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Dr. Andrew Rynne

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Trying to get baby. Semen analysis done. All reports are normal. What could be the reason?

Answered by
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Dr. Dattaprasad

Infertility Specialist

Practicing since :2002

Answered : 673 Questions

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Posted on Sat, 19 Jan 2013 in Infertility Problem
Question: We have been trying to have a kid for more than 3 years now without any positive results

All tests have shown that my wife is perfectly fine. She is 32

I am 33 years male

Semen Analysis:
My Sperm count was low. After medication, it is now around 20Mil/ml
Progressive motility (Grade a + b + c) is 0.9%
Immotile sperms is 99%
WBC (pus/epithelial cells) shows presence of Pus cells

Semen Culture test: Found Escherichia coli grown (Scanty growth)

Scrotum scan results showed that "mild to moderate bilateral varicocele is noted (left> right)"

Some other blood tests which I was asked to do recently about a week ago:

* PLASMA HOMOCYSTEINE (Nephelometry) 20.20 # mic.mol/L [4.70-15.00]

* Serum ZINC 221.0 # μg/dl [70.0-120.0]

* Serum VITAMIN D-(25-Hydroxy)*(MCIA) is 20.10 ng/ml
Deficiency : Less than 20 ng/ml
Insufficiency : 20-29 ng/ml
Optimum level : 30-80 ng/ml

* Serum VITAMIN B-12 (ECLIA) is 203.8 pg/mL [211.00-940.00] Deficient: 32 - 246

Below are some of the medications I have taken over last six months

Ubiphene, Maxoza, Taxim 200mg, Testoviron depot 250mg, Sustanon, Restore, PAN-40, Doxy, Pruflox 600mg, Cifran


The doctor whom i consulted wanted to perform varicocele surgery.

Zinc is too high and there is Vitamin deficiency. So, currently I am not sure what the cause for immotile sperms is. Please advice
doctor
Answered by Dr. Dattaprasad 37 minutes later
Hi,

Your count seems to be too low to allow natural conception with good chances of success.
Regarding the medications you are taking, Testoviron depot will suppress your sperm count further down, so please stop it immediately. If you had taken that injection in last 3 months, your semen analysis is not the true reflection of sperm production. You may need to wait for at least 3-4 months to see the effect on sperm count after stopping Testoviron depot.

Regarding varicocele surgery, if the varicocele is clinically apparent, then only it will improve sperm count, mere USG finding of varicocele should not be an indication, at least when there are other apparent causes for low sperm count. If sperm count doesn't improve after stopping Testoviron depot & correcting vitamin deficiencies, you can go for surgery in consultation with an infertility specialist / Urologist.

First & foremost important thing is to stop Testoviron depot.

The second thing to be corrected is vitamin deficiencies with tablets/injections in consultation with physician.

The third thing: Regarding high Zinc levels; these might be due to the supplements you are taking to improve sperm count. If all supplements contain zinc, this will cause high zinc. You can stop a few of the supplements in consultation with your physician & continue one or two necessary ones.
If after correcting all these factors sperm count remains low, you may need further evaluation & treatment.

If after all the corrections suggested, sperm count remains low, it's better to go for Test tube baby (ICSI) treatment rather than going on treating for low sperm count.

Hope this answers your query. Let me know if you have other concerns.
If you do not have any clarifications, you can close the discussion and rate the answer.

Wish you good health

Regards

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Dattaprasad 45 minutes later
Hello Doctor

I am not sure why you are referring to the sperm count as low in your response. Current count is 20 Mil/ml and this is above the recommended range.

Testoviron depot has been stopped 4 months ago.

i have stopped all medication for last 2 months, but zinc levels are at toxic level. could such high zinc levels lead to sperm motility issues. why is zinc so high, is there a way to isolate that.

you have not commented on any of the infections which i had mentioned.

could you also elaborate on what you mean on varicocele when you mean "clinically apparent".

To conclude - are you suggesting that i first get my zinc and vitamin to the normal range and then check count and motility. if there are still issues with motility, then go for varicocele. if even that doesnt help, then go for IVF?

Please advice
doctor
Answered by Dr. Dattaprasad 1 hour later
Hi,
Thanks for the quick reply.

I was referring to the motile sperm count in your case which is low (0.1% of 20million/mL which is equal to 0.2million of motile sperms/mL). Its these motile sperm which are going to be responsible for pregnancy.

Regarding Testoviron depot, it takes minimum of 3-4 months after last injection for improvement to be seen in semen analysis, but it can take more time than that.

High zinc levels might affect sperm motility. Common causes of high zinc levels are high zinc levels in drinking water & environment & taking excess of supplemental zinc. (Zinc is present in most of the nutritional supplements: multivitamin - multimineral tablets). You can just check the contents of medicines that you had taken in past 6 months.

Presence of pus cells in semen is not equal to having an infection, because both immature sperm & pus cells are round & appear similar. Escherichia coli growth in semen can be due to contamination (though its rarely so). You can do leucocyte peroxidase test on semen to know whether infection is really present. Otherwise you can repeat semen culture once more. Also you have received adequate antibiotics(Taxim, Pruflox) to take care of any infection if present.

Regarding clinically apparent varicocele: Varicocele is dilatation of testicular veins & backflow of blood in it. Ultrasound can over-diagnose varicocele(& can diagnose in very early stages when its unlikely to affect sperm count & motility). Clinically apparent varicocele is the one which is visible OR palpable on clinical examination (preferably done by expert urologist). Its the clinically apparent varicocele which might affect sperm count & motility.

Lastly regarding conclusion, you exactly got it correctly. You can skip step of varicocele surgery if you don't want surgery & want to go directly for IVF.

Let me know if you have other concerns.

Wish you good health

Regards

Above answer was peer-reviewed by : Dr. Shanthi.E
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