Fertility Challenges: Low Sperm Motility and Uterine Findings

Not using contraception for over a year?

Hello Doctor: My husband and I have been married for 1 year and 1 month.
We started trying to conceive a few months before our wedding without using contraception, having intercourse about 2-3 times a month, and trying to time it during the fertile window, but we have not been able to get pregnant.
At the end of June this year, we went to the hospital for a premarital check-up.
The only issue with my husband was low sperm motility.
How can this be improved? As for me, during the check-up, the doctor noted something in my uterus but was unsure what it was.
He suggested I return for a follow-up during or just after my menstrual period.
At the follow-up appointment the next month, there were no issues found.
Later, in September, I experienced slight bleeding a few days after my period and went to a different hospital for a consultation.
I had a Pap smear, and the doctor mentioned there was something but did not know what it was (similar to what the doctor said in June) and advised me to return for another check-up close to my next menstrual period.
The Pap smear results came back normal, my menstrual cycle is regular, and I do not experience much pain during menstruation.
I did not return for a follow-up in October, but I went back yesterday (November) on the sixth day of my period, still experiencing some bleeding.
The doctor said that the mass measured 16 cm in September and is now 8 cm, but he is still unsure what it is and wants to schedule surgery to remove it for analysis.
At that moment, I did not schedule a time but only requested the ultrasound images.
Upon closely examining the images, it states "8.49 mm," which would be 0.849 cm, correct?
Questions:
1.
How can we improve my husband's low sperm motility?
2.
What could this mass be that can change in size or disappear? Could it be a cyst?
3.
If it is a cyst, will it affect fertility? If I become pregnant, is there a chance it could disappear?
4.
The ultrasound states 8.49 mm, is the doctor correct in saying it is 8 cm? If it is 0.8 cm, is surgery necessary?
5.
We really want to conceive; what do you recommend we do? Thank you very much!

Zhi Xian, 30~39 year old female. Ask Date: 2020/11/10

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if you have poor sperm motility, it is recommended to wear less tight-fitting jeans and avoid working in high-temperature environments.
Regarding your concerns, it is advisable to consult a larger hospital for further examination.
Wishing you good health.

Reply Date: 2020/11/10

More Info

Understanding fertility challenges can be complex, especially when both partners face potential issues. In your case, the low sperm motility and the findings related to your uterus are significant factors to consider. Let’s break down your questions and provide some insights based on medical knowledge.

1. Improving Low Sperm Motility
Low sperm motility can indeed affect fertility, as it reduces the chances of sperm reaching and fertilizing the egg. Here are several strategies that may help improve sperm motility:
- Lifestyle Changes: Encourage your partner to adopt a healthier lifestyle. This includes maintaining a balanced diet rich in antioxidants (fruits, vegetables, nuts), regular exercise, and avoiding smoking and excessive alcohol consumption. These factors can significantly impact sperm health.

- Weight Management: Obesity can negatively affect hormone levels and sperm production. Achieving a healthy weight can improve overall fertility.

- Avoid Heat Exposure: Sperm production is sensitive to temperature. Avoid hot baths, saunas, and tight clothing that can increase scrotal temperature.

- Stress Management: High stress levels can affect hormone production and sperm quality. Techniques such as yoga, meditation, or counseling may be beneficial.

- Supplements: Some studies suggest that certain supplements, such as Coenzyme Q10, L-carnitine, and zinc, may improve sperm motility. However, it’s essential to consult a healthcare provider before starting any supplements.

- Medical Evaluation: If lifestyle changes do not yield improvements, consider consulting a urologist or a fertility specialist for further evaluation. They may recommend tests to check for underlying conditions that could be affecting sperm motility.

2. Uterine Findings
Regarding the "thing" seen in your uterus, it’s crucial to follow up with your healthcare provider. The fact that it has changed in size (from 16 cm to 8 cm) is noteworthy. Here are some possibilities:
- Fibroids: These are non-cancerous growths in the uterus that can vary in size and may cause symptoms depending on their location. They can sometimes affect fertility, especially if they distort the uterine cavity.

- Cysts: Ovarian cysts or other types of cysts can also appear on ultrasounds. Many cysts are benign and may resolve on their own.

- Polyps: These are growths on the uterine lining that can also affect menstrual cycles and fertility.

- Fluid-filled structures: These could be benign cysts or other types of fluid collections.

3. Impact on Pregnancy
If the finding is a benign cyst or fibroid, it may not necessarily prevent pregnancy. However, if it interferes with the uterine cavity or implantation, it could pose challenges. If you do become pregnant, some benign growths may shrink or change due to hormonal changes, but this is not guaranteed.

4. Size Clarification
Regarding the measurement, 8.49 mm is indeed 0.849 cm, which is less than 1 cm. If the doctor is suggesting surgery, it’s likely due to the need for further evaluation of the growth. It’s essential to discuss the risks and benefits of surgery with your doctor, especially if the growth is small and asymptomatic.

5. Steps to Take for Pregnancy
To enhance your chances of conceiving:
- Timing Intercourse: Continue to track ovulation and time intercourse during the fertile window. This is typically a few days before and the day of ovulation.

- Fertility Evaluation: If you have been trying to conceive for over a year without success (or six months if over 35), consider a fertility evaluation for both partners.

- Consult a Specialist: Given the complexities of both partners’ health, consulting a fertility specialist may provide tailored advice and treatment options.

In conclusion, while low sperm motility and uterine findings can present challenges, there are various strategies to improve fertility. It’s essential to maintain open communication with your healthcare providers and follow their recommendations for further evaluation and treatment.

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