If there is abnormal Semen Report, it's important to see the whole report, NOT merely the count. It's also important to ensure that the test has been done from an authentic laboratory and that laboratory should follow the WHO 2010 guidelines for semen analysis (Not the older version of WHO 1999 or WHO 1992). .

Again, we must see what's the Total Motile Count (TMC) of the sperms. If TMC is normal or mildly low, oral tablets can be advised (although their efficacy is doubtful) and the couple can try naturally. Lifestyle changes are also advised (avoiding smoking, excess alcohol, prolonged sitting, tight underwear and long driving). However, the female factors must be normal and the duration of trying must not be long. The repeat semen test should be done after at least 3 months, because it takes 3 months of time for the sperms to complete their formation. Again, the sperm count varies from day to day. So the next step of treatment (IUI/ IVF) should be decided after 3 months only.

If TMC is moderately low, the treatment is IUI (Intra Uterine Insemination) using Husband's sperms, provided female factors are normal and infertility is of short duration. Medicines and lifestyle changes are advised along with IUI. If 3 to 4 cycles of IUI fail, then only consider IVF (In Vitro Fertilization), if the semen reports remain the same.

But if TMC is very low, it is important to do some tests in an attempt to find out the cause. If no cause is found, better to consider ICSI (Intra Cytoplasmic Sperm Injection) soon. In this case, waiting to see whether medicines are acting, may be the waste of time. However, as ICSI is costly, medicines can be taken until the decision is taken. However, delaying ICSI in this case can further reduce the count. 

Therefore, the treatment depends on the count, motility and morphology of the sperms. 

This couple came to us 5 months ago with Infertility. Husband's sperm report was abnormal. We repeated the test and found that the TMC was mildly low. We advised him medicines and lifestyle changes and repeating the semen test after 3 months. All the reports of the wife were normal. But, as the wife's age was 35 years, we started Ovulation Induction (OI) for her (giving medicines to grow the eggs to improve the chance of pregnancy). We planned for 3 months of OI.

But after 2 months of taking medicines by the man and 2 months of OI, they returned with the good news.