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. Your sperm count is considered lower than normal if you have fewer than 15 million sperm per milliliter of semen.
Having a low sperm count decreases the odds that one of your sperm will fertilise your partner’s egg, resulting in pregnancy. Nonetheless, many men who have a low sperm count are still able to father a child.
Low sperm count symptoms may include:
1. Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
2. Pain, swelling or a lump in the testicle area
3. Decreased facial or body hair or other signs of a chromosome or hormone abnormality
When to see a doctor
See a doctor if you:
1. Are unable to conceive a child after a year of regular, unprotected sexual intercourse with your partner.
2. Have erection or ejaculation problems, low sex drive or other problems with sexual function
3. Have pain, discomfort, a lump or swelling in the testicular area
4. Have a history of testicle, prostate or sexual problems.
5. Have had groin, testicle, penis or scrotum surgery.
Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:
1. Varicocele. A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. It’s a common cause of male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm.
2. Infection. Some infections can interfere with sperm production and sperm health or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, including chlamydia and gonorrhea; inflammation of the prostate (prostatitis); inflamed testicles due to mumps (mumps orchitis); and other infections of the urinary tract or reproductive organs.
3. 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 ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra. Certain medications also may result in retrograde ejaculation, such as blood pressure medications known as alpha blockers. Some men with spinal cord injuries or certain diseases can’t ejaculate semen at all, though they still can produce sperm.
4. Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them. This is especially common in men who’ve had a vasectomy.
5. Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, or can affect the glands that release hormones related to reproduction (such as the pituitary gland). Surgery, radiation or chemotherapy to treat tumors can also affect male fertility.
6. Undescended testicles. During fetal 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.
7. Hormone imbalances. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal, may impair sperm production.
8. Sperm duct defects. The tubes that carry sperm can be damaged by illness or injury. Some men are born with a blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one of the tubes that carry sperm out of the testicles (vas deferens). Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether.
9. Chromosome defects. Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome, Young’s syndrome, and Kartagener syndrome.
10. Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
11. Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer medications and some other medications can impair sperm production and decrease male fertility.
1. Over exposure to certain environmental elements can affect sperm production or function. Specific causes include:
2. Industrial chemicals. Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead may contribute to low sperm counts.
3. Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
4. 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.
5. Overheating the testicles. Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or using a laptop on your lap for long periods of time also may increase the temperature in your scrotum and reduce sperm production. The type of underwear you choose to wear is unlikely to significantly impact your sperm count.
6. Prolonged bicycling. Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles.
Health, lifestyle and other causes
Other causes of low sperm count include:
7. Illegal 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 may temporarily reduce the number and quality of your sperm as well.
8. Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.
9. Occupation. Certain occupations may increase your risk of infertility, including those associated with extended use of computers or video display monitors, shift work and work-related stress.
10. Tobacco smoking. Men who smoke may have a lower sperm count than do those who don’t smoke.
11. Emotional stress. Severe or prolonged emotional stress, including stress about fertility itself, may interfere with certain hormones needed to produce sperm.
12. Weight. Obesity can cause hormone changes that reduce male fertility.
13. Sperm testing issues. Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation; was taken too soon after an illness or stressful event; or didn’t contain all of the semen you ejaculated because some was spilled during collection. For this reason, results are generally based on several samples taken over a period of time
Treatments for low sperm count include:
1. Surgery. For example, a swelling of the veins that drain the testicle (varicocele) can often be surgically fixed or an obstructed vas deferens tube repaired.
2. Treating infections. Antibiotics can cure an infection of the reproductive tract, but this doesn’t always restore fertility.
3. Hormone treatments and medications. Hormone replacement or medications may be prescribed to change hormone levels. It can take between three and six months before you’ll notice any effects on your semen analysis.
4. 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 is then inserted into the female genital tract, or used for in vitro fertilization or intracytoplasmic sperm injection.
When treatment doesn’t work
Sometimes male fertility problems can’t be treated, and it’s impossible for a man to father a child. If this is the case, you and your partner can consider either using sperm from a donor or adopting a child.