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Low sperm count

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 3 minutes read

A low sperm count doesn't cause any symptoms; it's usually found in fertility investigations when a couple finds it difficult to conceive naturally.

A semen analysis reveals a low sperm count, which is classed as fewer than 15 million sperm per milliliter of semen. It's found in one in three couples who are struggling to conceive. Depending on any other results from fertility tests, it may guide potential fertility treatments.

What causes a low sperm count?

We can list some causes of a low sperm count, but there is often no apparent cause. Sexually transmitted infections such as chlamydia and gonorrhea need to be excluded with simple tests – if found, they need to be treated. Prostatitis, diagnosed more on symptoms than any specific test, should also be treated with antibiotics.

Some medications may be responsible, including certain antibiotics, antidepressants, and cancer medication.

There has been much media focus on testicles overheating and the importance of loose underwear, and there is truth to this. Other conditions outside your control include if you had an undescended testis as a baby, hormonal imbalance that leads to reduced testosterone production, and genetic conditions such as Klinefelter syndrome.

Some lifestyle concerns can affect the sperm count, including smoking, alcohol, obesity, regular use of anabolic steroids, and taking street or party drugs, so you should take steps to eliminate these and reduce weight if this applies.

How is the sperm count tested?

Your doctor can arrange a semen analysis on your behalf. This can be organized if you and your partner have had difficulty conceiving after one year of trying.

Fertility problems can affect both individuals, so usually tests will be arranged for both. The semen analysis will inform you of the quantity and quality of your sperm. If there are any abnormalities, it is advised to repeat the test after three months.

For consistent abnormalities in your sperm analysis, your doctor will refer you to a specialist called a urologist or to a fertility clinic at your local hospital.

Home sperm count test kits are available to buy, but they may not be as accurate, and the information they give may be limited.

How is low sperm count treated?

Some couples can conceive naturally within the second year of trying, so doctors may encourage couples to continue having regular sex (at least 3 times a week), even while awaiting further review by a specialist. In addition, ways of fertility tracking can also maximize the chances of conception by helping focus on ovulation days.

In vitro fertilization (IVF) is one option for addressing low sperm count, where an egg and sperm are collected and then fertilized in a laboratory. The fertilized embryo is transferred back to the woman, with hopes that it will implant in the uterus, and the pregnancy continues.

If your sperm is very scarce or of poor quality, a single functioning sperm may be injected into an egg to fertilize it and then transferred to the womb in a procedure called intracytoplasmic sperm injection (ICSI).

If they are unable to isolate a single good sperm, donor insemination is an option, where another man donates sperm.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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