Low Sperm Count

Overview

Low sperm count means the semen contains fewer sperm than expected. Doctors call it oligospermia (say: ol-ih-go-SPER-mee-uh) when the count is below the usual range, and azoospermia (say: ay-zoh-oh-SPER-mee-uh) when there are no sperm at all. Sperm are the tiny cells made in the testicles that can fertilise an egg. Having a low count does not mean you cannot father a child — many men with low counts still do, sometimes with a little help from fertility treatment.

Yes, it is common. About one in six couples around the world have trouble getting pregnant, and a male factor plays a part in roughly half of those cases.

It affects men and boys who produce sperm, so from puberty onwards. It is usually noticed when a couple is trying for a baby. Children do not have low sperm count because they do not make sperm yet, but some childhood problems — such as an undescended testicle — can affect fertility later in life.

Symptoms

Common symptoms

• Usually no symptoms at all — many men only find out when a couple is trying to conceive
• Taking longer than expected to get a partner pregnant
• Low sex drive (libido)
• Trouble getting or keeping an erection
• Pain, aching or swelling in the testicles or scrotum
• Testicles that look or feel smaller than usual
• Less body or facial hair, or rarely some breast growth — signs of a hormone imbalance
• Problems from a past infection, such as pain when passing urine or discharge

Symptoms in children

• Low sperm count is not a childhood condition, because boys do not make sperm until puberty
• Some childhood issues can raise the risk later: a testicle that has not dropped into the scrotum by itself, hernia surgery in the groin, or puberty that starts very early or very late
• These are checked and managed by a doctor at the time, so there is nothing extra a parent needs to do beyond normal check-ups

Symptoms in older adults

• Sperm count does not usually fall suddenly with age, but sperm quality slowly declines and it may take longer to conceive
• Older men are more likely to have other health conditions and to take medicines that can affect fertility
• A partner's age also matters, and fertility is always a shared issue between two people

Causes

Main causes

• Swollen veins in the scrotum (called a varicocele, say: VAR-ih-koh-seel) — a common and treatable cause
• Hormone problems, such as low levels of the hormones that tell the testicles to make sperm
• Blocked tubes that carry sperm, sometimes from past infection, injury or surgery
• Infections of the testicles or genital area, including some sexually transmitted infections
• Genetic conditions, such as changes in the chromosomes that affect how sperm are made
• Medicines and treatments such as some drugs for cancer, or long-term steroid use
• Heat, chemical exposure or radiation affecting the testicles
• No clear cause found — this happens in roughly half of cases

Risk factors

• Smoking, vaping or using recreational drugs
• Drinking a lot of alcohol
• Being overweight or very inactive
• Frequent hot baths, saunas, hot tubs, or working in very hot places
• Long hours sitting, such as long-distance driving or cycling
• Anabolic steroids used to build muscle — these can switch off sperm production
• A history of an undescended testicle or groin surgery as a child
• Older age, which slowly lowers sperm quality

When to see a doctor

See a doctor urgently if:

• You find a new lump or hard swelling in a testicle
• You notice blood in your semen
• You have pain or swelling in the testicles that does not settle in a few days
• You have signs of infection, such as burning when passing urine, discharge, or fever

Book a routine appointment if:

• You and your partner have been trying for a baby for a year without success, or for 6 months if your partner is over 35
• You have a known risk factor, such as a past testicular infection, groin surgery, or cancer treatment
• You have low sex drive, erections that have changed, or other hormone-type symptoms
• You simply feel worried about your fertility and want to talk it through

Diagnosis

Your doctor will ask about your health, any medicines you take, your lifestyle, and any problems you had as a child. They will examine you, including your testicles, and arrange a semen analysis (a sperm test). Because counts vary from day to day, the test is usually done at least twice, several weeks apart. Your partner may also be offered checks, since fertility is a shared issue.

Tests that may be done

• Semen analysis — looks at how many sperm there are, how well they move, and their shape
• A repeat semen analysis a few weeks later to confirm the result
• Blood tests to check hormone levels and general health
• A physical examination, and sometimes an ultrasound scan of the scrotum
• A urine test to look for infection
• Genetic tests in some cases, especially if no sperm are found
• Fertility checks for your partner at the same time

What to expect at your appointment

You will usually be asked to provide a semen sample after 2 to 5 days without ejaculating. This can be done at the clinic or at home, depending on local arrangements. Results usually come back within a few days to a couple of weeks. Your doctor may then refer you to a fertility specialist, such as a urologist or a reproductive medicine team.

Treatment

Treatment depends on whether a cause is found. In about half of cases no clear cause turns up — that does not mean nothing can be done. Options include lifestyle changes, treating an underlying problem, and fertility treatments that help you conceive.

Self-care at home

• Stop smoking and avoid recreational drugs, including anabolic steroids
• Keep alcohol to a low level or cut it out
• Avoid overheating the testicles — skip hot tubs and saunas, and avoid laptops on your lap for long periods
• Take breaks from long sitting, cycling or driving
• Aim for a healthy weight with regular, moderate exercise
• Get enough sleep and find ways to manage stress
• Use condoms to protect against sexually transmitted infections
• Check with your doctor or pharmacist about any medicines or supplements you take, as some can affect fertility

Medical treatments

Doctors may treat a cause if one is found. That might mean antibiotics for an infection, surgery for swollen veins in the scrotum or a blocked tube, or hormone treatment if a hormone imbalance is found. If no cause is found, or treatment does not help, fertility treatments can still work. These include putting sperm directly into the womb (IUI), and IVF, where an egg is fertilised outside the body. In IVF, a single sperm can be injected into an egg (called ICSI). Using donated sperm is another option. Your specialist team will explain which choices suit your situation, along with the chances of success and the downsides.

When is surgery considered?

Surgery can help when there is a physical cause — for example repairing a varicocele, unblocking the tubes that carry sperm, or reversing a vasectomy. It is not right for everyone, and success rates vary. Your specialist will talk you through the benefits and risks before you decide.

Living with this condition

Low sperm count usually does not change your day-to-day life. Most of the work is about looking after your general health and giving yourself time. Try to keep the focus on small, steady changes rather than a total overhaul, and remember that sperm take about two to three months to develop, so changes you make now show up later.

Lifestyle tips

• Cut out smoking and limit alcohol
• Keep the testicles cool — loose underwear and avoiding hot tubs can help
• Move regularly and take breaks from long sitting
• Protect yourself from sexually transmitted infections
• Review any medicines, supplements or bodybuilding products with your doctor or pharmacist
• Keep up treatment for other health conditions, such as diabetes or thyroid problems

Diet and exercise

A balanced diet with plenty of fruit, vegetables, whole grains, beans, nuts and lean protein supports sperm health. Nutrients such as folate, zinc and selenium are found in these foods. Regular moderate exercise and a healthy weight help too. Very intense training, crash diets and anabolic steroids can work against you, so aim for steady and sustainable rather than extreme.

Mental health and emotional wellbeing

Trying to conceive can be emotionally hard, and many men feel shame, guilt or a sense of failure. These feelings are common and understandable, and they are not a sign of weakness. Fertility problems can also strain a relationship. Talking openly with your partner, a friend, or a counsellor can really help. If you ever feel hopeless, overwhelmed, or unable to cope, please reach out to a crisis support service in your country or speak to your doctor straight away — you do not have to manage alone.

Prevention

Not every case can be prevented, because some causes are genetic or come from childhood. But there is a lot you can do to lower your risk and protect your fertility: avoid smoking, drugs and heavy drinking, keep to a healthy weight, avoid overheating the testicles, and treat infections promptly.

Vaccines

Keep up with routine vaccinations. Vaccines that protect against mumps matter, because mumps can cause painful swelling of the testicles that may affect fertility. The HPV vaccine, which protects against some infections linked to cancer, is offered at certain ages depending on your country — ask your doctor if you are unsure whether you have had it.

Screening programmes

There is no routine screening test for low sperm count. A semen analysis is done when there is a reason, such as trouble conceiving or symptoms in the testicles. Routine health checks and prompt treatment of infections are sensible steps.

Complications

If left untreated

• It may take longer, or be harder, for you and your partner to conceive
• Stress, anxiety, low mood or strain on your relationship
• An underlying problem going unnoticed, such as a hormone imbalance, an infection, or a testicular condition
• In some cases, low testosterone effects such as tiredness, low sex drive or reduced muscle strength

Long-term outlook

The outlook is hopeful. Many men with a low sperm count go on to father children, either naturally or with fertility treatment. Counts can change over time, and lifestyle changes often make a difference. Even when no cause is found, treatments can still work — so it is worth getting checked and talking through the options with a specialist.

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