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Expert Q&A

	By Craig Sweet, M.D. Reproductive Endocrinologist

My spouse and I have been TTC for over 2 years now with no success. Earlier this year, his doctor asked for a semen sample and his analysis showed low volume, count and motility. After receiving his results he quit smoking and reduced his caffeine intake to 1 cup of coffee a day. After 4 months his doctor had asked him for another sample and the results did not change. His results are:

• Semen Volume: 2.5ml
• Semen Count: 13
• Sperm Motility: 50 percent

His semen PH, abnormal forms and leukocytes counts are within average/normal range.

What we would like to know is, is there a chance we will be able to conceive with these results?

Male factor infertility is probably responsible for 30 to 40 percent of all infertility. In general, only about 30 percent of the men will have an explanation for the abnormal semen analysis with the other 70 percent having issues that we simply do not yet understand or are a result of problems in the distant past that we can not precisely identify in the present.

Not knowing your age, two years is plenty of time to give it a try. About 93 percent of all couples will be pregnant by then. It is good that he quit smoking since this can cause problems with semen quality. I think it is less likely that the caffeine intake will have had a significant impact, though.

Most would agree that it is time to see a reproductive endocrinologist. Ideally, going to one that will see men is best, although there are few of these around. If not available, I would try to find a special type of urologist, one that underwent fellowship training in male infertility. It is quite probable, however, that you will eventually need to be seen by a reproductive endocrinologist. Male infertility is a bit more difficult to treat with simple remedies. At the risk of insulting some physicians, a general urologist is less likely to be able to identify anything other than anatomical problems and options other than surgery exist when the patient starts with a more experienced physician. Most would also agree that male infertility should not be treated for any duration by a general OB/GYN.

By the way, I somewhat doubt that his semen analysis was completed in a true reproductive lab (probably just a hospital or a general lab). It is quite unlikely that he had an isolated reduction of concentration with normal motility and normal forms falling within the normal range. I suspect that if repeated in a true reproductive laboratory, you will find the motility and the normal forms certainly less than expected. These problems travel together and are found far less often as an isolated laboratory finding.

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