Low sperm count is a common male fertility problem that can make it harder to achieve a pregnancy. It may not cause noticeable symptoms and is often discovered during a fertility evaluation.
Having a low sperm count does not mean pregnancy is impossible. Treatment may include lifestyle changes, medication, surgery, or fertility treatments such as IUI, IVF, or ICSI.
Understanding the symptoms, causes, diagnosis, and treatment options can help men make informed decisions about their fertility and seek the right medical care
Low sperm count, also called oligospermia, means that semen contains fewer sperm than the reference level used when assessing male fertility.
A commonly used reference point is fewer than 15 million sperm per millilitre of semen. A complete absence of sperm is called azoospermia.
Sperm count is only one part of male fertility. A semen analysis can also assess sperm motility, morphology, semen volume, and other characteristics.
A low count can reduce the chance that a sperm will reach and fertilise an egg, but it does not necessarily mean that pregnancy cannot happen.
In many cases, there are no obvious symptoms of low sperm count. The main sign may simply be difficulty achieving a pregnancy despite regular unprotected sex.
Some men may have symptoms related to the underlying cause rather than the low sperm count itself, such as:
Because these symptoms can have many causes, testing is needed to determine whether sperm production is affected.
Low sperm count can develop because of problems with sperm production, sperm transport, hormones, health conditions, lifestyle factors, or environmental exposure.
Common causes include:
A varicocele is an enlargement of the veins around the testicle. It can affect testicular function and is a recognised cause of male infertility.
The brain, pituitary gland, and testicles work together to control sperm production.
Problems involving testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), or other hormones can affect sperm production.
Some infections can interfere with sperm production or cause scarring that blocks the passage of sperm.
Certain sexually transmitted infections may also affect male fertility.
Previous testicular injury, undescended testicles, inflammation, or other testicular conditions may affect sperm production.
Some medicines, chemotherapy, radiation therapy, testosterone replacement therapy, and anabolic steroids can interfere with sperm production.
Testosterone treatment is particularly important to discuss with a doctor if you are trying to have a child.
Smoking, excessive alcohol use, some recreational drugs, obesity, significant stress, overheating of the testicles, and exposure to certain chemicals or heavy metals may contribute to male fertility problems.
Sometimes, no clear cause is identified even after testing.
Certain factors may increase the risk of having a low sperm count or other male fertility problems. These include:
Having one of these risk factors does not mean that you will have a low sperm count.
It simply means that discussing your fertility history with a healthcare professional may be worthwhile.
The main test for low sperm count is a semen analysis. A laboratory examines a semen sample to determine sperm concentration and other semen and sperm characteristics.
The World Health Organization provides standardized laboratory methods for semen testing.
Because sperm levels can vary between samples, a healthcare professional may recommend more than one semen analysis.
Depending on the results and medical history, further tests may include:
The purpose of these tests is not only to confirm a low sperm count but also to identify the underlying cause when possible.
Treatment depends on why the sperm count is low. Possible options include:
Hormonal disorders, infections, and some medical conditions may be treated directly. Correcting the underlying problem may improve sperm production or fertility.
When a varicocele is contributing to fertility problems, surgery may sometimes be recommended. In appropriate patients, treating the varicocele can improve sperm parameters.
Some medicines can affect sperm production. However, do not stop prescribed medication on your own. A fertility specialist can determine whether a different treatment is appropriate.
Specific hormone treatments may help men whose infertility is caused by particular hormonal problems. Use them only after an appropriate medical evaluation.
Lifestyle changes may support overall sperm health, although they cannot correct every cause of low sperm count.
Helpful steps may include:
Be cautious with fertility supplements. Evidence for many supplements is limited, and some may interact with medicines or health conditions. Speak with a healthcare professional before taking them.
If lifestyle changes or medical treatment do not improve symptoms enough, assisted reproductive treatments may be considered.
Intrauterine insemination (IUI) places prepared sperm directly into the uterus around the time of ovulation. It may be considered when there are enough usable sperm and other factors are suitable.
In vitro fertilization (IVF) involves fertilising an egg with sperm in a laboratory before transferring an embryo to the uterus.
For more significant male-factor infertility, intracytoplasmic sperm injection (ICSI) may be used. With ICSI, a single sperm is injected directly into a mature egg.
The most suitable option depends on sperm results, the cause of infertility, the female partner’s fertility factors, age, previous treatment, and the couple’s preferences.
Yes, some cases of low sperm count can improve, particularly when an underlying and treatable cause is identified. For example, treating certain medical conditions, addressing lifestyle factors, or correcting a varicocele may improve sperm production or sperm quality.
However, improvement is not guaranteed. Sperm production is a complex process, and some causes cannot be completely corrected.
It is also important to remember that fertility depends on more than sperm count alone. Sperm movement, sperm shape, the reproductive health of both partners, and other factors can influence the chance of pregnancy.
Consider speaking with a fertility specialist clinic, a urologist, or a gynaecology clinic if you have been trying to conceive without success or if a semen analysis has already shown abnormal results.
You may also want an evaluation sooner if you have a history of:
A fertility evaluation often considers both partners because pregnancy can be affected by male and female fertility factors at the same time.
Low sperm count can affect the chances of natural conception, but it does not automatically mean that you cannot become a father.
The first step is usually a semen analysis, followed by additional testing when needed to identify the possible cause.
Treatment may involve lifestyle changes, medication, hormonal treatment, surgery, IUI, IVF, or ICSI.
For men, discussing your results with a qualified fertility specialist can help you understand the cause of low sperm count and the treatment options that may be appropriate for your situation.
