Low sperm count means that the fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal. A low sperm count is also called oligospermia. A complete absence of sperm is called azoospermia. Your sperm count is considered lower than normal if you have fewer than 15 million sperm per millilitre of semen.
Having a low sperm count decreases the odds that one of your sperm will fertilize your partner's egg, resulting in pregnancy. Nonetheless, many men who have a low sperm count are still able to father a child.
What are the causes of low sperm count?
Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:
- Varicocele: A varicocele is a swelling of the veins that drain the testicle. It's the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it might be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm.
- Infection: Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis or testicles and some sexually transmitted infections, including gonorrhoea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
- Ejaculation problems: Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde or lack of ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra. Certain medications also might result in ejaculatory problems, such as blood pressure medications known as alpha blockers. Some ejaculatory problems can be reversed, while others are permanent. In most cases of permanent ejaculation problems, sperm can still be retrieved directly from the testicles.
- Undescended testicles: During foetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.
- Certain medications: Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications and other medications can impair sperm production and decrease male fertility.
Sperm production or function can be affected by overexposure to certain environmental elements, including:
Health, Lifestyle and Other Causes
- Industrial chemicals: Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead might contribute to low sperm counts.
- Heavy metal exposure: Exposure to lead or other heavy metals also can cause infertility.
- Radiation or X-rays: Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.
Other causes of low sperm count include:
- Drug use: Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana might reduce the number and quality of your sperm as well.
- Tobacco smoking: Men who smoke might have a lower sperm count than do those who don't smoke.
- Emotional stress: Severe or prolonged emotional stress, including stress about fertility, might interfere with hormones needed to produce sperm.
- Weight: Obesity can impair fertility in several ways, including directly impacting sperm and by causing hormone changes that reduce male fertility.
The main sign of low sperm count is the inability to conceive a child. There might be no other obvious signs or symptoms. In some cases, an underlying problem such as an inherited chromosomal abnormality, a hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms. Low sperm count symptoms might include:
- Problems with sexual function - for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling or a lump in the testicle area
- Decreased facial or body hair or other signs of a chromosome or hormone abnormality
Diagnosis of low sperm count
When you see a doctor because you're having trouble getting your partner pregnant, he or she will try to determine the underlying cause. Even if your doctor thinks low sperm count is the problem, it is recommended that your partner be evaluated to rule out potential contributing factors and determine if assisted reproductive techniques may be required. Testing and diagnosis may involve the following:
- General physical examination and medical history: This includes examination of your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and your sexual development.
- Semen analysis: A low sperm count is diagnosed as part of a semen analysis test. Sperm count is generally determined by examining semen under a microscope to see how many sperm appear within squares on a grid pattern. In some cases, a computer might be used to measure sperm count.
- Scrotal ultrasound: This test uses high-frequency sound waves to look at the testicles and supporting structures.
- Hormone testing: Your doctor might recommend a blood test to determine the level of hormones produced by the pituitary gland and testicles, which play a key role in sexual development and sperm production.
Treatments for low sperm count include:
- Surgery: For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
- Treating infections: Antibiotics can cure an infection of the reproductive tract, but this doesn't always restore fertility.
- Treatments for sexual intercourse problems: Medication or counselling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
- Hormone treatments and medications: Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
- Assisted reproductive technology (ART): ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used for in vitro fertilization or intracytoplasmic sperm injection.
Natural remedies for low sperm count
There are steps you can take at home to increase your chances of getting your partner pregnant, including:
- Increasing the frequency of sex: Having sexual intercourse every day or every other day beginning at least four days before ovulation increases your chances of getting your partner pregnant.
- Having sex when fertilization is possible: A woman is likely to become pregnant during ovulation, which occurs in the middle of the menstrual cycle. This will ensure that sperm, which can live several days, are present when conception is possible.
- Avoiding lubricants: Some products such as Astroglide, lotions, and saliva might impair sperm movement and function. Ask your doctor about sperm-safe lubricants.