An interesting article which speaks about the virtue f the Scottish kilt. Apparently kilt wearers have better sperm count than others who wear the more mainstream trousers. The slight naughty undercurrent to the piece of news is that, that “real” Scottish men will not bother with undergarments when wearing the kilt. The medical point is that undergarments warm the testes and are thus likely to reduce the sperm count. How far this is true is not easy to say but this news has advocated the benefits of lowering the temperature around the testes.
First some basic physiology and developmental milestones. The male gonads i.e. testes are located outside of the abdominal cavity whilst the female gonads i.e. ovaries are internal. Their location means the testis enjoy temperature of around 1-2 degrees lower as compared to the core temperature of the body. Since humans are warm blooded animals, the main temperature control happens through blood flow regulation and external cooling will not lower the temperature beyond a certain point. The scrotum i.e. the sac in which the testes rest have a muscle within the skin called the “dartos”, which not only gives the scrotum it’s wrinkled skin. Another muscle called the cremastric muscle goes along the cord of each of the testis and in response to cold, will contract raising the testes closer to abdomen, increasing the temperature. All this physiology is well known to my male readers. The testes are not however in their final location right at birth. It takes almost a year or even more in some cases for the testes to send into the scrotum. If that doesn’t happen, we should be concerned about undescended testes. Beyond the first three or four years the undescended testes can get damaged because of the high temperature in the abdomen leading to irreversible testicular failure. For that reason operation for undescended testes is done earlier when the child is young. Doing it at puberty is in many ways far less successful.
There is a small caveat however that we need to consider. Many a times even after performing an operation to get the testes down, the sperm count is not entirely normal and that is because there may be an intrinsic failure on the testes and its hormones to effect the descend in the first instance. The fact that the testes haven’t descended as if would suggest that something was wrong. The lack of descent is a manifestation of that problem, though in turn it worsens the problem.
What is normal ?
The WHO criteria for normal sperm is to suggest 20 mil per ml as normal count it has now been revised downwards to 15 mil per ml. most experts will put more emphasis on the motility of the sperm rather than pure numbers as the more important criteria. Having hundreds of millions of abnormal and immotile sperms is pointless.
IVF-ICSI the great game changer
With the advent of IVF need for sperm number has decreased. Counts as low as 5 to 10 mil may not be good for normal fertility or IUI procedure but are enough for an IVF treatment. After washing and purifying the sperm and choosing the motile ones we barely need 100000 for IVF fertilization. In 1992 the process of ICSI (intra cytoplasmic sperm injection) was discovered which made it possible that men with far poorer sperm numbers i.e. less than 1 mil could now have their own children. This new process was an amazing bonanza especially for those who had issues – personal or religious, accepting sperm donation.
A more lenient and easy going when it comes to patients asking if they can have cold baths to improve their sperm count. More determined men have asked if icepacks around the testes will be the good idea ! Whilst letting the testes not get too warm is a good idea trying to cool them down with ice and whatever else may be a step too far. Besides very uncomfortable, i guess. Wearing loose cloths especially loose cotton underwear or even no underwear may not be such a bad idea if you so wish.
Avoiding very hot soaking baths, is perhaps a good idea. That has a risk of keeping the testes too warm for a very long time if the bath water is too hot.