A very low sperm count used to mean a very low chance of having a child. Now with the use of IVF and ICSI (intracytoplasmic sperm injection), pregnancy can be achieved with a high likelihood, even with just a small number of sperm. And, though less likely, natural conception is also possible with low sperm counts. But when it is discovered that a patient has low sperm density not amenable to improvement through treatment, is it necessary or even appropriate to recommend freezing sperm to mitigate against the risk of a lower or zero sperm count (azoospermia) in the future?
There are a number of causes of very low sperm production including prior mumps infection, history of chemotherapy, testicular failure and certain genetic conditions such as Klinefelters or y chromosome microdeletion. With respect to the latter, y chromosome microdeletions are generally relegated to AZF “a”, “b” and “c” regions and specifically an AZF c or partial b + c microdeletion can result in the ability to accomplish either no or only minimal amounts of sperm production. In a study by Marinaro et al, (sept 15 2023 fertnstert) this question is examined. 50 men with complete AZF deletions had at least 2 semen analyses at different times. Applying statistical analysis to the values revealed no significant change in values over time; however, there are caveats. 19 of the 50 were persistently azoospermic. The median time of follow up was less than a year and the longest duration of follow up for any patient was less than three years.
There are other reasons for a severe low sperm count. Klinefelters (47XXy) usually presents with azoospermia; however, a minority of men will have severe oligospermia. These men are generally counselled to freeze sperm with the concern of progressing to azoospermia at a relatively young age. Men who are going to undergo chemotherapy are encouraged to freeze sperm in advance. There is also evidence that men with an elevated FSH will likely see their sperm counts deteriorate as time passes. Finally, a number of men are now freezing their sperm if they are not fathers by their mid thirties. Some of the rationale behind this relies on the observation that, as we age, we produce sperm with more epigenetic changes; these are changes to modifiers on our DNA that turn off and on certain genes and epigenetic changes have been linked to certain health disorders. For example, it’s known that the offspring of older father’s are at higher risk for dwarfism and of developing schizophrenia later in life. Although there is no clinical evidence that freezing sperm at a younger age reduces the incidence of these problems, the rationale currently appears to have some merit.
in my practice, in the setting of a man seeking to initiate a pregnancy at some point in the future, but who has severe oligospermia or cryptozoospermia (severe low sperm count), unless it causes undo financial hardship, I recommend sperm banking with a duly certified and qualified bank.
