Low Sperm Count

[u/moxietrot]

So my journey has been a bit of roller coaster. Wife(33F) and I (35M) are TTC from last year but wanted to be proactive by getting baseline tests done. We did our check ups and she was suspected of PCOS. My sperm analysis was very disappointing. Also has low T levels. They suspected Azoospermia. Doctor asked for repeat test which showed 100K immotile sperm and referred to Fertility clinic. We both did all our tests again and clinic confirmed wife of PCOS and me of having very low sperm count -140k motile sperm. I was devastated as we were looking for natural conception but our case was looking at IVF. I asked my dr to prescribe clomid and in parallel I startes taking prenatal for myself. Dr asked for repeat test within 7 weeks which happened last week. Results havent improved much. I now have 200K sperm count. T level is at 21.5. Urologist appointment is scheduled next week.

For the men in this journey, how do you cope up with the feeling of being insufficient or incapable to provide one thing in conception journey? How do you deal with thoughts of being a failure?

For the couples who had similar case as ours or close and have gone through IVF, how was your experience through it all? How draining was it emotionally?

For reference we are based in Toronto and have our treatment at Generation Fertility, Vaughan.

[u/DrBrianSteixner]

First, I want to say very clearly that infertility is not a reflection of your value, masculinity, or worth as a husband. As a fertility doctor, I can tell you that many men with severe male-factor infertility describe exactly what you are feeling: guilt, shame, inadequacy, grief, and the sense that they are “failing” their partner. However, biologically, fertility is not a measure of character or strength. You did not cause this intentionally, and the fact that you are being proactive, pursuing evaluation, taking treatment seriously, and emotionally invested in building a family already says a lot about the kind of partner and future father you are. Scientifically, your situation still represents very severe male factor infertility, but not complete absence of sperm. The fact that sperm are present — even in very low numbers — means biological parenthood may still absolutely be possible through advanced reproductive techniques like IVF/ICSI.

Emotionally, IVF can absolutely be draining for both partners, but often in different ways. I see this all the time in my office. Many men feel helpless because they watch their partner carry the physical burden while simultaneously feeling responsible for why treatment is needed in the first place. Many women feel emotionally and physically overwhelmed by medications, monitoring, retrievals, and uncertainty. The couples who tend to survive this process best are usually the ones who stop seeing infertility as “his problem” or “her problem” and start viewing it as a shared medical challenge THE RELATIONSHIP is fighting together. Importantly, your numbers may still evolve. Seven weeks is actually early in terms of sperm recovery because spermatogenesis takes roughly 74–90 days, and medications like Clomiphene citrate often require several months before maximal semen changes appear. Your testosterone response to treatment is encouraging, and the reproductive urologist visit next week is very important because they may evaluate for reversible causes such as varicocele, hormonal optimization, or additional medical therapy. Right now, try not to equate needing IVF with failure. Many couples with stories very similar to yours do ultimately become parents.

[u/moxietrot → u/DrBrianSteixner]

Dr. Brian, first off I deeply appreciate your detailed response and empathy shown towards me. It is very reassuring to hear from another perspective. I do understand that infertility may not be due to something I did or didn't but my guilt/inadequacy also shows up when I have to plan for IVF treatment for my wife. It feels unfair and disappointing that women usually have to undergo so much during IVF and if only I could have better results from my end, her journey would have been easier. Hate to put her to pain due to my condition. Thank you for listening and putting some new perspective for me to think as well.

Based on your experience, how successful are IVF cases like us? Do couples get conception in 1 cycle? I will have to not just plan emotionally and financially but also how far we can go with it. I obviously understand that your feedback is general and not medical advise as it can only be case to case basis.

[u/DrBrianSteixner → u/moxietrot]

Based on my experience, many couples in situations very similar to yours do ultimately become parents, especially because you still have sperm present and your wife is 33, which is still a favorable reproductive age for IVF outcomes. In severe male-factor infertility cases like yours, IVF with Intracytoplasmic sperm injection (ICSI) is specifically designed to overcome extremely low sperm counts because embryologists only need a single viable sperm per mature egg. The biggest variables influencing success are usually the female partner’s age, egg quality, ovarian response, embryo development, and whether enough viable sperm can be obtained consistently. Statistically, many couples do not achieve success in one cycle, but many absolutely do. Others may require multiple retrievals or transfers before success. At 33, your wife’s age is actually one of the more reassuring aspects of your situation because IVF success rates decline much more sharply after 38–40.

Emotionally, one of the hardest parts for men is exactly what you described — feeling guilty watching their partner go through injections, monitoring, retrievals, and emotional strain because of a male-factor diagnosis. I hear that all the time. But I would strongly encourage you not to interpret her going through treatment as “pain you caused.” Infertility is a medical condition, not a moral failing. The couples who tend to do best emotionally are usually the ones who stop viewing IVF as “her suffering because of me” and instead see it as the two of them fighting the same problem together. Also remember: you are still very early in your treatment timeline. Seven weeks on Clomiphene citrate is not long biologically, since sperm production cycles take roughly 74–90 days. Your reproductive urologist may still identify treatable contributors such as Varicocele, hormonal optimization opportunities, or additional therapies that could improve sperm retrieval options or IVF outcomes further.

[u/TotterTates → u/DrBrianSteixner]

please stop using ai.

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[u/Dogmama1230]

Wife (with PCOS) of a husband who has (had?) azoospermia. We just completed our first round of IVF, and ended up with 12 blasts. It’s a hard journey, I’m not going to lie. We’ve been trying for over 2 years and no inkling of a positive test. We are hopeful for the future though. Let me know if there’s any questions I can answer.