One of the commonest requests I get is - Doctor, I have a low sperm count. Which is the best medicine to boost this?

They try to manipulate their diet and their lifestyle, with the hope that something will work. Popular interventions include:
Coldwater showers
Boxer shorts
Sexual abstinence
Lots of almonds ... it's a long list!

There are lots of myths and misconceptions about low sperm counts. Let's try to dispel this one by one.

Firstly, lots of men think they have a low sperm count, when in fact they don't! This is because labs are extremely unreliable - and there are still many labs that report normal sperm counts as being more than 60 million per ml! This means that a man who has a sperm count of 30,000,000 per ml ( which is completely normal) starts thinking that he's infertile because of a low sperm count! infantile. However, the WHO has defined a normal sperm count as being more than 15,000,000 per ml - and if your count is more than this, and if your motility is normal, this means your semen analysis report is normal and you do not need any treatment at all! Not only is this something lots of men don't understand, but many gynecologists are also still not aware that normal ranges for sperm counts have changed so dramatically over the last few years, as our understanding of sperm physiology has improved. This means that a lot of men who seem to have a low sperm count actually have a completely normal sperm count and don't need treatment at all!

What about the ones who actually do have a low sperm count? What's the best medicine for increasing their sperm count? Sadly, there really isn't any medicine at all, and this is part of the problem. It's because there is no effective medicine that there are lots of medicines - because nothing works! Everyone is trying to hunt for something which will work - which is why there are so many trial and error. Doctors know that no medicine works, but are reluctant to tell the patient the truth. The doctor is worried that if he does not write a prescription, he will lose the patient, who will go to some other doctor. This is why they waste a lot of the patient's time, money, and energy, prescribing ineffective medicines such as antioxidants, herbal mediations, and vitamins, under the garb of empiric treatment. When nothing works, patients get frustrated and start losing confidence in doctors - not just the doctor who wrote the prescription, but all doctors! They start believing that doctors don't know what they're doing and that their medicines are completely ineffective.

What happens if the sperm count does increases after taking the medicine? This is common and happens all the time - not because of the therapeutic efficacy of the medicine, but for many other reasons. Thus, the sperm count may rise from 5,000,000 to 8,000,000 and the patient may get excited ( as will his doctor), but this is of little clinical benefit to the patient.

Remember that sperm counts fluctuate all the time - even for normal fertile men. Thus, it's quite common for the count to rise temporarily. The patient gets excited because they think they are finally on the right track and are seeing improvement, based on an upward trend. The doctor is happy to take all the credit, as well - but what goes up randomly can come down again - and when it drops down again in the next test, the patient is back to square one.

Men need to remember that it's not just the sperm count number which is important - this is not a bank account after all! The question is - can the sperm achieve a pregnancy or not - and even if the count does rise, the sperm usually remains of poor quality and are unable to fertilize the egg.

Not only do men waste a lot of time and money on these ineffective treatments, but they also deprive themselves of the opportunity of using the effective treatment, such as IVF or ICSI. Assisted reproduction allows us to achieve in the lab what is not happening in the bedroom, no matter how poor the quality of the sperm. However, because they postpone doing IVF, the wife becomes older, and her egg quality starts declining, as a result of which the IVF pregnancy rates drop dramatically - because they wasted so much time on ineffective treatment.

This is the real tragedy - partly because it's so preventable - and if the patient had bothered to take the time and trouble to educate and inform themselves about the treatment options for low sperm count they would not have wasted this valuable time.

If you have been told you have a low sperm count, please confirm the diagnosis by repeating the semen analysis at least twice. It's very important that you select a reliable lab. It's fine to try the empiric treatment, but keep a time limit on your trials - and if you do not see improvement in 3 months, consider moving on!

If you need help with making sense of your sperm test report, I'll be happy to provide a free second opinion. Please send me your medical details by filling in the form at
https://www.drmalpani.com/free-second-opinion so I can guide you better?