelter syndrome, 47, XXY or variants such as 46, XY/47, XXY or 48, XXXY will cause either azoospermia or very severe oligospermia)
Y chromosome micro deletions (in the azoospermia factor (AzF) regions A, B or C)
Cystic fibrosis testing (cystic fibrosis is frequently characterised by absence of the vas deferens causing obstructive (post-testicular) azoospermia
Testicular ultrasound (looking for the size of the testes, varicoceles and for the presence of the vas deferens)
Post-ejaculatory void analysis (examination of the urine produced after ejaculation to determine whether retrograde ejaculation is the cause of the impaired sperm count)
Additional information is available at www.healthymale.org.au.