Sperm Concentration and Total Sperm Count

Infertility is defined as inability to conceive after 1 year of regular, unprotected intercourse. Approximately about 10–15% of couples suffer from infertility all over the world. Male fertility may be impaired by abnormal sperm parameters and contributes to 50% of all cases of infertility. The causes of male infertility are widely varied and are best evaluated by an expert in male reproductive health. Some causes of male infertility can be identified and reversed (or improved) with specific surgery or medication, while other causes can be identified but not reversed. The main cause is low quality and quantity of sperm. In more than 90% of cases, male infertility is due to either low sperm count or poor semen quality or both. Semen analysis remains the single most useful and fundamental investigation in the search for the cause of male infertility. It is a simple test that assesses the formation and maturity of sperm as well as how the sperm interacts with the seminal fluid so it provides insight not only on sperm production (count), but sperm quality (motility, morphology) as well. Nonetheless, conventional semen analysis may provide inadequate information regarding the etiology of infertility. To overcome the limitations of routine seminal evaluation, several invasive and non-invasive approaches have been developed for the management of male factor infertility. While today we are more successful in treating male infertility, pregnancy is still not always achieved likely due to factors that remain poorly understood. Clinicians treating infertility should advocate for couple-based therapy and require that both partners have a thorough evaluation and an informed discussion before undergoing specific therapies/treatments. The current chapter addresses the methodology of sperm concentration and total sperm count testing and its usefulness to diagnose male infertility; etiology of male reproductive dysfunction; possible causes implied in low sperm count; non-ART management of patient with low sperm count and concentration; and ART management of patient with low sperm count and concentration.