Terminology Tuesday: Oligospermia (Low Sperm Count)

Last week we discussed the parameters for a normal and abnormal sperm count.  This week we will discuss the main option of therapy when oligospermia (sperm count < 20 million sperm / mL) is discovered.

Artificial insemination (also known as IUI) is an accepted form of treatment for oligospermia.  According to the textbook Clinical Gynecologic Endocrinology and Infertility, IUI has been used to treat infertile couples for almost 200 years.¹ IUI is the placement of sperm past the cervix and into the uterine cavity via a small catheter.  In general, an insemination is quick, painless, and is performed in the office.

The uterus can only accommodate a small amount of fluid.  Thus, prior to an IUI, the husband’s sperm is concentrated into a smaller volume by removing seminal plasma.  The resultant concentrated sperm is also known as “washed” sperm.  IUI with sperm concentrate delivers most of the sperm ejaculate to the upper female genital tract.

The sperm count and morphology play important roles in the success rate of an IUI.  The probability of successful IUI increases when the total motile sperm count exceeds 10 million and the normal morphology exceeds 14%.^{2, 3}

A large study in the New England Journal of Medicine suggested that the conception rate is as high as 10% when IUI is performed using infertile partner sperm.⁴ This study further proved that the success rate of an IUI can be increased when more eggs are developed through the administration of medications prior to the IUI.⁴

If the sperm count reveals severe oligospermia (less than 5 million sperm / mL), IUI may not prove to be a successful option for therapy.  In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is an accepted form of treatment for severe oligospermia.

In next week’s installment of Terminology Tuesdays, we will discuss ICSI for severe male factor infertility.

Dr. Lowell T. Ku is a Reproductive Endocrinology and Infertility specialist at Dallas IVF and clarifies the many confusing terms used in the world of Infertility therapy using straightforward explanations.

1. Speroff L, Fritz MA, Clinical Gynecologic Endocrinology and Infertility , 7th ed. Philadelphia: Lippincott Williams & Wilkins, 1156, 2005.
2. Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J, Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization, Fertil Steril 75:661, 2001.
3. Lee RK, Hou JW, Ho HY, Hwu YM, Lin HM, Tsai YC, Su JT, Sperm morphology analysis using strict criteria as a prognostic factor in intrauterine insemination Int J Andrology 25:277, 2002.
4. Guzic DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, Hill JA, Mastroianni L, Jr., Buster JE, Nakajima ST, Vogel DL, Canfield RE, for the National Cooperative Reproductive Medicine Network, Efficacy of superovulation and intrauterine insemination in the treatment of infertility, New Engl J Med 340;177, 1999.