Low sperm count, infertility

Worried about your condition? Talk to a GP.

Symptoms of a low sperm count

A low sperm count usually causes no symptoms you'd notice yourself, and most men only find out after having fertility tests. The main sign is difficulty getting your partner pregnant after a year of regular, unprotected sex.

If an underlying condition is causing your low sperm count, you might also have:

a lower sex drive
erectile dysfunction
pain, swelling or a lump in a testicle
less facial or body hair than usual.

Causes and risk factors

A low sperm count can have many different causes, and often more than one factor is involved.

varicocele, swollen veins in the scrotum, which affects around 4 in 10 men with a low sperm count and is one of the most common causes
infections, including sexually transmitted infections and urinary tract infections
hormone conditions, such as low testosterone
genetic conditions, such as Klinefelter syndrome or cystic fibrosis
a blockage in your reproductive system that stops sperm leaving your body
previous testicle surgery, or undescended testicles as a child
certain medicines, including some antidepressants, steroids and chemotherapy drugs.

Lifestyle and environmental factors also play a part, including being overweight, smoking, drinking a lot of alcohol over long periods, using recreational drugs such as anabolic steroids or cocaine, and exposure to chemicals such as pesticides, solvents or heavy metals at work. Your testicles work best slightly cooler than the rest of your body, so overheating them regularly, for example with tight underwear or long stretches in hot tubs, can also lower your sperm count.

How low sperm count is classified

Doctors describe low sperm count by how severe it is. A normal sperm count is 15 million or more per millilitre of semen. Having oligospermia means your count is below this; severe oligospermia means fewer than 5 million sperm per millilitre. If there's no sperm in your semen at all, this is a different condition called azoospermia.

Diagnosing a low sperm count

The main test for a low sperm count is a semen analysis, where a sample of your semen is checked for the number of sperm, how well they move, and their shape.

If this first test suggests a problem, you'll usually be asked for a second sample around 3 months later to confirm it, since sperm counts can vary. If the second test also shows a low count, you'll be referred to a specialist for further tests, which may include blood tests to check your hormones, a genetic test, a urine test, or an ultrasound scan of your testicles to look for problems such as varicocele.

Treatment for a low sperm count

Treatment depends on what's causing your low sperm count, and in some cases it can be improved or reversed.

antibiotics, if an infection is the cause
hormone treatment, if a hormone imbalance is affecting your sperm production
surgery, to correct a varicocele or clear a blockage
counselling or medicine, if erectile dysfunction is a contributing factor.

Lifestyle changes can also help, including cutting back on alcohol, reaching a healthy weight, stopping smoking, and avoiding recreational drugs. Your doctor may also suggest vitamin or mineral supplements, such as coenzyme Q10, L-carnitine or vitamin C, if poor nutrition is contributing, though it's best to check with them before starting any of these.

If your sperm count doesn't improve, or the cause can't be treated, assisted conception may still make pregnancy possible. This can include in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg. If your sperm count is very low, using donor sperm is another option.

When to see a doctor

See a GP if you and your partner have been having regular, unprotected sex for over a year (or 6 months if your partner is 36 or older) without becoming pregnant. Your GP can arrange fertility tests for both of you, including a semen analysis.

It's worth getting checked sooner if you have erection or ejaculation problems, a low sex drive, or any pain, discomfort, swelling or a lump in a testicle.

FAQs

Can I still get my partner pregnant with a low sperm count?

Yes, it's often still possible, especially with a mild reduction in sperm count, though it may take longer than average. Your chances depend on the underlying cause and your partner's fertility too, since roughly half of fertility problems involve the female partner.
How common is low sperm count?

It's a common finding in couples struggling to conceive. Research suggests low sperm count or poor sperm quality affects around 1 in 3 couples experiencing fertility problems.
What is a varicocele, and can it be treated?

A varicocele is a swollen vein in the scrotum, similar to a varicose vein, and it's one of the most common causes of a low sperm count, found in around 4 in 10 men affected. It can often be treated with surgery, which may improve sperm count and quality, though it doesn't help everyone.
Can lifestyle changes really improve my sperm count?

Yes, for some causes. Cutting back on alcohol, reaching a healthy weight, stopping smoking, avoiding recreational drugs, and keeping your testicles cool by wearing loose underwear can all help. Improvements aren't immediate, so give any changes several months before expecting to see a difference and consider a repeat semen analysis after that time.
What's the difference between oligospermia and azoospermia?

Oligospermia means you have some sperm in your semen, just fewer than normal. Azoospermia means there's no sperm in your semen at all. They're related but distinct conditions, and azoospermia usually needs different tests and treatment.
Are there vitamins that can help increase sperm count?

Some vitamins and supplements, including coenzyme Q10, L-carnitine and vitamin C, may help if poor nutrition is contributing to your low sperm count, particularly antioxidant vitamins that protect sperm from damage. Speak to a healthcare provider before starting any supplement.

Low sperm count