Low sperm count can reduce the chances of pregnancy, but it does not make conception impossible. It usually causes no noticeable symptoms, and is not diagnosed until the couple have difficulty conceiving. The diagnosis of low sperm count is primarily determined by a semen analysis test; to assess sperm count and quality in the male partner
There are multiple causes of low sperm count, and many of which can be treated (depending on the underlying cause). (1)
What Is a Low Sperm Count?
A low sperm count (also known as oligospermia), means having less than 16 million sperm per milliliter of semen. (2)
Knowing that a typical sperm count ranges from 16 -200 million sperm per milliliter.
A count below 5 million sperm/milliliter is generally classified as severe oligospermia. (1)
Is Pregnancy Possible With a Low Sperm Count?
Yes.A low sperm count can actually reduce pregnancy chances, but it does not make pregnancy impossible. Conceiving may take longer or become more difficult to the couple, and that depends on how low the sperm count actually is, the underlying cause, and if there are other factors affecting both partners’ fertility. (1)
What Causes Low Sperm Count in Men?
For the body to produce healthy sperm, the testicles and fertility hormones should be working properly.
Sperm is produced in the testicles, then it is transferred through tiny tubes where it mixes with fluids to form semen, which leaves the body during ejaculation.
A problem in any of these stages may cause low sperm count. (3)
Some causes affect sperm production in the testicles, while others prevent sperm from reaching the semen.
Here is an overview of the main causes of low sperm count: (3)(4)
1. Medical Conditions
- Varicocele: this is enlarged veins in the scrotum that may reduce sperm count and quality.
- Hormonal imbalances: Problems with hormones produced by the testicles or the glands that regulate them can reduce sperm production.
- Infections in the testicles or nearby ducts: These may affect sperm production or block the passage of sperm to the semen.
- Blocked sperm ducts and ejaculation problems: The testicles may be producing normal amounts of healthy sperm, but a blockage or a problem such as retrograde ejaculation can prevent sperm from leaving the body normally.
- Conditions present from birth: These conditions include undescended testicles and genetic conditions that affect the reproductive system or its hormones.
- Certain medications: Certain medications and substances: Some medicines can affect sperm production or ejaculation. Testosterone replacement therapy and anabolic steroids can suppress sperm production. A doctor should review any possible medication effects; prescribed treatment should not be stopped without medical advice.
- Tumors, cancer treatments, and surgery: Tumors, chemotherapy, radiation therapy, and certain surgical procedures may affect sperm production or transport.
2. Lifestyle and Environmental Factors
Smoking, obesity, heavy alcohol use, and repeated exposure to excessive heat, pesticides, or heavy metals may contribute to low sperm count.
How Is Low Sperm Count Diagnosed?
Assessment usually includes a medical history, physical examination, and semen analysis. Because results can vary between samples, repeat testing may be needed. Depending on the findings, the doctor may recommend hormone tests, imaging, or genetic testing.(4)
Can Low Sperm Count Be Treated?
The choice of treatment for low sperm count depends on its underlying cause.
In some cases sperm count may start improving with lifestyle changes or by replacing a medication that appears to be affecting sperm production. Other cases may require medication or surgery. (1)
- Treating infections: If a bacterial infection is found in the reproductive tract, the doctor may prescribe antibiotics. However, treating the infection does not always restore sperm count to normal levels.
- Lifestyle changes and medication review: Quitting smoking, avoiding anabolic steroids used for muscle building, maintaining a healthy weight, and limiting excessive heat exposure around the testicles may help support sperm health. If a medication is affecting sperm count, the doctor may change it or adjust the dose. Prescribed medications should not be stopped without medical advice.
- Treating hormonal problems: If tests show a hormonal imbalance that is affecting sperm production, the doctor may prescribe medication to regulate hormone levels or stimulate sperm production.
- Surgery: In selected cases, surgery may help repair a varicocele or remove a blockage in the tubes that carry sperm, depending on the cause and the results of the fertility evaluation.
- Treating associated sexual problems: Medication, psychological counseling, or sex therapy may help manage erectile dysfunction or certain ejaculation problems and improve the chances of conception. However, these treatments do not directly increase sperm count.
- Assisted reproductive technologies (IVF/ICSI): IVF or ICSI may be recommended when sperm count is very low or when sperm quality is significantly reduced.
Learn more about when ICSI may be recommended and how it helps with fertilization
How Long Does Treatment Take to Work?
Sperm take around two to three months to develop and mature, For this reason, the effects of treatment or lifestyle changes may not appear on a semen analysis until about three months later, and improvement may take longer depending on the underlying cause and type of treatment.
Your doctor will usually recommend when to repeat the semen analysis to assess your response to treatment, rather than judging the results after only a few weeks. (2)
Can Vitamins and Supplements Help?
Supplements may help correct certain nutritional deficiencies, but the evidence on whether they can significantly increase sperm count or improve the chances of pregnancy is still inconclusive. There is also no single supplement that is recommended for every case.
For this reason, it is best to speak with a doctor before taking vitamins or supplements and not rely on them instead of identifying and treating the underlying cause of low sperm count. (4)
Read more about the evidence and limitations of vitamins to increase sperm count.
