Low Sperm Count: Symptoms, Causes, Diagnosis & Treatment

A study of medical literature on male fertility will show that the sperm count has fallen by >50% in the last 50 years. Not only is this an alarming situation for human reproduction but also shows that men are increasingly becoming unhealthier. Oligozoospermia or low sperm count is one of the many common male infertility problems. It is a term for a condition where a man’s 1ml semen contains <15 million sperm. Sperm quality and quantity are two factors that commonly cause problems in conceiving. 

Symptoms and Signs of Low Sperm Count

Out of the few low sperm count signs, the primary one is the inability to conceive. In fact, male infertility accounts for nearly half of all such cases where a couple fails to have a child even after 1 year of unprotected sex. However, many men with oligospermia are still able to naturally have kids. 

The other symptoms of low sperm count include-

• Sexual dysfunction issues like low libido/ sex drive and/or erectile dysfunction 
• Testicles may feel swollen and sore, or there may be lump in that region
• Less facial and body hair might be due to low testosterone levels which can be a result of hormonal imbalance, or chromosomal abnormality, or even obesity
• Deep voice, though generally indicates a good testosterone level, may be associated with a low sperm count
• Inability to build much body muscles can also indicate high estrogen levels and a low sperm count

Reasons for Low Sperm Count 

Sperm production requires the well-coordinated functioning of the testicles, pituitary, and hypothalamus glands. These glands are responsible for the secretion of hormones required to trigger the testes to make sperm. Certain tubes then transfer the sperm cells from testicles to urethra. Seminal fluid joins sperm at the prostate gland resulting in the semen that is ejaculated from the penis after a man reaches the climax. 

Problems with any of the above processes will result in abnormal sperm production. The resulting condition can either affect the number of sperm cells produced, or shape, size, or motility of the sperm.

Here are some medical causes for a low sperm count:

• Varicoceles- the scrotum has veins that drain it. Swelling of these veins can restrict the sperm from passing into the urethra. It usually happens due to the abnormal testicular temperature and is treatable.
• Undescended testicles- if, during the fetal stage, the testes fail to come down from the abdomen into the scrotum, decreased fertility can be the result. 
• Autoimmune reaction where one’s own body makes antibodies that attack its own sperm cells, destroying them and reducing their number.
• Retrograde ejaculation- after orgasm, when the ejaculated semen enters the bladder instead of going out through the penis it leads to infertility. This condition can be caused because of various factors like spinal injuries, diabetes, surgery of the bladder or prostate. Some medications like alpha blockers can also lead to this condition. It can be both permanent and temporary but even in permanent condition, sperm can be taken directly from the testes.
• Tumors- both cancerous and non-malignant tumors may negatively affect the reproductive system. Treatments used to eliminate cancer like chemotherapy, radiation, and surgery can also affect fertility.
• Infections like epididymitis (affects epididymis), orchitis (affects testicles), and certain sexually transmitted diseases (STDs) like HIV and gonorrhea can cause permanent damage to the testicles. However, it is still possible to retrieve sperm cells.
• Hormonal imbalance- if the secretions from pituitary, hypothalamus, adrenal, and thyroid glands are in any way abnormal, it will affect the sperm production and quality.
• Blockage in the vas deferens, or tubules that drain the testes will render the movement of sperm/semen impossible. It might happen due to injury, infection, trauma, or inherited conditions like cystic fibrosis.
• Celiac disease– excessive sensitivity to gluten that causes problems in the digestive system can also lead to male infertility.
• Chromosomal aberrations like in Klinefelter syndrome (a male has 2 X and 1 Y chromosomes instead of 1 X and 1Y), Kartagener’s syndrome, and Kallmann’s syndrome lead to an abnormally developed male reproductive system. 

Some health and lifestyle problems that can cause low sperm count are:

• Excessive alcohol consumption lowers the sperm production
• Drugs like steroids taken to enhance muscle strength and growth can cause the testicles to shrink in size and produce less no. of sperm. Cocaine and marijuana also have a similar effect 
• Smoking tobacco has been found to be detrimental to sperm health and production
• Stress and depression affect the reproductive system by interfering with the required hormones and making the semen less concentrated
• Obesity also contributes to negative sperm health
• Occupations like welding or those involving a lot of sitting time may increase the temperature in and around the scrotum, thus affecting the no.of sperm

Lastly, there are some environmental factors that may result in low sperm count and other forms of male infertility:

• Prolonged/ regular exposure to industrial chemicals like herbicides, insecticides, benzene, toluene, paints, organic solvents, lead, etc., might make you prone to having a low sperm count
• Excessive exposure to radiation like X-rays may cause infertility problems
• Heavy and toxic metal (present in air as pollutants) can also lead to poor sperm health

A very common question linked to causes is- does masturbation cause low sperm count? Looking at the existing data on this, we can safely say that masturbation (even when done daily) isn’t supposed to reduce the sperm count. It may however temporarily cause less semen ejaculation. So, if you’re trying to have a baby, it is advisable to masturbate less as it will mean more concentrated semen while having sex.

Diagnosing Low Sperm Count

A semen analysis test is usually the first thing any doctor will ask you to get done if you go to them with the problem of not being able to have a baby. This test requires the male partner to give a semen sample (usually in the lab itself because the technicians can quickly examine the sample before the sperm starts dying). Make sure you collect all of the semen in the container, if some is spilled let your doctor know about it. You may also collect the sample at your home. For this you’ll have to use the particular type of condom recommended by your doctor. Keep the sample at body temperature and take it to the lab within an hour of ejaculation.

Sometimes they ask you to give 2 or 3 more such samples in the span of 7 to 14 days to get an average sperm count as the number may vary from day to day. Generally, you ought to refrain from having sex or masturbating for 2 to 7 days so that the sample you provide is of the highest quality. 

Now, some of you might be wondering…how to check low sperm count at home? There are various at-home kits available in the market that let you collect samples and use the device to count sperm cells. Some kits even enable you to see the movement of the sperm cells and see their density in your smartphone. Then there are other self-collection kits that allow you to collect the semen sample at home but need you to send it to the lab for analysis. These tests will provide you with more information. However, remember that neither of these in-home tests can be done fertility center. 

Low Sperm Count Treatment

For those of you who’re wondering, can low sperm count be cured? The answer is yes. Depending on the cause of oligospermia, one or several of the following measures can be taken to treat it:

• Try to have sex after every 2-3 days.
• If you’re overweight, consider getting regular exercise to lose some weight. It is known to improve both sperm count and motility in men.
• Quit smoking and drinking alcohol or at least reduce their consumption.
• Maintain a regular sleep schedule.
• Check with your doctor regarding any medication that might be temporarily causing low sperm count and see if you can find a better alternative for it.
• Fenugreek is known to help increase sperm count so incorporate it in your diet.
• Getting sufficient vitamin D and calcium have been observed to be important for good sperm health.
• Eat food that is rich in antioxidants as it counteracts the free radicals present in our body and saves the sperm cells from damage.
• You should limit the intake of estrogen-rich food like soy.

Tips for Getting Pregnant with Low Sperm Count

1. Intrauterine insemination (IUI) low sperm count- IUI can be helpful in achieving pregnancy as it bypasses the long journey that the sperm cells have to make otherwise.

2. In-vitro fertilization & low sperm count- IVF has been no less than a miracle for couples who had long struggled from infertility. It is equally effective for certain female and male infertility issues. It can be a solution for you if you have a slightly low sperm count. However, the IVF success rate with low sperm count and motility is not very high.

3. If you have tried the traditional IVF method and still couldn’t get the desired results, ICSI may be your way out. Intracytoplasmic sperm injection or ICSI is a modified IVF procedure which is usually suggested in cases where the man has a high sperm count but low motility. This procedure can also be used for males having a low sperm count. In it, a single suitable sperm is selected and manually injected into the egg. It is a better option for people who have very few sperm cells in their semen. 

4. Another option is to take sperm from a donor. This means, the sperm used in IVF or ICSI will not be your partner’s but some other donor’s. 

Conclusion

Low sperm count is not an uncommon condition. It can be diagnosed mainly by the inability to get one’s wife pregnant. And though low sperm count is a problem that causes delayed pregnancy, it can be cured. One only needs to find the underlying probable reason(s) and then address them accordingly. Lifestyle and dietary changes can be immensely helpful in increasing your sperm count. Medical science also has multiple techniques to assist couples who are suffering from male infertility issues and all you have to do is take an appointment with a doctor and share your problem.