To help a couple get pregnant quickly as possible, the goal is to increase the total motile sperm count to at least 80 million. This has been shown to increase the odds of a spontaneous pregnancy.
The concentration, motility, and volume all play a factor in determining the total motile sperm count. In men there are hormonal factors, anatomic abnormalities, and other unknown factors which can have a negative impact on the total motile sperm count.
What factors can be fixed:
Every male patient under goes a thorough hormonal evaluation, history taking, and physical examination. There are a variety of medications which can influence a man's hormonal profile and have a favorable impact on semen parameters. These medications include Clomid (clomiphene citrate), arimidex (a type of aromatase inhibitor), and exogenous gonadotropins (such as HCG). The right choice of medication depends on the nature of the hormonal profile.
The male anatomy may show clues about what can be contributing to poor total motile sperm counts. Men can have a dilation of the veins from the testicles. This abnormality is called a varicocele. Through a variety of mechanisms, this abnormality can have a negative impact on the total motile sperm count and decrease the likelihood of having a pregnancy. Getting a varicocele fixed is a straight forward procedure and can have a positive impact not only on the total motile sperm count and sperm morphology but also on a man's testosterone level.
Other therapies may be employed to improve the total motile sperm count and sperm morphology including prescription anti-inflammatory medications and over the counter fertility supplements such as Vitamin E, selenium, L carnitine, acetyl-L carnitine, folic acid, and zinc sulfate. Based on current literature, safe and effective doses of these supplements can be used to improve sperm parameters.
If there are high levels of white blood cells (WBCs) in the semen specimen, this is sign of inflammation in the genitourinary system. Depending on the history and exam findings, options include antibiotic therapy, anti-inflammatory medication, a sperm harvesting procedure, and antioxidant therapy. Many patients get a favorable response with medical therapy alone.
If the semen samples show a pattern of low ejaculate volumes, possible explanations are that the semen is going in the wrong direction or that there is a blockage of the ejaculatory ducts. Retrograde ejaculation (semen going the wrong way) can be tested for by a specialized semen analysis performed on the first voided urine after ejaculation. A blockage of the ejaculatory ducts can be confirmed with a prostate and seminal vesicle ultrasound. For individuals with blocked ejaculatory ducts, transurethral resection of the ejaculatory duct (TURED) is a treatment option which can fix the low ejaculate volumes.