Low sperm count affects millions of men around the world, and is a leading cause of infertility. Here’s what you need to know about oligospermia, what causes it, and the available treatment options.
Oligospermia, or low sperm count, is a male fertility issue in which the number of sperm produced in an ejaculaton is significantly lower than normal [1]. This medical condition is among the leading causes of male infertility worldwide [2].
Healthy sperm count range varies greatly. Counts of between 15 million sperm per millilitre to 200 million sperm per millilitre is considered normal, while those with counts in the 200s and above are said to have high sperm count [3].
In contrast, anything less than 15 million per millilitre of semen is indicative of oligospermia. Additionally, if a single ejaculation contains fewer than 39 million sperm, low sperm count is also indicated [3].
Understanding low sperm count
How common is oligospermia?
Definitive figures are hard to come by, but some healthcare providers estimate that around 1 in 3 couples trying to conceive grapple with low sperm count and other sperm abnormalities [4].
Given that globally, up to 48 million couples and up to 168 million individuals experience infertility challenges, low sperm count is a more common problem than we may think [5].
Is low sperm count permanent?
Oligospermia can be caused by several different factors, ranging from underlying medical conditions, to environmental and lifestyle factors. Therefore, depending on what the actual cause is, low sperm count in an individual may be temporary or permanent.
Severe damage, disease or genetic causes may permanently lower sperm count. Meanwhile, if the cause can be resolved, such as making certain lifestyle changes, then the condition may be reversed [6].
We will discuss the underlying causes of low sperm count in more detail later in the article.
Because low sperm count means there is less sperm to fertilise the egg, reducing sperm loss during sex may be helpful. twoplus Fertility’s Sperm Guide is designed to retain more sperm throughout the vaginal tract, increasing the number of sperm available for successful conception to take place. Drug-free and easy to use, the Sperm Guide is a fertility product for men and women that helps improve fertility outcomes when used in conjunction with your fertility care plan.
Oligospermia versus azoospermia
Note that there is a difference between low sperm count, and a sperm count of zero.
Yes, some men do really ‘shoot blanks’. Around 10% of all infertile men, and 1% of all men are estimated to not have any sperm cells in their ejaculate [7].
This condition is known as azoospermia, and is classified into 2 categories — obstructive and non-obstructive. Obstructive refers to sperm being unable to enter the ejaculate [7]. Non-obstructive, on the other hand, refers to an abnormality in sperm production that leads to no presence of sperm in the ejaculate [7].
Like oligospermia, azoospermia has many potential causes. These range from genetic conditions, poor testes development and anatomical abnormalities to certain medical treatments and recreational drug use [7].
How is low sperm count diagnosed?
Low sperm count is not something that can be physically felt, and commonly does not have any accompanying symptoms. As such, many couples may not be aware they have this issue until they run into difficulty becoming pregnant [8].
As part of a fertility checkup, your doctor may order a semen analysis [9]. This involves collecting a sperm sample to be examined by fertility specialists in a clinical setting.
During a semen analysis, the patient’s sample is checked for
- Sperm concentration
- Sperm motility (ability to swim)
- Sperm morphology (shape and structure of sperm)
If the sperm concentration is found to be below the threshold of 15 million per millilitre, or 39 million in total, a diagnosis of oligospermia may be given.
Can I check for low sperm count at home?
While there are at-home sperm count kits available over the counter, these test kits may not be able to provide the complete picture.
This is because they only measure sperm concentration — showing if your sperm levels are in the normal range. Other important factors such as motility, morphology, and total sperm count are not measured [10].
Note that having normal sperm concentration doesn't tell you if you are fertile or not. Hence, it is advisable to consult your fertility specialist for a more comprehensive assessment of your fertility health.
What causes oligospermia?
Medical reasons [8]
There are several medical and health conditions that can lead to low sperm count in men.
For instance, genetic diseases such as Klinefelter syndrome and cystic fibrosis, and a history of testicular symptoms such as varicocele, injury, sexually transmitted infections and surgery have been known to cause oligospermia.
Cancer and its treatments can also be a factor. Chemotherapy drugs may interfere with the body’s hormonal system, leading to a lowering in sperm production, while radiation from radiotherapy can damage the testes.
Beside chemotherapy drugs, medications such as antibiotics, antifungal and ulcer drugs can also cause low sperm count. As these medications are more commonly prescribed, you might want to give your doctor a head’s up if you are trying to conceive the next time you visit the clinic.
Environmental causes [11]
Certain toxins and chemicals found in the environment can also lower sperm count. In particular, prolonged exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials, lead and other heavy metals are thought to cause oligospermia.
Another environmental factor to be wary of is excess heat, as elevated temperatures have been shown to impair sperm production and function. Frequent and extended use of saunas or hot tubs, working with a laptop directly on the lap, tight clothing and continuous sitting can also cause low sperm count.
Lifestyle factors [11]
Besides medical, health and environmental causes, lifestyle factors can also play a role in low sperm count.
Using anabolic steroids, opiods and marijuana can impact your body’s ability to manufacture sperm. Heavy or uncontrolled use of tobacco or alcohol, and being overweight can also cause low sperm count.
Depression, as well as severe and prolonged emotional stress will also disrupt the natural balance of hormones required for healthy sperm production.
How to treat low sperm count
Treatment for oligospermia or low sperm count depends on the underlying factors leading to the condition, of which there are several, as discussed above.
Thus, in order to be effective, a low sperm count treatment plan would need to address the root causes of oligospermia. This could range from lifestyle changes, to replacing or altering medications or medical treatments, or surgery to resolve blockages or heal damage.
Given the potential complexities that could arise, it is best to seek advice from your fertility specialist.
Can supplements help improve low sperm count?
There is evidence that including certain supplements in your diet can help improve sperm health.
A literature review published in 2016 found positive correlations between consumption of CoQ10 supplement and an increase in sperm count, motility and quality [12].
Of the studies cited, one showed that after supplementing with CoQ10 for 28 weeks, men with unexplained infertility showed improvements in sperm concentration, motility and morphology [12]. This finding was further corroborated in another meta-analysis that found a global improvement in sperm concentration and other parameters.
Additionally, positive effects were observed at relatively low dosages. Taking at least 150mg of CoQ10 daily induced positive changes in semen parameters in male participants of another study included in the review.
Conclusion: When should couples seek help for low sperm count?
Low sperm count is a direct cause of infertility. If you and your partner have been trying to get pregnant for more than a year, a fertility checkup is likely in order — regardless of age or fitness level.
Are you taking too long to conceive? Check out our Getting Pregnant 101 Guide for must-know TTC tips below & above 35 years old.