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Treatment for sperm problems
Men with low sperm counts or low motility often ask for treatment to
correct the defect. Unfortunately, this is not often possible. Many cases
of sperm abnormalities are genetic in origin. Since there is currently no
way to correct such genetic defects, we end up working with the couple in
ways that will (hopefully) increase their reproductive efficiency. This
usually involves either intrauterine insemination, or in vitro fertilization
Hormone deficiencies
If the man has a hormonal deficiency, it might be treatable with medications.
These are rare cases.
Varicocele ligation
A varicocele is an abnormal tortuosity and dilation of veins of panpiniform
plexus within the spermatic cord. If there is a varicocele, it can be
surgically treated - which might help fertility in some cases. However,
well controlled studies of surgery vs. no surgery have failed to consistently
demonstrate increased pregnancy rates with surgical correction. Some studies
have shown better pregnancy rates after surgery, but other studies have
shown lower pregnancy rates following surgery...
Clomiphene citrate (Clomid, Serophene) for the infertile male
Some men with relatively mild sperm abnormalities have been treated with
clomiphene citrate (tablets) in an attempt to improve the semen. According
to published medical literature, Clomid for the male sometimes can improve
the sperm count or motility. However, well-controlled medical studies have
shown no increase in pregnancy rates.
A "double blind" study (World Health Organization study, published in the
International Journal of Andrology, 1992) of 190 couples, gave clomiphene or
placebo ("sugar pills) to men with abnormal semen parameters. The men took
either clomiphene or placebo for 6 months. Pregnancy rates were not increased
with clomiphene:
8.1% pregnant in clomiphene group
11.7% pregnant in placebo group
Intrauterine insemination and in vitro fertilization
Mild to moderately low sperm counts and/or motility:
Inseminations for about 3-6 months
Then consider IVF with ICSI if not pregnant
Severely low counts and/or motility:
IVF with ICSI
Infertility due to relatively mild to moderate sperm abnormalities can
sometimes be successfully treated with ovarian stimulation of the woman in
conjunction with intrauterine insemination. Moderate degrees of sperm
abnormalities can also be treated with IUI, however, more often they will
require in vitro fertilization in order to conceive. Severe sperm abnormalities
require either in vitro fertilization with intracytoplasmic sperm injection
(ICSI) or donor sperm insemination, whichever the couple prefers.
Approximate chance for getting pregnant with one month of various treatments
Female age under 35, 2 years of trying to conceive
Type of Treatment
Total Motile Sperm Count (in millions)
Less than 1
1-5
5-10
10-20
> 20
Intercourse
(Trying on your own)
.2%
1%
2%
2.5%
3%
Intrauterine Insemination - IUI
.4%
2%
4%
5%
7%
Stimulated IUI
(Ovarian stimulation of female)
.5%
2.5%
7%
8%
10%
IVF with ICSI:
For year 2000 at our center
(IVF pregnancy rates vary between clinics)
60%
60%
60%
60%
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