My wife and I have been trying to conceive for two years without any luck. I had two sperm counts taken (16 million after three days of abstaining and 28 million after seven days). I have read that any count under 20 million is “functionally sterile” and the likelihood of conceiving is remote. Is a count under 20 million a great cause for concern? If I abstain from sex for longer periods of time (more than seven days) will my count increase?

The issues about sperm count are more complicated than you might realize. To begin with, there are a number of measurements involved in the semen analysis. First, we look at the concentration — how many sperm there are per milliliter of semen (the fluid). Next, I need to know how many mL of semen are present. So a count of 40 million sperm per mL with only 1cc of fluid may not be as good as a count with 16 million and 4mL. I like to see more than 20 million sperm per mL and 2-5cc of semen. Another measurement to consider is what percentage of the sperm are moving forward progressively; 50 percent motility is considered normal. The next factor is sperm morphology — that is, what percent of sperm look normal. When you assess the fertilizing potential of a given specimen, you must consider all these factors. Thus, a slight abnormality in sperm count may be compensated for by better motility or an increase in volume. So you can see this is a bit more complicated than just one number. We find that delaying ejaculation may increase the total concentration of sperm and perhaps the volume of semen. However, the percentage of normal sperm and the percentage of motile sperm decreases with infrequent ejaculation. Overall, it appears that ejaculation three to four times per week will ensure the optimum number of “nice-looking” motile sperm. If your sample shows a sufficient number of motile sperm, you may be rewarded by a treatment protocol that includes ovulation induction and intrauterine insemination.