Low Sperm Count: Causes, Treatments and Prevention

Doctor holding tablet displaying the word "oligospermia".

Introduction

A low sperm count, or oligospermia, occurs when there are a fewer than normal number of sperm found in the semen. A sperm count is regarded as below normal when there is less than 15 million sperm per milliliter of semen.(1)

Men with low sperm counts have a reduced chance of fertilizing their partner’s eggs. However, it is still possible to have a low sperm count and father a child.(2)

Causes

Sperm production is complicated process involving the testes (testicles), and the brain’s pituitary and hypothalamus glands. After the sperm are made in the testes, they are transported along fine tubes where they are mixed with the semen and ejaculated from the penis.

Issues with any one of these organs can cause problems that could affect sperm formation. Other problems include abnormal morphology (shape), motility (movement) or function of the sperm.(3)

Additionally, it is not at all uncommon for the reason for the low sperm count to go unidentified.

Medical Factors

A variety of medical conditions and treatments can lead to a low sperm count. Some of the more common causes include:

  • Varicocele – The most common treatable form of male infertility, varicoceles are a swelling of the veins in the testicle. While the exact cause of varicoceles are not known, the condition does lead to a decrease in sperm quality.
  • Defects involving transport tubes – Sperm is transported through a number of tubules which can become blocked due to previous infections, injury, surgical procedures, or from irregular development due to certain inherited conditions (see below).
  • Surgery – Certain types of surgery could prevent sperm from being present in the semen, such as a vasectomy, hernia repair, surgery involving the testicles or scrotum, prostate surgery, and others. However, these blockages can sometimes be reversed with surgery, or at least sperm can be retrieved directly from the testicles.
  • Infections – Certain infections can affect sperm health and production, or result in scarring that prevents sperm from being transported. These infections include epididymitis (inflammation of the epididymis) or orchitis (inflammation of the testes), and STDs, such as gonorrhea, chlamydia, syphilis, or HIV. Certain infections can cause permanent damage to the testicles, but sperm can still usually be collected in most cases.
  • Hormonal imbalances – The pituitary and hypothalamus glands, as well as the testes, produce hormones that are essential for sperm production. Changes in these and other hormone levels may cause a decrease in sperm production.
  • Ejaculation issues – Certain health conditions can result in no ejaculate during orgasm, including diabetes, injury to the spinal cord, or surgery involving the prostate, bladder, or urethra. Problems with ejaculation may also be caused by certain medications, such as a type of blood pressure medicine called alpha blockers. Sperm can still be extracted from the testicles in most cases of permanent ejaculatory issues.
  • Immunity disorders – In some people, certain immune system cells called anti-sperm antibodies erroneously target sperm as foreign invaders and attack them.
  • Tumors – Both malignant and non-malignant tumors can impact the male reproductive system directly, or indirectly by affecting sex hormone-related glands, like the pituitary and hypothalamus. Treatments for tumors, such as surgery and radiation, can also negatively impact sperm count.
  • Genetic disorders – Certain inherited conditions can cause irregular development of male reproductive organs, including Klinefelter’s syndrome, cystic fibrosis, Kartagener’s syndrome and Kallmann’s syndrome.
  • Undescended testicles – ​​​​​A congenital condition where one or both testicles do not descend into the scrotum, which increases the likelihood of male infertility.
  • Celiac Disease – Caused by gluten sensitivity, celiac disease is a digestive disorder that can lead to male infertility. However, following a gluten-free diet may improve fertility in men having this condition.
  • Medications – Long-term use of anabolic steroids, cancer medicines, certain antibiotic and antifungal medications, testosterone replacement, and other medications can negatively affect sperm count and reduce male fertility.

Environmental Factors

Regular exposure to certain environmental factors can affect the production and function of Sperm. Some examples include:

  • Heat Exposure – Higher temperatures can negatively affect sperm function and production. Frequently using a hot tub or sauna may cause a temporary decrease in sperm count.
  • Industrial-grade chemicals – Low sperm count may be caused by prolonged exposure to toxins such as pesticides, herbicides, benzenes, xylene, toluene, lead, painting supplies, or organic solvents.
  • Radiation and X-rays – Sperm production can decrease from radiation, in some cases taking years before returning to normal sperm production. Large doses of radiation can permanently reduce the production of sperm.
  • Heavy metals – Infertility can also be caused by exposure to heavy metals, such as lead or mercury.

Long periods of sitting, extended use of a laptop computer, and wearing tight clothing can cause an increase of temperature in the scrotum, leading to a decrease in sperm production.

Lifestyle Factors

Low sperm count can also be caused by certain factors related to health and lifestyle, including:

  • Using illicit drugs – The use of Anabolic steroids to increase muscle growth and strength can cause shrinking of the testicles and a reduction in sperm count. Drugs like marijuana and cocaine can also decrease sperm count and quality.
  • Alcohol consumption – Consuming alcohol can cause a drop in testosterone and a decrease in sperm production.
  • Employment – Although research is unclear, some occupations may increase the risk for infertility, such as welding or jobs involving extended periods of sitting, like truck driving.
  • Smoking – Smoking tobacco is believed to reduce sperm production.
  • Stress – Extreme or ongoing psychological stress could negatively impact hormones that are crucial for sperm production.
  • Depression – Men who are depressed may cause a reduction in sperm concentration.
  • Obesity – Obesity may adversely affect fertility in a number of ways. It can directly impact sperm and cause hormonal changes that can decrease male fertility.
  • Technical testing issues – A low sperm count result can occur when analyzing a semen sample that was obtained too soon after the last ejaculation, or if taken immediately following illness or a stressful event. A low score could also occur if the sample contained only a partial amount of the ejaculate due to spillage during collection. Because of this, results are typically determined after testing two or more samples taken over a certain time period.

When to Consult a Physician

You should talk to a doctor if you have not been able to conceive a child after one year of unprotected, regular intercourse. Additionally, you should see a doctor sooner if you are suffering from any of the following:

  • Problems with sexual performance, including erection and ejaculation problems, or low sex drive.
  • A lump, swelling, pain or discomfort in the area of the testicles.
  • Previous problems involving the testicles, prostate or sexual performance.
  • Surgery involving the testicle, scrotum, penis or groin area.

Before Your Appointment

It’s best to initially see your family doctor, or general practitioner. If necessary, they may refer you to an fertility specialist. The following are some basic questions you can ask your doctor:

  • What might be causing my low sperm count?
  • What are the possible causes of my partner and I not being able to conceive?
  • What types of tests should I take?
  • Does my partner need to be tested too?
  • What available treatment options are there to increase my sperm count? Which treatment do you recommend?
  • Will I need to adhere to any restrictions?
  • When should we start looking at other options, such as sperm donation or adoption?
  • Do you have any pamphlets or educational materials that I could take with me? Can you suggest any websites that I can visit?

Do not hesitate to ask any other questions you may have during your visit.

Physical Exam and Medical History

The doctor will perform an examination of your genitals and ask you about any chronic or inherited conditions, surgeries, injury or illnesses that might affect your fertility. You may also be asked questions concerning your sexual habits and development.

There are several questions that your doctor might ask you, including:

  • How old were you when you began puberty?
  • Have you ever had a vasectomy?
  • Are you currently using any illicit drugs, including marijuana, cocaine, or anabolic steroids?
  • Are you regularly exposed to chemicals, pesticides, lead, radiation or other toxins?
  • Are you currently taking any medicine or nutritional supplements?
  • Have you ever had undescended testicles at any point?

Semen Analysis

A diagnosis of a low sperm count is made by using a test called a semen analysis. Typically, the sperm count is measured by analyzing the semen with a microscope. Sometimes, the sperm count may be determined by using a computer.

There are a few ways to obtain a sample of your semen.  The most common method of doing this is to masturbate and ejaculate into a specimen cup at your doctor’s office. An alternate method is by wearing a specialized condom that’s used during intercourse to collect your semen.

Sperm cells are constantly being produced in the testicles, taking around 40-75 days to fully mature. Therefore, a recent semen analysis will only be representative of the past 3 months, so any new changes you’ve adopted won’t show for several weeks.

An incomplete or incorrect collection of sperm samples is among the leading causes for a low sperm count result. A man’s sperm count can also vary from day to day. For these reasons, and to ensure consistency, doctors will usually test more than one semen sample over a period of time.

To ensure that your semen analysis is accurate, your doctor will ask you to:

  • Ensure that all your semen gets in the collection container or condom when ejaculating.
  • Not ejaculate for 2-7 days prior to providing a sample.
  • Provide another sample at a minimum of two weeks after providing the first.
  • Avoid lubricants as they can negatively impact sperm motility.

Microscope images of normal sperm count vs. low sperm count.

Interpreting the Results

The normal sperm density ranges from 15 to over 200 million sperm per milliliter. A sperm count is considered low when you have less than 15 million sperm/milliliter, or fewer than 39 million total sperm per sample.

Your odds of conceiving a child decrease with a lower sperm count. Some men produce semen that does contain any sperm at all, a condition called azoospermia.

It is important to understand that there are numerous factors that influence reproduction, with sperm count being just one of these. Men with a low sperm count can still father children, and those with a normal sperm count may not be able to do so.

Other factors, such as normal sperm movement and motility, are crucial to conceive a child, regardless of sperm count.

Additional Testing

Your doctor may recommend that you take additional tests based upon your initial results. These could include:

  • Ultrasound (scrotal)- Checks the testicles for abnormalities using high-frequency sound waves.
  • Hormone testing – Checks the hormone levels in the testicles and pituitary. These hormones play an important role in sperm production and sexual development.
  • Urinalysis – A post-ejaculation urinalysis may be performed to check for sperm in the urine, which could indicate that your sperm have traveled backwards into your bladder (retrograde) during ejaculation.
  • Genetic testing – If sperm count is extremely low, it could indicate a genetic problem. Genetic testing may also be performed to diagnose congenital and inherited disorders.
  • Biopsy – A test that involves taking samples from the testicle using a needle. A testicular biopsy is usually only performed for a specific reason and is not typically used for determining the source of infertility.
  • Antibody tests – Checks for the presence of anti-sperm antibodies, which are immune cells that attack sperm, interfering with their function.
  • Specific sperm function tests – Various other testing can be utilized to determine sperm’s ability to penetrate and attach to an egg, as well as survivability after ejaculation. However, these types of tests are uncommon.
  • Ultrasound (rectal) – High-frequency sound waves examine the prostate gland, as well as the seminal vesicles and ejaculatory ducts for blockages.

Treatment For Low Sperm Count

Medical Treatments

Some common medical treatments used to address a low sperm count are:

  • Treatment of infections – Cases of infection can be cured with antibiotics, although there is no guarantee that fertility will be restored.
  • Surgery – In certain situations, surgery can correct the problem. Some examples include repairing a varicocele or tube blockage, a vasectomy reversal, or retrieving sperm directly from the testes.
  • Sexual performance treatments – Counselling or medication can improve fertility conditions related to things like erectile dysfunction and premature ejaculation.
  • Hormone replacement and medication – In situations where there are either inadequate or excessive levels of specific hormones, or issues with how hormones are used by the body, your doctor may recommend hormone replacement or medication.
  • Assisted reproductive technology – ART Treatments use sperm obtained by ejaculation, surgical retrieval, or through a sperm donor. The sperm is then placed into the woman’s reproductive tract, or is used for IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection).

Lifestyle Changes

To improve your fertility and prevent future fertility issues, avoid known factors that can negatively impact sperm count and quality. Some of these include:

  • If you smoke, quit.
  • Limit alcohol consumption, or don’t drink at all.
  • Stay away from illicit drugs.
  • Ask your doctor about which medications might affect sperm count.
  • Maintain a healthy body weight.
  • Avoid exposure to excess or prolonged heat.
  • Learn healthy ways of coping with stress.
  • Avoid exposure to chemicals, heavy metals and other toxins.

Nutritional Supplements

Another popular treatment for improving sperm count is by taking nutritional supplements. Some of the best supplements to boost sperm count and quality include:

These supplements and their ingredients have been thoroughly researched and shown to increase sperm count and sperm quality, and are highly recommended. Be sure to discuss the benefits and risks of nutritional supplementation with your doctor if you are considering using them.

When Treatment Doesn’t Work

There are rare cases in which male fertility problems cannot be treated, and fathering a child is just not possible. In this situation, you and your partner might consider using donor sperm or looking into adoption.

See Also: The Top 8 Ways to Increase Sperm Count


References:

  1. https://www.nhs.uk/conditions/low-sperm-count/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343360/
  3. https://www.healthline.com/health/infertility/low-sperm-count#causes
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