Often we see men are coming to us with abnormal semen analysis report showing very low ("Oligospermia") or absent ("Azoospermia") sperm count or very poor "motility" (ability to move) of the sperms. Naturally, they are very much worried and want to know whether medicines can be helpful.

Two things must be remembered
1) Semen Report must be REPEATED from an AUTHENTIC LABORATORY after ABSTINENCE of 3-5 days. This is important, as the sperm count varies day to day. It takes almost 3 months to produce the sperms. therefore, if today you wear very tight underwear or you have high fever, your sperm count (checked after 3 months from today) will be low. As a result, a SINGLE ABNORMAL SEMEN ANALYSIS report does NOT HAVE ANY SIGNIFICANCE. You need to repeat it.

2) Both Male and Woman should be seen together. What treatment is required, actually depends on the reports of both the partners, their age and duration of infertility. Moreover, the pregnancy will ultimately happen on the woman. That's why, we need to see both together.

What medicines should I take if the second semen analysis report is also abnormal?
It all depends on how abnormal the report is. In case of mild abnormalities, we give medicines called "Antioxidants" (special types of minerals and vitamins that act on the sperms) for 2-3 months and ask to repeat the test again to see if there is any improvement. At the same time, some life-style changes are advised. These include avoidance of smoking and alcohol, reducing weight, avoidance of using tight underwear, prolonged sitting and driving.

However, if the problem is severe, you can take antioxidants. But it is more IMPORTANT to do some tests to FIND OUT THE CAUSE. Sometimes, we can find the cause like diabetes, which if controlled, can improve your sperm count without any other treatment.

What tests are required?
You may need physical examination of your genital organs by the doctor. You may be advised some blood tests for hormones (Testosterone, FSH, LH, Sugar etc). Some ultrasound examination of your testicles or prostate gland may be advised. In severe cases, some genetic testing (blood test to see if there is any chromosomal problem) may be needed.

Can any medicines help if there is severe problem?
In most of the cases, medicines cannot help. You can take antioxidants but SHOULD NOT RELY solely on it. In most cases, you will require IUI or IVF. However, there is ONLY ONE CASE where medicines can ACT DRAMATICALLY. That is if there is problem in the pituitary gland (situated in the brain). In that case, taking gonadotrophin injections for 3-6 months will significantly improve your sperm count.

What's the problem if medicines are taken for long time?
As such, medicines will not harm. But if you take medicines despite the fact that your sperm count is not improving, you can land up in azoospermia. This is because, in male having severe oligospermia, there is a tendency that sperm count may further decrease over time. Therefore, relying on medicine will INDIRECTLY HARM you. Rather, you should think of IUI or IVF.

Can Testosterone be taken?
Even if your testosterone is low, if you start taking tablet/ injection of testosterone from outside, your SPERM COUNT WILL DECLINE FURTHER. Therefore, under any circumstances, if you want to become father, you SHOULD NOT TAKE TESTOSTERONE. Sometimes, after hormonal tests, we can advise tablets like Letrozole, which can help to improve the testosterone level, indirectly.

IUI or IVF- What to do?
If the sperm count is mildly/ moderately low, IUI (Intrauterine Insemination) can be tried. however, if its severely low, you should go for special type of IVF (in vitro fertilization), called ICSI (Intracytoplasmic Sperm Injection). All of these will be done using your sperms only.

What to do if there is no sperm (Azoospermia)?
You need some investigations to find out the cause. If there is pituitary gland problems, injections can be helpful. In most of the other cases, no medicines can help. But you can become the biological father of your baby using your own sperms, collected from your testicles, by small needle (TESA- Testicular Spwerm Aspiration). those sperms can be used for ICSI.

Conclusion-
In most of the case, we may not be able to improve your sperm count by medicines. Taking medicines years after years, can rather be harmful. In most cases, you can become biological father of your own baby using your own sperms.