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 (more below).

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.