Low sperm count or oligospermia: symptoms, causes and treatment

Due to various lifestyle issues and many other causes like hormonal imbalance, illness, disorder that obstructs the passage of sperms, injury, sexual dysfunction, chronic health problems, genetic causes, and environmental factors such as exposure to radiation or X-ray, and industrial chemicals, there has been a considerable increase in male infertility mainly caused due to low sperm count.

Low sperm count technically known as Oligospermia, Oligozoospermia is a very common cause of subfertility or infertility in males. It ususally does not prevent pregnancy from occuring, but it may take some time as it reduces the chance of a viable sperm in fertilising the female partner’s egg and in some cases might prevent pregnancy.Numerous males those who have a low sperm count are still able to father a child. It should be kept in mind that, it takes two to conceive and the health of female partner also matters significantly for conception.

difference between normal sperm count and low sperm count
Difference Between Normospermia (Normal Sperm Count) and Oligospermia (Low Sperm Count)

Low sperm count

Low sperm count or Oligospermia means that the number of sperm in a man’s ejaculate or semen is below normal. A total lack of sperm in the ejaculate is known as Azoospermia. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility.


A sperm count in the ejaculate can vary throughout a man’s life. A healthy sperm count is necessary for fertility. The World Health Organisation (W.H.O) in its latest statement of semen quality (2010), considers a sperm count at 15 million/mL or above as normal sperm count. And anything below that is considered low and diagnosed as oligospermia or oligozoospermia.

Low sperm count symptoms

The primary symptom is the inability to have a baby. There can be no other noticeable signs and symptoms. In some cases, a fundamental issue, for example a hereditary chromosomal abnormality, a hormonal imbalance, dilated testicular veins or a disorder that obstructs the passing of sperm could potentially cause warning signs. The symptoms 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 chromosomal or hormonal imbalance.

Low sperm count diagnosis

Most of the cases of oligospermia are detected once the man tries to become a father, and when pregnancy is not achieved in a natural way, even after a year of regular unprotected intercourse, then both the male and female partner must undergo tests to check their fertility conditions.

A gynaecologist or an infertility consultant may order a semen analysis test. The diagnosis of low sperm count or oligospermia is based on low sperm count found in a semen analysis test. However, two tests should be performed to confirm the results. A semen analysis test usually checks at:

Main parameters that are seen in a semen analysis test

1. Ejaculate Volume ( > 1.5 mL)
2. Sperm Concentration ( > 15 million/mL)
3. Total Motility ( > 40%)
4. Progressive Motility (>= 32%)
5. Morphology (>4%)

 

along with pH etc. It is more than just a sperm count that matters for a pregnancy to occur, in normal methods of conception as well as assisted methods such as artificial/intrauterine insemination or in vitro fertilisation.

Low sperm count in the ejaculate may at times be accompanied with an abnormality in sperm motility and morphology, if the motility is poor, the sperm will not be able to reach the oocyte. If the morphology is poor, the sperm would not be able to penetrate the egg. Hence fertilisation is affected.

Types of low sperm count or oligospermia

When a man has less than 15 million sperm per mL, depending on how low his count is, we distinguish between different levels of severity. The levels are used to diagnose how severe the problem is on a case to case basis and the treatment would be totally dependent on the level of oligospermia. It is classified in the following groups.

Types of low sperm count
Types Sperm concentration in Ejaculate
Normozoospermia >15 million sperm/ml
Mild Oligospermia 10 million to 20 million sperm/mL
Moderate Oligospermia 5 million to 10 sperm/mL
Severe Oligospermia 1 to 5 million sperm/mL
Cryptozoospermia 0 to rare sperm, hidden sperms found after centrifugation
Azoospermia 0 sperm

 

Types-of-low-sperm-count-or-oligospermia
Types of Oligospermia or Low Sperm Count

 

  • Mild oligospermia

    When the number of sperms found in the semen ranges from 10 million to 20 million sperms per millilitre.

  • Moderate oligospermia

    When the number of sperms found in the semen ranges from 5 million to 10 million sperm per millilitre. Improvement can be achieved in these cases following proper treatment and healthy lifestyle for a few months. Semen analysis should be repeated after a few months.

  • Severe oligospermia

    When the number of sperms found in the semen ranges from 1 to 5 million sperms per millilitre. Pregnancy in this case can only be achieved by ART (Assisted reproductive technology).

  • Cryptozoospermia

    When the number of sperms found in the semen sample after centrifugation is 0 to rare. Pregnancy in this case also can only be achieved by ART (Assisted reproductive technology).

  • Azoospermia

    When there are no sperms found in the ejaculate, the condition is called azoospermia. Pregnancy in this case can only be achieved by ART (Assisted reproductive technology).

    Even though pregnancy with oligospermia is possible, still it should be kept in mind that depending on the severity of the case, infertility treatments are available, which allow couples to overcome these obstacles and allow fertilisation to occur successfully.

Low sperm count causes

Most men are completely unaware of their fertility status, unless they can make a female pregnant till then they are in the dark. Many reproductive and non-reproductive causes have been reported, but in most cases the cause remains unexplained because a low sperm count can occur as a temporary alteration. Low sperm count can be caused by a number of medical issues, environmental factors and lifestyle choices. Treatment will be totally dependent on the cause of the problem.

Causes of low sperm count
Medical Causes Environmental Causes Lifestyle Choices
1. Varicocele 1. Industrial Chemicals 1. Drug Use
2. Infection 2. Heavy metal Exposure 2. Smoking and Alcohol Consumption
3. Ejaculation Problems 3. Radiation or X-rays. 3. Stress
4. Tumours 4. Overheating of Testicles 4.Weight
5. Hormonal Imbalances
6. Medications
7. Genetic Causes

 

causes of low sperm count
Causes Of Low Sperm Count

Medical causes– A low sperm count can be caused by a number of health issues and medical treatment.

  • Varicocele results in reduced quality of sperm. Enlarged veins in a man’s scrotum disrupts blood flow to the testicle, this causes the temperature in the testicles to increase and an increase in the temperature can impact sperm production.
  • Infections interfere with sperm production or sperm health and can cause permanent testicular damage as well. Infections like epididymitis (inflammation of epididymis), orchitis (inflammation of the testicles) can reduce sperm count in semen. Even sexually transmitted disease can cause low sperm count.
  • Ejaculation problems due to some health issues like diabetes, spinal injuries, surgery of the bladder, prostate or urethra can cause retrograde ejaculation that is semen enters the bladder instead of flowing out from the tip of the penis.
  • Tumours – Surgery, radiation or chemotherapy to treat tumours can lower sperm count.
  • Hormonal imbalance – the brain and the testicles produce several hormones that are responsible for ejaculation and sperm production, and a hormonal imbalance may lower sperm count.
  • Medications – Some medicines like beta blockers, antibiotics and blood pressure medications can cause ejaculation problems and reduce sperm count.
  • Genetic defects – Men with severe low sperm count that is when the count is less than 5 million sperm per millilitre of semen have a higher risk of genetic abnormalities. These may result in structural or functional testicular abnormalities. Only 20-30% of men with severe oligospermia and azoospermia are finally diagnosed to have a specific disorder. Identified genetic causes of low sperm count can be Klinefelter’s syndrome, Y chromosome deletion, cystic fibrosis.

Environmental causes – Exposure to environmental toxins and chemicals can affect sperm production and function.

  • Industrial chemicals – Extended exposure to benzene, toluene, xylene, herbicides, pesticides, organic solvents, painting materials might lead to low sperm count.
  • Heavy metal exposure – Exposure to lead or other heavy metals can cause low sperm count.
  • Radiation or X-rays – Exposure to radiation can reduce sperm production and function. With high doses of radiation, sperm production can be permanently reduced.
  • Overheating of testicles – An increase in the temperature reduces sperm production and function. Use of hot water tubs, saunas, sitting for long hours, wearing tight clothing increases the temperature in the scrotum which results in reduced sperm production.

Lifestyle choices – Other causes of low sperm count includes one’s lifestyle choices.

  • Drug use – Anabolic steroids that are taken to stimulate muscle strength and growth can cause the testicles to shrink and hence sperm production decreases. Use of illegal drugs too reduce the number and quality of sperm.
  • Smoking and alcohol consumption – Men who smoke more than 20 cigarettes in a day tend to have a low sperm count. And excess consumption of alcohol can lower testosterone levels and hence cause decreased sperm production.
  • Stress – Severe or prolonged psychological stress might cause hormonal imbalance which might cause low sperm count.
  • Weight – Obese people can have a low sperm count. Adipose tissues (fat) converts testosterone to oestrogen, and extra oestrogen in a man’s body can negatively impact sperm count and sperm quality. Excessive body fat and low muscle mass keeps testosterone levels below normal leading to poor quality of sperm.

Depending on the origin where the alteration in sperm production has occurred, the causes can be categorised under three types.

Causes according to origin of alteration – sperm production
Pre-testicular Oligozoospermic causes

(Refers to hormonal imbalance that interferes with sperm production and external factors that have an impact on the body)

Testicular Oligozoospermic causes

(Caused by testicular diseases)

Post-testicular Oligozoospermic causes

(Refers to ejaculation problems, sperm production function works properly, but problem appears during the time of ejaculation)

1. Medical treatment which affects sperm production 1. Varicocele 1. Obstruction of the vas-deferens
2. Cannabis and alcohol 2. Age 2. Infection such as prostatitis
3. Junk Food 3. Injury to the testicle 3. Retrograde Ejaculation
4. Hypogonadism 4. Genetic abnormalities 4. Erectile Dysfunction

 

difference between normal sperm count and low sperm count
Causes According To Origin Of Alteration – Sperm Production
Tips to increase sperm count naturally

When a low sperm count is reported after a complete evaluation of all reports like semen analysis, along with blood work to check hormonal levels, an ultrasound, a physical examination, and a detailed family history, then if the condition is treatable, then it should be corrected before opting for assisted reproductive technology. A doctor might recommend some dietary changes, may suggest some vitamins or medicines, may tell to make some lifestyle changes to improve sperm quality and number.

  • Taking vitamin supplements regularly and food rich in zinc and folic acid (green leafy vegetables) and antioxidants (berries, other brightly coloured fruits and vegetables)
  • Avoiding unhealthy habits like smoking, drinking alcohol and taking illegal drugs because it causes low sperm count and problem in sperm motility. Smoking inhibits sperm production.
  • The scrotum should be avoided from exposure to intense temperatures. Few degrees increase in scrotal temperatures can severely affect sperm production. So, wearing tight fitting underwear should be avoided, and hot tubs and saunas should also be avoided.
  • Minimising stress as much as possible. Exercising regularly, relaxing and avoiding stressful situations as much as possible. Studies have linked stress to hormonal imbalance.
  • Maintaining a healthy weight. Being overweight or underweight can affect sperm count. Oestrogen and testosterone levels are affected by body mass and the amount of body fat one has.
  • Avoiding steroids as they can cause testicular reduction and infertility.

If sperm count doesn’t increase after this, it is recommended to visit an infertility specialist, he or she might treat you depending on the cause of the underlying condition. Might suggest some medication or suggest assisted reproductive technology for conception.

Low sperm count treatment

Low sperm count is treatable area in the field of infertility, and treatment depends on the cause of the condition. A man who is suffering from varicocele, surgery is the most common treatment. For low sperm counts due to infections of the urinary or reproductive tract, antibiotics are prescribed to clear the infection. Medication and hormone replacement treatment is used when the cause of low sperm count is related to a hormonal imbalance. If a couple still finds it difficult to get pregnant, then it would be advisable for them to visit a infertility specialist and assisted reproductive technology might be recommended to facilitate conception either by IUI (Intrauterine insemination), IVF (In vitro fertilisation), ICSI (Intracytoplasmic sperm injection) and in cases where no sperms are found in the ejaculate or very low sperm count testicular sperm aspiration procedures are recommended which allow sperms to be suctioned and extracted from the testicles and then to be used in conjunction with IVF.

Check out our blog on “How to get pregnant with low sperm count”.

CONCLUSION

Even though it takes only one sperm to fertilise an egg, but it takes millions of sperms to increase the chances of that one sperm to find its way to the egg and fertilise it, and thus create an embryo. In a normal sperm count, of the 40-200 million sperm present per mL of the ejaculate, only a few hundred sperm make it to the fallopian tubes. And then one healthy sperm will release an enzyme that will help to penetrate the egg shell.

Men who have low sperm count that is less than 15 million per mL are not considered infertile, but it means it will take a longer time, more finesse and planning for the couple to conceive a healthy child. If natural ways of conception or sperm enhancement fails, there is assisted reproductive technology to achieve pregnancy in such cases.

Low sperm count success story

Rishi (41) and Ankita (39) were trying to conceive for over a year but without any luck.

We already have a boy who is 7 years old but wanted to extend our family. After a year of trying naturally when Ankita didn’t conceive, we couldn’t get the reason behind it as we already have our own biological son. That there could be issues related to fertility, never crossed our mind. After much thoughts, and a suggestion from a dear friend to visit Medicover Fertility, who had his second issue after 10 years, after his wife was treated for some fertility issues in Medicover, I decided to visit Medicover.
There we met Dr. Sweta Gupta (Clinical Director), who listened to our concern patiently. Thereby she suggested some preliminary tests for both of us. Ankita’s test report were all normal, but my semen analysis test showed a low sperm count of 2 million sperm per millilitre. I was devastated. Dr. Sweta said not to worry but let’s get to the reason behind my low sperm count. After more tests, ultrasounds, it was found that I had a varicocele which needed to be operated to enhance my sperm count.
As I was detected with severe oligospermia and Ankita’s age was also advancing, the team of doctors present there suggested that during my varicocele surgery a testicular sperm aspiration would be done, and the sperms extracted would be used for ICSI in conjunction with IVF. They also suggested sperm cryopreservation for future use.
And yes, everything went as planned, Ankita conceived in the first cycle itself. The varicocele surgery, the testicular sperm aspiration, the ICSI-IVF, all these nerve wrecking moments are worth when I see the face of my daughter. We are a complete family now.

Thank you, Medicover Fertility.

 

Low sperm count treatment at medicover fertility

Medicover Fertility is a renowned international brand. We have a team of highly skilled and experienced doctors who help couple deal with infertility. Medicover Fertility has a very high fertility success rate as we use the latest technology in fertility treatments. Here the couples are carefully examined to find out the actual cause of infertility.

Receiving a diagnosis of male infertility due to low sperm count can be emotionally disturbing. Best is to speak to a doctor who will recommend a treatment plan. Dr. Sweta Gupta (Clinical director in Medicover Fertility) has over 23 years of experience in infertility. A lot of cases with low sperm count are dealt in Medicover Fertility. Depending on the type of oligospermia a treatment plan is chalked out. IUI may be recommended in cases of very mild oligospermia, conventional IVF in moderate oligospermia cases, ICSI-IVF in cases of severe oligospermia to cryptozoospermia, at times testicular aspiration of sperm is done when no sperms or rare sperms are found in the ejaculate. The doctors in consultation with the embryologists will chalk out the best treatment plan by looking at the medical history of the couple.

 

RELATED QUESTIONS:

Q) Can a man with low sperm count have a baby?

A) Yes, a man with low sperm count can have a baby, but it might take a longer time to impregnate the female, provided the female does not have any reproductive issues. If natural conception does not happen, then depending on his level of low sperm count, he can opt for assisted reproductive technology.

Q) What is the main cause of low sperm count?

A) A single cause of low sperm count is not identified. Causes of low sperm count can be due to hormonal disorders, illness, injury, obstruction that prevents release of sperms in the semen, sexual dysfunction, chronic health problems, genetic causes, lifestyle choices and environmental factors.

Q) Can a low sperm count be treated?

A) Yes, treatment is available, either with medications for hormonal imbalance or infections. And for men with oligospermia who are still unable to have children, assisted reproductive technology might help. In case of mild oligospermia they can either conceive naturally or by means of IUI. In severe cases, pregnancy can be achieved by IVF or ICSI-IVF.

Q) Can low sperm count lead to miscarriage?

A) Low sperm count does not cause miscarriage, but a recurrent miscarriage can depend on low sperm quality as well as DNA damage.

Q) How can you tell if a man is infertile?

A) In most cases, there are no signs of infertility. Ejaculation usually happens in these cases without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye. Medical tests like a semen analysis test, blood tests to find out hormonal disorder, an ultrasound, a physical examination with a detailed family history is needed to find out if a man is infertile.

References :
1. https://natural-fertility-prescription.com/how-to-get-pregnant-with-low-sperm-count/
2. http://ovulation.guide/how-to-get-pregnant-with-low-sperm-count/
3. https://www.parenting.com/article/misconception-low-sperm-count-no-big-deal
4. https://oligospermia.info/pregnancy/
5. https://www.performanceinsiders.com/oligospermia.html
6. https://academic.oup.com/jcem/article/98/3/873/2536497
7. https://www.ncbi.nlm.nih.gov/pubmed/16669917
8. http://www.lowspermcount.org/
9. https://www.ncbi.nlm.nih.gov/pubmed/20831771
10. https://www.ncbi.nlm.nih.gov/pubmed/1248659

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