Can you still get pregnant if sperm has low motility?

Low motility is a condition that can sometimes be easily resolved. The easiest way to address this is through an IUI. When the concentration allows us to obtain at least 5 million sperm with good motility, we can proceed with IUI. In cases where the motility is worse, we may opt for IVF. It’s true that low motility, depending on each case, may reduce natural fertility, but with either IUI or IVF, we can achieve good chances of success if the egg quality is good.

First of all, low motility means that the number of sperm that are alive and moving and moving in the right direction, there is enough number of them so, that that the sperm once it gets inside the cervix has a long way to make, to get to the egg, so unless it’s alive and swimming well in the right direction, we will not get a natural pregnancy. In order to improve this and as already mentioned, we can work with the lifestyle changes, we look at the patient’s lifestyle and see how we can improve it. Sometimes, some medications can help to improve the sperm motility as well and if it is borderline and can improve to get within the normal range, then there is no reason if there is no underlying issue that can cause the infertility, then there’s no reason why the patient cannot get pregnant naturally.

Low motility normally is termed as asthenospermia which is a condition where the man produces a high number of sperm but a very low number of them are motile. According to the WHO criteria at least 32% of the sperm produced need to be to exhibit a forward motility in order for the man to be considered with normal motility characteristics. In cases where the man, the patient, has lower motility that means that his ability to produce a pregnancy is lower. However, we can still have a pregnancy when in low motility cases. What I would advise to our patients in case of asthenospermia is to try to optimize their lifestyle habits in an effort to improve motility characteristics and some of the examples is to quit smoking, to reduce BMI and to increase the intake of supplements (such as multivitamins) and increase sport activity. All of them have been linked to improve motility characteristics and something else also would be to avoid a high temperature in the scrotum area. Again, this has been linked to low motility characteristics. Over the last years, it has shown that increased frequency of ejaculation may also help motility improvement. If all of these have been tried and we still see that the motility remains low, then we should refer the man to the andrologists to check for the presence of varicocele because varicocele (a medical condition) which affects the vascularity of the testis may also contribute and reduce the motility characteristics. In any case when everything has been checked and improved and if we still have low motility and no pregnancy, then we should aim and succeed by giving the option of an assisted reproduction technique such as IUI or IVF or even ICSI in severe forms of asthenospermia.

Because it’s all a question of degrees. Certainly, it’s not a switch between being normal sperm quality and being sub-optimal sperm quality – it’s kind of a process of kind of graduation. Basically, the answer is yes, I mean, the most important thing is having significant numbers of progressively moving sperms but it doesn’t have to be entirely normal if you still just have a chance of conceiving but it is something that is important. Sometimes various lifestyle factors can have a minor impact on sperm quality that you can think about trying to improve movement if it’s an issue but if it’s profoundly affected if the sperm movement is very very low, very very poor especially in terms of progressive motility and it probably represents a significant barrier to conceiving naturally.

As we all know, sperm parameters are important predictors of the quality of the semen. The basic parameters analyzed in a seminogram are concentration, morphology and motility and they are important for testing male infertility factors. Today I will talk about sperm motility, known as the movement of the sperm. 
We can classify the motility of sperm in 4 different categories, fast progressively motile, slow progressively motile, non-progressively motile and immotile (that is graded as a, b, c or d). According to the World Health Organization, it’s very important to analyze the differences between these movements because it has clinical importance.
Moreover, according to the World Health Organization, good motility is considered when more than 32% of the sperm has a progressive motility or when the progressive and non-progressive motility is higher than 40%. Therefore, samples that are under these reference values are considered to have low motility and the medical term used for diminished sperm motility is asthenozoospermia. 
So, why is the motility of the sperm important to evaluate? And how may it affect infertility? Motility is a very important parameter because the spermatozoa has to be able to swim inside the uterus to reach the egg and also it has to be able to pass through cervical mucus and the oocyte layers, and finally fertilize the egg. So, if they can’t move or if they have difficulties swimming, it will be really difficult to reach the egg. That’s why the extent of progressive sperm motility is related to higher pregnancy rates and the total number of motile sperm in the ejaculate has a biological significance.
There are different causes of low sperm motility. First of all, as we all know, lifestyle has a big effect in all the semen parameters and in the fertility of men and women. Related with motility, low motility of sperm is often linked to obesity, a sedentary life, smoking and the consumption of alcohol and drugs. Improving the lifestyle in a lot of cases can improve the seminogram. Moreover, excess sperm with low motility is also associated with clinical problems such as the presence of varicocele, having had an episode of high fever or infections. In addition, alterations during the sperm transit through the epididymis, that is where sperm acquired the motile ability, can cause alterations in sperm mitochondrial functioning and affect the sperm motility.
It’s also important to highlight the possible genetic cause of the low motility. For example, Kartagener’s syndrome is an autosomal recessive genetic ciliary disorder characterized by the absence of the dynein arms in the internal structures of the sperm tail. That is what makes sperm unable to swim.
So, low motility may mean that there are genetic problems or the DNA is fragmented which results in fertility problems and difficulties in conceiving a healthy baby.
Therefore, motility is an essential parameter in reproduction and a high percentage of sperm with low motility can make the couple take longer than normal to get pregnant or require the help of some fertility treatment to get it. Hopefully thanks to the IVF techniques, nowadays we can select, through different techniques, those sperm with better motility and more capable of fertilizing the egg. That is why techniques such as ICSI is a good option for people with sperm motility problems because we can select the spermatozoa and directly microinject it inside the oocyte, helping the spermatozoa to reach the oocyte overcoming the natural physical barriers. 

Yes, low motility is actually the main reason couples come to do IVF when the problem is that of a male. So for the male, the low motility may be treatable by conservative measures such as hormones, or vitamins, or antioxidants, and so on. If it doesn’t respond to these non-specific treatments then one can use what we call intrauterine insemination (IUI), whereby we take the sperm, we centrifuge, we concentrate and separate the motile from the non-motile and then do insemination at the time of ovulation, by inserting the prepared sperm into the uterine cavity. That is the treatment before the last and most effective treatment for low sperm which is ICSI, which stands for Intracytoplasmic Sperm Injection, whereby under microscopic control we take a single spermatozoon and inject it into the egg using micro tools. This is the revolution in IVF that happened in 1992 and has been since the most frequently used treatment in IVF.