Low sperm count is the term used to define the condition when men have fewer than 15 million sperm per milliliter of semen when compared with normal. It is also called oligospermia.

Having a low sperm count reduces the chances of pregnancy. However, many males that have a low sperm count but are still in a position to father a baby as sperm count varies in men.

No sperm count is the term used to define the condition when men have complete absence of spermatozoa in the ejaculate even though they may be producing sperm. It is also called azoospermia and is associated with infertility. In humans, azoospermia affects nearly 1% of the male population and may be seen in up to 20% of male infertility situations.

When sperm cannot move through a man’s genital tract because of any obstruction, or if there is a mechanical problem with them getting to where they need to be, sperm can be retrieved through surgical sperm extraction methods such as:

• Testicular sperm aspiration (TESA)
• Percutaneous sperm aspiration (PESA)
• Microsurgical epididymal sperm aspiration (MESA)
• Testicular sperm extraction (TESE)

The most of the semen ejaculate volume is contributed by secretions from seminal vesicles and prostrate gland. If there is low semen volume (≤1.5 ml) one should first rule out the possibility of spillage of semen sample during collection and then confirm the results by repeat semen analysis.

After confirming the low semen volume then one should suspect the other physiological reasons for some kind of abnormality or obstruction as highlighted below:

• Seminal vesicles are abnormal or obstructed
• Ejaculatory ducts are obstructed.
• Ejaculatory dysfunction (failure of emission or retrograde ejaculation)
• Absent Fructose and acidic pH are suggestive of ejaculatory and obstruction or seminal vesicle pathology.

When low percentage of live, and high percentage of immotile, spermatozoa are present in an ejaculate then it is called necrozoospermia.

Sperm vitality is the test, which will reveal the proportion of spermatozoa that are “alive” and the proportion of the spermatozoa that are “dead”. The percentage of live spermatozoa is assessed by identifying sperms with an intact cell membrane, from dye exclusion or by hypotonic swelling sperm function test.

• The dye exclusion method is based on the principle that damaged plasma membranes, such as those found in non-vital (dead) cells, allow entry of membrane permeating stains with loss of osmo-regulation which does not allow the dye to diffuse out.
• Hypo-osmotic swelling test (HOS) presumes that only cells (sperms) with intact membranes (live cells) will swell in hypotonic solutions.

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