Good health can be described as priceless and highly sought by humans. One of the fundamental duties of animals and very importantly humans, is procreation. When this becomes difficult, it is usually associated with a high level of low self-esteem and frustration. This act of procreation involves the coming together of a woman’s matured and released egg and a healthy sperm cell from the male partner. The presence of sufficient healthy and motile sperm cells in the semen is what qualifies the ejaculated fluid from the man to fertilize the egg released by the woman at the fallopian tube during ovulation. Low sperm count is a major cause of male factor infertility. From the medicines use point of view, we shall highlight medicines which affect sperm production negatively.
Low sperm count (oligospermia) means that the fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal (less than 15million sperm per milliliter of semen). A complete absence of sperm is called azoospermia.
SYMPTOMS OF LOW SPERM COUNT
The main sign of low sperm count is the inability to conceive a child. There might be no other obvious signs or symptoms. In some men, an underlying problem such as an inherited chromosomal abnormality, a hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms.
Low sperm count symptoms might include:
- Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling or a lump in the testicle area
- Decreased facial or body hair or other signs of a chromosome or hormone abnormality
Medicines which cause Low sperm count
It is important for pharmacists to know medications which adversely affect sperm health and count so as to guide medicines users who may be having difficulty with conception.
- Anabolic Steroids: Supplemental testosterone and other anabolic steroids used by athletes and non-athletes for muscle building can cause defects in sperm production. When testosterone is given to a man, the hormonal signals that tell the testicles to make testosterone and to make sperm are blocked, and the man’s natural testosterone production stops. This causes the level of testosterone in the testicles to drop sharply--too low to support strong sperm production.
- Ketoconazole: This antifungal medication is commonly applied to the skin as a cream, ointment, or powder. There is no evidence to suggest that applying ketoconazole to the skin harms male fertility. However, when taken as a pill, ketoconazole hurts testosterone production and decreases sperm production.
- Chemotherapy: All chemotherapy medications used to treat cancer will inhibit sperm production. Depending on the type of chemotherapy and the duration of treatment, men may have return of sperm production within two years. Occasionally, sperm production never returns and the man becomes infertile. If you are preparing to go on chemotherapy, talk to your doctor about freezing sperm before starting the chemotherapy.
- Opiates - Long-term use of opiates, a special class of analgesics (pain killers) can disrupt the signals that control testosterone production, which can cause low testosterone and decrease the quantity and quality of the sperm. The extent of the impact depends on the opiates being used, the dose, and how long the man is using the opiates.
- Alpha-blockers: Silodosin and Tamsulosin are examples of alpha-blockers used in the treatment of enlarged prostates. These can both cause a sharp decrease in the volume of ejaculation or may inhibit ejaculation completely.
- Selective serotonin reuptake inhibitors (SSRIs): These medications are commonly prescribed for the treatment of depression and anxiety. These medications may prevent the proper movement of sperm through the reproductive tract or otherwise harm the sperm. Examples of these drugs include Fluoxetine, Escitalopram, Sertraline, Paroxetine, etc.
- Other medications:
- Some antibiotics such as minocycline, sulfasalazine
- Diuretics such as Spironolactone,
- Anti-ulcer medications suh as Cimetidine,
- Anti-hypertensive e.g. Nifedipine,
- Anti-gout medication e.g. colchicine.
OTHER CAUSES INCLUDE
- Varicocele. A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. Varicoceles result in reduced quality of the sperm.
- Infection. Epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV.
- Retrograde ejaculation
- Antibodies that attack sperm.
- Tumors and cancers.
- Undescended testicles during fetal development
- Inbalances from hormones necessary to produce sperm
- Defects of tubules that transport sperm caused by injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.
- Chromosome defects: E.g. Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann's syndrome and Kartagener's syndrome.
- Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
- Prior surgeries.
- Extended exposure to Industrial chemicals such as benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and heavy metals such as Lead.
- Exposure to Radiation or X-rays.
- Overheating the testicles. Elevated temperatures impair sperm production and function. Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also might increase the temperature in your scrotum and slightly reduce sperm production.
Health, lifestyle and other causes
- Drug use as with cocaine or marijuana might reduce the number and quality of your sperm as well.
- Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.
- Tobacco smoking. Men who smoke might have a lower sperm count than do those who don't smoke.
- Emotional stress. Severe or prolonged emotional stress, including stress about fertility, might interfere with hormones needed to produce sperm.
- Depression. Being depressed may negatively affect sperm concentration.
- Weight. Obesity can impair fertility in several ways, including directly impacting sperm and by causing hormone changes that reduce male fertility.
- Sperm testing issues. Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation; was taken too soon after an illness or stressful event; or didn't contain all of the semen you ejaculated because some was spilled during collection. For this reason, results are generally based on several samples taken over a period of time.
To protect your fertility, avoid known factors that can affect sperm count and quality. For example:
- Don't smoke.
- Limit or abstain from alcohol.
- Steer clear of illicit drugs.
- Talk to your doctor about medications that can affect sperm count.
- Maintain a healthy weight.
- Avoid heat.
- Manage stress.
- Avoid exposure to pesticides, heavy metals and other toxins.
Culled from Clevelandclinic.org with special inputs from Pharm. Joseph Ebirim