While only one sperm is needed to fertilize an egg, the chances of getting pregnant is higher the more sperm you have. On average, a man releases at least 100 million sperm during ejaculation. These travel from the woman’s vagina to the fallopian tubes, many of which die in the process.

Low sperm count is also known as oligospermia. It occurs when the semen contains fewer sperm than normal. Based on guidelines by the World Health Organization, low sperm count is when the number is below 15 million per milliliter (mL). As a result, it increases the risk for male infertility.

While pregnancies can still occur, having a low sperm count can make it more difficult. Poor lifestyle choices and certain medical conditions can affect sperm count and quality.

How common is low sperm count?

Male infertility is usually associated with sperm problems, including low sperm count. This, however, is very common. According to an article, 50% of men dealing with infertility identified low sperm count as the primary cause.

In the Philippines, 25% of infertility cases are attributed to male infertility caused by injuries, low sperm count and quality, and genetic defects.

What are the symptoms of low sperm count?

Infertility is the main symptom of oligospermia or low sperm count. However, there are certain underlying conditions which may cause physical changes to occur. The common symptoms of low sperm count are:

Varicoceles

Varicoceles are enlarged veins in the scrotum. These affect proper blood flow, thus, making it hard for the sperm to grow and develop.

Erectile dysfunction

It is the inability to maintain an erection for sexual intercourse. Blood flow is disrupted, and therefore, cannot reach penile arteries.

Testicular pain and swelling

Pain, swelling, and inflammation around the testicular region is a common symptom of low sperm count.

Obstruction

Reproductive structural problems can block the sperm during ejaculation. For example, tubes that carry the sperm might be damaged due to injury, repeated infections, or developmental defects since birth.

Unusual Symptoms of Low Sperm Count

Low sperm count can also cause symptoms that are more uncommon. These include:

Less facial and body hair

This is usually an indication of a hormonal imbalance. Hormones from the pituitary gland are responsible for the production of sperm in the testicles. It can also be due to chromosomal abnormalities.

Difficulties in sexual functionality

For example, having low sex drive can make it difficult to climax. Moreover, it can also lead to retrograde ejaculation. This occurs when the semen goes back inside the body. The muscles around the bladder do not close during orgasm.

Sperm antibodies

In rare cases, the body releases antibodies that fight off sperm.These antibodies affect sperm activities and function. Antibodies are usually a result of surgery or infection.

When should I see my doctor?

Consult with a doctor if after one year of regular, unprotected sex, you still are not able to conceive. Make an appointment if you have also been experiencing the following:

• Pain, discomfort, swelling, or a lump around the testicles
• Ejaculation or erection difficulties
• A history or testicle, prostate, and other sexual issues, including sexually transmitted infections.
• Previous surgical treatment in the groin, penis, or scrotum

What increases my risk for low sperm count?

There are many risk factors for low sperm count. These can be categorized into three main areas: medical, environmental, and lifestyle.

Medical

You increase your risk for low sperm count due to certain health issues and medical treatments. These include the following:

• Genetic defects. Gene mutations or chromosomal conditions affect sperm production. Inherited disorders such as Klinefelter’s syndrome, cystic fibrosis, and Down’s syndrome can cause abnormalities in the male reproductive organs.
• Varicoceles decrease the number of sperm. This is because blood flow is disrupted causing veins to swell, thus, draining the testicle.
• Infections can affect sperm health by damaging the reproductive system. Blockages develop which can interfere with sperm production. Sexually transmitted infections like gonorrhea or HIV can affect testicular functionality. Other infections that may affect sperm production include inflammation in the epididymis (epididymitis), testicles (orchitis), as well as severe mumps.
• Cancer treatments. Radiation, chemotherapy, and surgery are used to treat tumors. However, these can damage the cells that produce sperm.
• Past surgeries. Certain surgeries can stimulate low sperm count. Surgeries to the male reproductive system include hernia repairs, scrotal or testicular surgeries, abdominal surgeries for rectal cancers, treatment for undescended testicles, and vasectomies.

Environmental

Overexposure to certain environmental elements increases the chance of having low sperm count, including:

• Heat. Subjecting your testicles to elevated temperatures can reduce sperm production. Avoid staying in hot tubs and saunas for long periods of time. Moreover, refrain from wearing tight clothing and opt for those made with breathable fabric.
• Industrial chemicals. These include contamination from pesticides, organic solvents, and other harmful chemicals found in paint and detergents.
• Radiation. Extended exposure to high levels of radiation can impair the reproductive organs.

Risk factors related to low sperm count also include:

• Obesity. Being overweight can cause hormonal imbalances which affect fertility.
• Vices. Drug, alcohol, and tobacco use can cause testicles to shrink, reducing the number and quality of your sperm.
• Emotional health. Severe emotional stress or depression can affect hormones responsible for sperm production.
• Health supplements. Regular intake of certain vitamins, boosters, and other workout supplements can reduce sperm count. This is due to the contained anabolic steroids which shrink the testicles.

How to Make Sperm Healthy for Pregnancy

How is low sperm count diagnosed?

Low sperm count is difficult to diagnose especially when its symptoms do not often physically show. It is usually when you engage in unprotected intercourse that you will notice irregularities.

Having a low sperm count decreases your fertility. Sperm evaluation is necessary. Diagnosis usually involves medical history, physical exam, and semen analysis.

• Medical history. Your medical history will help determine factors that contribute to your low sperm count. These include everything from your health to surgical histories. Your doctor will ask about inherited defects, past injuries and accidents, current health problems, and surgeries. Moreover, you may also need to disclose your sexual habits, including frequency and problems encountered.
• Physical exam. Examination of the genitals can uncover visible symptoms, such as lumps and swelling. Varicoceles can also be easily detected through a physical exam.
• Semen analysis. A sample of your semen will be examined under a microscope. You will be asked to ejaculate into a sterile cup. Apart from sperm count, a semen analysis will also study your sperm’s concentration, volume, and motility. These help determine if you are able to conceive.

Depending on the doctor’s findings, you might be recommended to take additional tests. Some of these may include:

• Hormonal testing. Blood tests are done to check if there are hormonal imbalances, which affect sperm growth and development.
• Testicular biopsy. This involves inserting a needle through the testicles to collect tissue samples. These are then taken to a lab for analysis to determine if you have normal sperm production.
• Testicular ultrasound. This uses high frequency sound waves to map out the entire reproductive organ. This test can help discover if there are structures blocked or damaged.

How is low sperm count treated?

Treatments for low sperm count usually depend on the cause. These include:

• Surgery. Varicoceles, organ damage, and blockages in the vas deferens (muscular tube from which sperm travels during ejaculation) can be surgically repaired. The patient can also undergo vasectomy reversals. If tested with little to no sperm presence during ejaculation, assisted reproduction procedures like in vitro fertilization (IVF) are done. In other cases, sperm is surgically retrieved from the testicle or epididymis.
• Medications. Infections in the reproductive tract can be treated with antibiotics. In cases of hormonal imbalances, hormone replacement or treatments are recommended. However, avoid those with anabolic steroids and over-the-counter testosterone boosters.
• Counselling. Issues with infertility caused by low sperm count can bring stress and anxiety. Moreover, it can develop self-esteem issues, especially when dealing with erectile dysfunction and premature ejaculation. These conditions can be managed through counselling as well.

Lifestyle changes and home remedies to manage low sperm count?

Apart from medicines and surgical options available, one way to prevent low sperm count is to adapt a healthier lifestyle. Improve your health by eating a balanced diet, exercising regularly, and limiting the use of alcohol, drugs, and tobacco.

Research shows that maintaining good overall well-being increases the chances of successful pregnancy. There are also steps you can do at home to help you conceive:

• Have sex regularly. Increase frequency of intercourse, especially before and after ovulation
• Time intercourse with ovulation. Conception is highly possible during ovulation. This occurs in the middle of the menstrual cycle. The sperm are likely to survive during this time.
• Avoid using lubricants. Excessive use of lubricants can impair sperm movement and function.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Lower sperm count, while common, is a leading cause of infertility. Pregnancies can still occur but it will take more time and can present other difficulties. This condition is a result of underlying medical conditions, past surgeries, and poor lifestyle choices.

Signs and symptoms of low sperm count are not usually visible unless you try to conceive. Low sperm count may be characterized by pain and swelling in the testicles, low sex drive, and ejaculation difficulties.

Having your sperm evaluated can identify factors affecting your fertility rate. Moreover, it will help you determine treatment options and explore other conception methods.